Shameful

VA

Entering the downtown Washington D.C. headquarters, two plaques are visible: the first tells individuals where they are; the second lays out its mission – a mission that has, over decades, lost much of its trustworthiness.

“In 2013,” CBS reports, “Vietnam veteran Zion Yisrael was told he had five years to live. He has stage 4 liver disease, caused by hepatitis C — which has infected as many as 230,000 veterans. Most veterans contracted it in Vietnam where it was spread by battlefield blood transfusions and vaccinations. … After decades of suffering, earlier this year, Yisrael was overjoyed to learn there’s a cure.

“I felt like my prayers were answered,” Yisrael said.

According to the report, the drug, sofosbuvir claims it can cure up to 99 percent of those suffering from hep C sufferers.

“But there’s a catch,” CBS says, “the retail price for a 12 week treatment is $84,000. The Department of Veterans Affairs gets a 50 percent discount, but even with that the VA told Yisrael they can’t afford to give it to everyone who needs it — including him.

“ ‘Come back next year,’ he recalled them saying. ‘And all the time I’m thinking about that, well, my condition is getting worse.’ ”

And the story gets worse, as well.

“Dr. Raymond Schinazi,” reporter Chip Reid points out, “founded the company, Pharmasset, and led the scientific team that discovered sofosbuvir. He also works for the Department of Veterans Affairs and has since 1983.

“He said he is only a 7/8th’s government employee…. spending less than 1/8th of his time on private companies.

“Dr. Schinazi made more than $400 million when he sold his company for $11 billion to pharmaceutical giant Gilead in 2012. …

“If you’re surprised that a government scientist can make that kind of money,” Reid continues, “given federal laws surrounding conflicts of interest, so were we.

“CBS News asked Dr. Schinazi if anybody ever questioned the arrangement that allows him to become very wealthy while working 7/8th’s of his time with the government.

“ ‘Nobody has questioned anything yet,’ he replied. ‘I think I’ve done everything, I’ve disclosed everything to the VA.’ ”

In a statement to CBS, the VA said: “Federal employees are allowed to invest in private companies, provided all conflict of interest rules are followed.”

“Gilead, the company that now owns and sets the price on Sovaldi and Harvoni, told CBS News the cost is “…in line with the previous standards of care.”

“But in a 2013 trade journal, Dr. Schinazi said it only costs about $1,400 to manufacture the full 12 week treatment — that’s less than two percent of the retail price.

“Why is it so much more expensive than what it costs to make it?” Reid asks Schniazi.

“ ‘That’s a good question. I think the price will come down eventually,’ he said.

“But Zion Yisrael wonders if the price will come down in time to save him — in the two years his doctor said he has left.”

Newsweek magazine (May 22, 2015), writes, “Some 3.5 million Americans are infected, including an estimated 234,000 veterans. Approximately 174,000 veterans in government care have been diagnosed with hepatitis C, but an additional 50,000 are thought to carry the infection unbeknownst to them. …

“The VHA issued a policy memorandum in September 2011 stipulating that cost should not be a factor in prescribing more effective drugs, but Bob has no doubt the VA has been slow to utilize the new medications because of their striking price tag. He says his treating physician told him of meetings where VA administrators from various departments, including pharmacy, have said, flat out, ‘We are just not going to pay that kind of money.’ They didn’t say they don’t have the money. They said they aren’t going to spend that kind of money on these drugs.’

“Dr. David Ross, director of the VA’s hepatitis C program,” Newsweek says, “strenuously denies that. ‘Historically, treatment rate has been low for two reasons,’ he says. ‘One, standard treatments have been awful. The drugs are horrible and don’t work that well. Secondly, a lot of patients have conditions such as depression or substance abuse problems that get in the way of treatment.’

“According to Ross, some 50,000 veterans infected with hepatitis C have been treated and 15,000 cured since 1999. In addition, since the beginning of 2013, more than 14,000 patients have been treated with the new class of antivirals. Close to 700 veterans are going on the new antiviral medications every week, he says. The increased use of the new antivirals shows in the budget: Between 2011 and 2013, the VA spent an estimated $100 million on medications. For fiscal year 2015, Ross says, the VA has allocated $696 million for new HCV drugs (17 percent of the VA’s total pharmacy budget).

“Ross also stresses that he recommends treating HCV as early as possible. However, a recent VA memo recommends urgently treating those with advanced liver disease but holding off for patients with mild cases of the illness. Meanwhile, the Centers for Disease Control and Prevention states clearly that ‘the longer people live with hepatitis C the more likely they are to develop life-threatening liver disease.’ ”

“That’s a view a view shared by Dr. Bennet Cecil III, who worked as a gastroenterologist at the Louisville VA Medical Center, in Kentucky, for 16 years before retiring last year. Cecil has for years been sparring with Ross over what he considers to be the VA’s “lack of enthusiasm” for handling the crisis. He claims that at the VA medical center where he worked, denying treatment for budgetary reasons was not official policy but he saw it happen all too often.

“ ‘The problem has been the cost of treatment,’ Cecil says. ‘The VA is a bureaucracy, and bureaucrats have to guard their budgets. They get so much money each year, and that money has to last. Since treatment has been expensive, they have slow-walked it.’ ”

What is Zion Yisrael’s response?

“ ‘It’s just not right,” he told reporter Reid, “that the vets would risk their lives and come here and because of $84,000 we can’t get cured? A medication, produced by the country, that we’re protecting?’ ”

However, as The National Journal pointed out in a story from May, 2014, “Looking for a lone villain in the VA debacle… is a fool’s errand. It’s true that — despite holding the world’s most powerful post for five years — Obama is yet to eliminate the long waiting times for veterans seeking help. Blaming him alone, however, is to ignore roots of the problem that stretch back decades before Obama took the Oval Office.

“Instead, the sheen of shame over the VA’s failures spreads across time and party affiliation. It stains the legacies of presidents as far back as John F. Kennedy and condemns past Congresses whose poor oversight allowed the problem to fester. The VA it-self is also not without fault, as bureaucracy and intransigence let the department deteriorate to the point the problem became nearly impossible to fix.”

The motto selected by the Veterans Administration comes from the conclusion of Lincoln’s second inaugural address.

“With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow, and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.”

Indeed, Mr. Lincoln would be shocked and embarrassed by the lack of vital care shown thousands of veterans. Congress, the President, and all political candidates need to re-read Lincoln. There is no greater responsibility.

Update: According to a recent memo, the FDA has approved Zepatier for treatment of chronic hepatitis C. I have yet to determine if the drug will be made available to the VA.

1 comment… add one
  • John Baldwin MD, FACS, Major, US Army February 2, 2016, 3:31 pm

    A patient of mine, Dennis Haines, which Jim Lichtman wrote up in his two classic essays, (December 23, 2009 and again December 12, 2012), received nearly 40 bottles of blood as we rescued him at the great 24th Evacuation Hospital in Long Binh, Vietnam in 1968, following two AK-47 shots to his head. Lichtman followers need to read those two tributes of incredible bravery. Dennis got Hepatitis C from one of those transfusions and has had brutal chemo and immunotherapy since to keep him alive and productive. (He designed the University of Pennsylvania, Hershey Medical Center) He STILL has not been a recipient of the new CURE Hep C medication, despite our and his efforts. The VA seems to “Be waiting for us to die,” Dennis remarked.

    In a similar vein, with parents living to 86 and 90, I required heart surgery for a 95% blocked “widowmaker left coronary” at age 55, a non-smoker, athletic, cardiac surgeon, and after surgery was urged to “get out of the stress” by my surgeon, the great Dr. Norman Shumway, heart transplant pioneer at Stanford. Later, I learned that Agent Orange was used DAILY over my base in Long Binh, Vietnam where, between my 1,800 cases, we played volleyball and sun-bathed in shorts only. Data released by DOD records 234,000 Gallons of AO sprayed by fixed-wing delivery and thousands more by helicopter and trucks to “keep the jungle back” during my years there. Little did we know that AO was instrumental in causing birth defects, diabetes, leukemia and coronary heart disease and the VA was authorized by Congress to care for and recompense these veterans.

    I can only state that my detailed and persistent exams and data have been denied for any benefits, as “you have done well since your surgery and have no long-lasting effects.” That I was operated upon and advised to retire in my prime from a vocation that I loved and was good at, doesn’t matter. This VA reply is TYPICAL and I thank Jim for shining at least his honest light at the problem.

    VA director General Shinseki resigned two years ago for poor performance, but since, nothing much has changed. I know, as active member of California’s largest Vietnam Veterans of America, Chapter 391 because our 600+ members experience VA “care” quite often. “They are waiting for us to die and be quiet,” is what our now-70 year old kid soldiers say.

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