OP ED

Doctors: Prop. 303 isn't in patients' best interests

Jeff Schriber and 49 doctors
AZ We See It
Proposition 303's heart is in the right place. But it's a bad idea for desperate patients.
  • Prop. 303 runs counter to "above all do no harm"
  • The proposal is poorly crafted. A new bill limited to certain drugs might be better
  • Above all%2C it would be better to involve the medical community in crafting solutions for desperate patients

Proposition 303, the "Right to Try" ballot question, has its heart in the right place, but its mind, sadly, is not.

It is important to know that 86 percent of drugs after a positive Phase 1 trial will prove to be less effective than current therapy. It gets worse, the proposition simply says you have to have completed, not passed, Phase 1. If you include these drugs, less than 6 percent will be beneficial.

Patients who are the most desperate will be taking drugs, many with significant side effects with a very small chance of any benefit. This directly contradicts the "above all do no harm," which is part of our medical culture.

A Phase 1 trial does not examine if the drug is effective. It simply determines if it might be safe, usually by testing normal volunteers. Fewer than half even pass this safety standard.

As proposed, patients would potentially receive drugs with no proven benefit. There are also no provisions for who will pay for the drug and the treatment of any side effects. This will increase health-care costs for the individual but also for the taxpayer if patients are on Medicare or the Arizona Health Care Cost Containment System, the state's Medicaid program.

Effectively, patients may end up spending their last dollars on an ineffective therapy that could make them sicker.

We need methods to potentially fast-track therapies that may help a terminally ill patient. However, making drugs available that have not passed even the basic safety aspect is misguided at best. There are mechanisms for compassionate-use trials, although they can be cumbersome at times.

A new bill limited to drugs that have passed Phase 2 trials may be a model to consider. Drugs that pass this stage appear to be safe and effective. Patients can have a reasonable expectation that there may be a benefit with less safety concerns. Such a bill would minimize risks and could serve as a model for the country as a balance between risk to patients and offering hope for those in desperate need.

Patients and families who face a terminal illness are often desperate and willing to try almost anything. Ideally they should discuss all options with their physicians.

But if we are trying to make this issue one of health-care policy and access, we owe it to these patients to have a law that doesn't just tug at our heart but has a real chance to offer true hope.

We owe them a law that doesn't endanger their health, doesn't have the potential for financial disaster and shows real promise in other patients. Involving cancer physicians and nurses and others who have an interest in crafting such a law would be a great first step.

Sadly, Proposition 303 is not such a law, and we urge you to vote no on this measure.

Jeff Schriber is the medical director of the Cancer Transplant Institute at the Virginia G. Piper Cancer Center. Forty-nine other doctors who oppose Prop. 303 have signed this piece. They are:

Adrienne Briggs, Jonathon Abbas, Devinder Singh, James Choi, Andrew Buresh, Joan Dahmer, Pat Donovan, Giraldo Kato, Anjali Iyengar, Paul Wassermann, Michael Roberts, Henry Lee, Mazen Khattab, Peter Mathern, Sharon Ondreyco, John Bibb, Tania Cortas, Chenthilmurugan Rathnasabapathy, Matesh Sieethram, Jerry Lucas, Irene Taw, Deborah Lindquist, Manuel Modiano, Laurie Chen, Steven Ketchel, Raymond Taetle, Richard Rosenberg, Jeffrey Issacs, Tara Iyengar, Rajesh Kukunoor, Joseph Nabong, Jason Salganick, Harrison Bachrach, Puneet Bhalla, Marvin Chassin, Ian DeRoock, Neal Dharia, Nathaniel Fastenberg, Sujith Kalmadi, Roopesh Kantala, Parvinderjit Khanuja, Anita Kosyk-Szewczyk, Sumeet Mendonca, Michael Musci, Clayton Polowy, Mikhail Shtivelband, Larry Kasper, Martin Langford.