In his June 27, 2012, JAMA piece, Dr. Donald Berwick tells the story of Isaiah, a troubled youth from the Roxbury section of Boston, who at the age of 15 developed acute lymphoblastic leukemia. Chemotherapy put him in remission; but as predicted, he relapsed within three years.
When Dr. Berwick held out a bone marrow transplant as the only hope for cure, Isaiah jumped at the chance. The transplant took, but also left him with diabetes and asthma.
As horrendous as that sounds, other factors in Isaiah’s life were even more difficult to overcome. He had been introduced to dope at age 5, committed armed robbery at age 12 and was addicted to crack by age 14. Two of his 5 brothers were in jail—one for murder—and a third was later killed in a drug dispute. Isaiah never finished school. His world was the street.
Eventually, Isaiah succumbed to a diabetic induced seizure, lapsed into a persistent vegetative state and died two years later. In Dr. Berwick’s words: “Cured of leukemia. Killed by hopelessness.”
In her recent article In Treatment for Leukemia, Glimpses of the Future, New York Times reporter Gina Kolata tells the story of Lukas Wartman, a young physician who developed acute lymphoblastic leukemia during his final year of medical school. Like Isaiah, chemotherapy threw Wartman into remission; like Isaiah, his cancer came back. And also like Isaiah, Wartman received a bone marrow transplant to cure his cancer. But three years later the cancer returned. This time it didn’t respond to chemotherapy and hormones.
In a last-ditch effort to save him, Wartman’s doctors sequenced his cancer’s genome, looking for clues as to what was driving the proliferation of abnormal cells. They identified an overactive FLT3 gene and discovered that it was sensitive to an existing drug. Because it was terribly expensive, Wartman’s insurance refused to pay for it; and Pfizer, the drug manufacturer, declined to provide the medication under the compassionate use program.
In the end it was Dr. Wartman’s research colleagues who chipped in to cover the cost of the medication. The treatment proved to be a success.
There you have it: one nearly universally fatal disease, two patients—each a product of circumstance and chance.
Each one received appropriate care for his condition, except in Dr. Wartman’s case a team of highly motivated colleagues banded together to go above and beyond the usual measures to insure that he received the best care possible. Even when the system refused to step up to the plate, his colleagues made sure that Dr. Wartman received the proper treatment.
In a county that boasts the best medical care in the world, accessing it might still be a problem, no matter which end of the social strata you find yourself.
But in these situations, it certainly helps to be born into the relatively well-to-do, privileged and well-connected socioeconomic class in our contemporary classless society.