Dear Dr. Roach: After a three-year battle with multiple myeloma, my husband passed away in July. During those three years, he had almost every kind of chemotherapy known. As time progressed, the drugs got more expensive. Last summer, they wanted to try a drug called Revlimid. When we investigated what the cost to us would be with our Medicare Part D, it was $25 per pill, and they wanted him to be on the medicine for three weeks, then off for a week. I tried several "patient assistance programs" and was told by each that we wouldn't qualify because we were covered by a government insurance. Why would they help younger patients and not those of us who are over 65? Luckily, my husband served in the Navy and he was able to get his Revlimid through the Veterans Affairs system, but what are seniors who didn't serve in the military supposed to do? Are there any options for us? Someone is making a bunch of money at our expense.
A: Lenalidomide (Revlimid) is a relative of thalidomide, and may be of benefit to several types of "liquid" cancers, those of the bone marrow. Without insurance, the pills are over $600 each. Your insurance did help (a lot), but I understand that $500 for three weeks of medications can still be a real hardship for many. However, you would be horrified, as I have been, to hear what some people pay out of pocket for medication.
Lenalidomide is moderately effective: It improves disease-free survival by about six months, and people on lenalidomide for multiple myeloma achieved a complete response (no evidence of tumor by blood testing) 16 percent of the time, compared with 3 percent for the group without lenalidomide. That makes the drug worth more than its alternatives.
Many oncology medications are very expensive, and this is one. On the other hand, it is a significant advance in helping people live longer. I don't have the answer to runaway pharmaceutical costs in the U.S. It's very different in other countries.
Dear Dr. Roach: Several articles on the internet suggest that megadoses of vitamin C given intravenously can help in cases of severe sinus infection, for which we literally have no effective antibiotics, in order to treat them. Could this be true?
A: I couldn't find any high-quality research on intravenous vitamin C for sinus infections. However, there is some interesting research being done on vitamin C in severe sepsis, a physiological consequence of severe infection. In one study, the risk of dying from sepsis in people treated with vitamin C and steroids was 8 percent, compared with 40 percent in the control group. If confirmed, this would be a major advance for one of the biggest killers in the hospital. I am hopeful; however, I have seen other promising treatments for sepsis fail in large-scale studies.
For sinus infection in particular, if antibiotics aren't effective, there is surgical treatment. However, many times the issue is that the wrong antibiotics inadvertently are used, and choosing the right antibiotic may require a procedure to identify the exact bacteria present in the sinuses. There are certainly times in the hospital when there are no effective antibiotics, but I personally haven't seen that in sinus infections.
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Readers: The booklet on COPD explains both emphysema and chronic bronchitis, the two elements of COPD, in detail. Readers can obtain a copy by writing: Dr. Roach, Book No. 601, 628 Virginia Dr., Orlando, FL, 32803. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow 4-6 weeks for delivery.