The economics of equity.

As oncologists we are called to help our patients live better, if not always longer, creating a huge overlap in the fields of oncology and palliative care. A recent SEER analysis confirmed that early introduction of palliative care among patients with advanced cancer nationwide was associated with less aggressive (i.e., higher quality) end-of-life care. This is great, but what about the millions of people worldwide without ready access to this evidence-based quality-enhancing medicine? This month the Lancet-sponsored Commision of Palliative Care and Pain Relief formulated five tenets of recognizing and addressing this global public health crisis in a logical and affordable way. Perhaps most disturbing are the current giant international variations in drug prices (e.g., morphine is dirt cheap in the U.S. where it is readily available but is over 5x more expensive in the lowest income countries where there is desparate need). Prudent study of global opiate supply and demand will afford countries in need the negotiating power they lack. And you know what they say: give a country opiates and it has pain relief for a day; teach a country to be competitive in the opiate market and it has pain relief forever.