PUT aside the unseemly nature of John Edwards using a young woman’s death and her family’s grief to boost his political campaign – we’ve come to expect politicians to engage in this sort of exploitation of personal tragedy. What Edwards’ repeated references to Nataline Sarkisyan’s death reveal is the obscenely cynical way he’d govern as president.
Sarkisyan was a 17-year-old who battled leukemia for three years. Shortly after she received a bone-marrow transplant from her brother, her liver failed and she slipped into a coma. Her doctors at UCLA recommended a liver transplant, but the administrator of her insurance plan, Cigna, at first refused to pay, citing the lack of evidence of the effectiveness of such treatment. Under public pressure, Cigna reversed its decision – but Sarkisyan died hours later.
Edwards has been talking about the story for weeks. At a Manchester, N.H., rally last Sunday, he showcased the girl’s grieving brother and parents, who accused Cigna of “killing” Nataline.
Edwards honed this sort of emotional appeal during his years as a trial attorney. But he’s too smart not to know that in this case (at the very least) it’s dishonest and ignores important public-policy concerns: Cigna didn’t kill Sarkisyan, her disease did.
Leukemia is a serious, frequently fatal disease often treated with bone-marrow transplants. While UCLA hasn’t released details of Nataline’s treatment, liver failure following bone-marrow transplant usually results from veno-occlusive disease or graft-versus-host disease. There are scattered case reports of short-term “successful” liver transplants in this setting – but there is no statistically valid data that shows a benefit from transplantation.
Should an insurer pay for a transplant in this setting? Should doctors perform it? Should public officials be championing it?
Medical-insurance firms are highly unpopular with both patients and especially physicians – and with good reason. Insurers routinely deny claims, delay payments, drag their feet in approving treatments and, in general, do whatever they bureaucratically can to keep from spending money. But in this case, contrary to Edwards’ rant against corporate greed, the Sarkisyans’ insurer authorized payment for three years of treatment for Nataline, including an expensive bone-marrow transplant.
Insurers are obliged to preserve resources to pay for subscribers’ medical needs. That is, they need to direct a limited pool of cash to treatments most likely to work. If they pay for lots of unproven, experimental, expensive procedures (liver transplants cost more than $150,000), they have less left to pay for proven therapies for other patients.
Here, Cigna was only acting as the administrator of Sarkisyan’s father’s employer’s health plan; it would not directly benefit from denying a transplant. It was preserving the plan’s funds for the next leukemia patient.
Edwards’ grandstanding was irresponsible. Livers are scarce, life-saving resources. Far too few are available; thousands of potential recipients die awaiting a transplant. A transplant for Nataline would have doomed another potential liver recipient to death for want of an organ – or subjected a live donor to risky surgery for little likely gain.
Should one potential recipient be jumped over others because John Edwards has found it politically expedient to champion her cause? Should an organ be used for an unproven indication when it’s far more likely to save other possible recipients?
We can’t expect parents and even the treating physicians to decide that the prospects of success are so slim or uncertain that their daughter or patient shouldn’t receive a scarce, life-saving liver. But public officials, particularly ones who aspire to overhaul the health system, must be able to.
In Manchester, Edwards asked the crowd, “What kind of fighter do you want to have on your side when your family is faced with this sort of crisis?” We want someone who will tell the truth, who won’t distort the facts, who won’t exploit other people’s tragedies for his personal gain.
We want a president who is interested in sound policy, who can clearly consider everyone’s welfare free of the emotional overlay and distortion that have become Edwards’ stock in trade.
Dr. Joel Zinberg is vice president of the New York County Medical Society and associate clinical professor of surgery at Mount Sinai Hospital. The views expressed here are his own.