By Henry Ehrlich
A latest Tweet by our pal and generally contributor, Australian allergist Dr. John Weiner caught my consideration: I for one am shocked. IVIG has at all times been free to the affected person in Australia for this indication. All prices are shared by Fed/State gov.*
It referred to a press stories a few deposition by which former Aetna Medical Director, Dr. Jay Ken Iinuma testified that “he never looked at patients’ records when deciding whether to approve or deny care.” This deposition was a part of a lawsuit introduced by Gillen Washington, a 23-year-old with frequent variable immune deficiency (CVID). Aetna denied him protection for an infusion of intravenous immunoglobulin (IVIG) 4 years in the past.
Forbes reported, “In this particular case, Iinuma admitted that he had minimal if any knowledge of the medical condition, common variable immune deficiency (CVID), that Washington suffered from. He was also not clear about what the most effective drug would be to treat the patients’s condition, the symptoms of CVID, or even the consequences of the abrupt discontinuation of therapy for the condition.”
Insurance coverage denials are dog-bites-man tales as of late—totally different canine, totally different man, however we’ve heard all of it earlier than and it’s at all times outrageous. What me about this explicit incident was IVIG itself. I’m guessing that most individuals have by no means heard of it. Happily, we’ve got slightly piece archived on this web site that throws slightly mild on this obscure drug from 2012, an account of a chat by Dr. Mark Ballow, long-time pal and mentor of Dr. Ehrlich, and former president of the AAAAI. On the danger of being self-referential, I’m going to recycle myself.
“Dr. Ballow was speaking about intravenous immune globulin (IVIG), a extremely refined type of the substance acquainted to allergic folks in every single place as IgG, which we at aac.com name IgG(ood), to differentiate it from the allergic antibody IgE(vil). IVIG was initially injected into the muscle groups for immune problems, however for the reason that 1980s, intravenous injections have confirmed to be very efficient at boosting platelet counts and decreasing irritation. This holds promise for a lot of off-label makes use of, i.e. circumstances for which it isn’t now permitted, together with breakthrough therapy for issues like allergic reactions, auto-immune problems like MS, and even Alzheimer’s Illness.
“As Mark said in an article* on the subject (and repeated in his talk), ‘In fact, the IgG molecule is the single most important naturally occurring specific immune component capable of modulating the immune system.’”
“Exciting though the data was, however, it was also an object lesson in why medical breakthroughs take so long to make it into clinical use and why they are so expensive. Seventy percent of IVIG applications are off-label, so gaining approval for new ones will require a good deal of extremely expensive testing and red tape. Also the basic molecule will require further refinement to work well with the alphabet soup of receptor cells involved in various conditions. But the biggest cost barrier lies in manufacturing enough of the stuff to go around. IVIG can now only be created by refining human blood plasma, and it has to be plasma with the right properties. The arithmetic is daunting. It costs $50-70 per gram. An effective dose is two grams PER KILO of body weight per month. The great hope, Dr. Ballow says, is that it can be bio-engineered to bring that cost way down. Only then will we find out whether this stuff is as promising as it sounds.”
*My reply to Dr. Weiner was “Welcome to US health care, John @AllergyNet”
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By Henry Ehrlich