PHARMA: Can There Be Too Many Cures for Cancer? by Maggie Mahar

Last week, an upbeat story
  in the New York Times
described how big pharmaceutical companies have discovered
  cancer. A few years ago, the article points out, companies like Pfizer, Glaxo
  and Wyeth had relatively little interest in what they saw as a "niche market."

While a great many people die of cancer, the disease takes so many different
  forms that each market is relatively small. Big Pharma generally would rather
  focus its research on diseases with a broad base-allergy medications, for example,
  are a big favorite (even if, according to the National
  Institute for Health Care Management
, most people taking allergy medications
  don’t actually suffer from allergies.)

Drugmakers also prefer drugs that customers can be counted on to take for many
  years. (There is a saying in the pharmaceutical industry: "A pill that
  cures is good. A pill that you take every day is better.") Cancer patients
  tend to "die within months," the Times pointed out, curtailing profits.

But recently, big drug-makers have begun to recognize that cancer drugs can
  be profitable-if the price is high enough:

". . . companies have discovered that some patients will tolerate prices
  of tens of thousands of dollars a year, " the Times observed, "making
  drugs for even rare cancers into big moneymakers. Gleevec, which is used primarily
  for two obscure cancers – chronic myelogenous leukemia and gastrointestinal
  stromal tumor – had sales last year of $2.2 billion."

The race to get on the cancer bandwagon could lead to a flood of "me too"
  drugs that duplicate each other, the article acknowledged. But from the standpoint
  of the patients there [are] never too many, cancer drugs, the article asserted,
  quoting Dr. Robert J. Motzer, a kidney cancer specialist at Memorial Sloan-Kettering
  Cancer Center in New York City.  After all, the more drugs there are in the
  pipeline, the better chance a patient has of finding one, or a combination,
  that will work for them. Besides "competition could . . . bring down prices,"
  the Times suggested.

Really? If so, that would be a first.

When it comes to healthcare, competition almost never leads to lower prices.
  In most markets, comparison shoppers reward quality at a lower price. But when
  you’re dying of cancer, you’re probably not hunting for a bargain-even if you’re
  paying 20% of the cost out of your own pocket.

More importantly, even if you wanted to compare cost and quality, how would
  you go about doing it? As anyone who has ever been seriously ill knows, the
  more you learn about the pros and cons of various treatments, the less certain
  you are likely to be as to which might be the best for you.

Ambiguity haunts medical care. In my newest book, (Money-Driven
  Medicine: The Real Reason Health Care Costs So Much
Harper/Collins, May
  2006 )," I quote Dr. Atul Gawande, who describes "uncertainty"
  as "the core predicament of medicine . . . the thing that makes being a
  patient so wrenching, being a doctor so difficult and being part of a society
  that pays the bills so wrenching."

A Boston surgeon and author of Complications: A Surgeon’s Notes On An Imperfect
  Science, Gawande is quick to admit that even the physician is often not at all
  sure as to the "best" treatment for a given condition. Little wonder
  that patients are not able to bring down prices by shrewdly picking the product
  that offers the best value.

As for the idea that when there are more drugs in the marketplace, patients
  stand a better chance of finding one that works, some physicians warn that too
  many new drugs only adds to the confusion in a marketplace where free market
  competition has turned into a free-for-all.

According to the Pharmaceutical Research and Manufacturers Association, some
  400 cancer drugs from 178 companies are now in clinical trials-and many oncologists
  complain that this is more cures than they can hope to keep track of.

A sign of the times: in 2004 the
  Times reported
that one session of the American Society of Clinical Oncology’s
  conference was titled "Therapy of Metastatic Colorectcal Cancer: What Do
  We Do with So Many Options?"

As each drug company races to fill its own pipeline, a fragmented industry
  spawns a dizzying array of half-way cures. Too many drugs shrink tumors-but
  don’t bring any mortality benefit. Meanwhile, too much competition and too little
  collaboration makes it difficult for oncologists to sort out which drugs are
  most effective alone, which should be used together-and in what sequence.

When I was writing Money-Driven Medicine Dr. Genie Kleinerman, chief of pediatrics
  at Houston’s M. D. Anderson Cancer Center, recalled how two companies refused
  to work together to help her prove that two of their drugs might do a better
  job of targeting malignant cells of osteosarcoma ( a bone cancer that occurs
  in children), if they were used in combination. In the lab, Kleinerman had shown
  that you could mix the two agents. Now, she needed the company to do clinical
  trials in order to win approval from the FDA.

"But the lawyers for the two companies couldn’t come up with an agreement
  on who would own the rights to the combination and who would pay for what,"
  Kleinerman recalled, still frustrated. "Today it would be the same situation
  -or probably worse. The pharmaceutical industry has become so protective of
  who owns the intellectual property. You probably couldn’t even get them to sit
  down at the same table."

Instead, companies pursuing parallel research squander millions producing tumor-shrinking
  drugs that, too often, offer "no
  improved survival, no better quality of life, no added safety
" according
  to one study in the British Medical Journal–though they almost always cost

And as the pharmaceutical industry’s big guns elbow their way into the cancer
  marketplace, peddling pills that cost tens of thousands for a course of treatment,
  they are gobbling up much-needed health care dollars. Paying for these drugs
  is straining the system. Two years ago, Bains & Company, a management consulting
  firm estimated
  that paying for all of the drugs in development would require $60 billion a
  year-up from $10 billion at the time.

"Who’s going to pay for that? It’s just going to become unaffordable,"
  said Elgar Peerschke, head of the North American health care practice at Bain.

Oncologists like Genie Kleinerman believe that if government gave drugmakers
  incentives to pool their research, they might be able to develop fewer, more
  effective and more affordable remedies at a lower cost. But that’s not how free
  market competition normally works-at least not according to the conventional
  wisdom of a market-driven health care system.

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6 replies »

  1. Cancer is a very complicated illness. Many people have died because of this problem. Our science and our medicines have developed some medicines which allow to control this illness in a good way if the patient doesn’t have the sickness in a very advanced stage.
    When a tumour appears in any part of the body, you must go to your doctor because this is not normal. Besides, there are some other symptoms such as: anaemia, lack of appetite, constant pain in some parts of the body, etc.
    Nowadays, there are many things producing cancer and every one of us needs to take care of anything: foods, drinks, home articles, clean products, etc.
    If you want to have a good solution for cancer treatment, don’t hesitate to visit this website:

  2. I heard a rumor that there was going to be a pharmacy that was going to start selling cancer drugs at-cost, for no profit. Has anybody heard anything about this? This would sure help people who had a hard time paying for their cancer drugs after the pharmaceutical companies price the drugs so high.

  3. I am not so sure there isn’t more blood in that turnip: I have a sneaky feeling we’ve finally gotten enough “excess cash” out of the system that actual change is becoming necessary. The only way we can (apparently) push improvement is to continue removing resources from the system. For the managers inside the delivery network, the trouble is payments can be reduced faster than they can reconfigure physical facilities and assemble different workforces. So they see stranded assets and can’t recruit enough nurses and techs capable of working in the unstructured environments, and so they say “we can’t cut any more”. Of course, they said the same thing 25 years ago. And it is true they “can’t cut any more” without making some fundamental changes. But that’s what is needed: fundamental change.
    The method used a Toyota to make it such a high-quality low cost producer of cars is described thluly: at first, the manufacturing system is like a big, lazy river. The water in the river represents money. With so much water in the river, all you have to do is keep more or less to the middle of the channel, and watch out for a couple of big rocks and the occasional shoal.
    Then Toyota started lowering the level of water in the river. Some of the less-deep spots turn into baby-rapids, there appeared a few more rocks to steer around, and the channel got narrower.
    Then they let out more water. The river moves faster now, and there is a premium on shooting rapids and on steering. Snags appear here and there, meaning the course you took last week might not work this week: you need alternatives planned out.
    This is what I think is beginning to happen in healthcare. There’s plenty of water left to float the rafts, but now its more challenging: we’re not rafting the lower Mississippi anymore: now we’re in the Grand Canyon. But even so, they take tourists down the Grand Canyon. It is not impossible.
    By the way, Dr. Schwab, I read your book and thought it was terrific. I like the little “rules of thumb” like “if you can see through it, you can cut it”. I got some insights into physician training and enculturation. I appreciate your commitment to continuous improvement and accountability (some here call it ‘transparency’).
    Apropos your comment about finding which doctors generate less cost while getting equivalent or better results you might want to read a paper published in the Journal of the American College of Surgeons and titled “Evaluating Individual Surgeons Based on Total Hospital Costs: Evidence for Variation in both Total Costs and Volatility of Costs” and available here by Dr. Bruce Hall and a cast of others. I am proud to say I worked with Dr. Hall on a cost study (not this one, unfortunately for me), and have borrowed books from Professor Hamilton. The password of the pdf file is “case”. The conclusion is that costs (holding constant surgical complexity and other factors) vary by about 50% among surgeons. This is the next frontier, but as you noted somewhere towards the end of Cutting Remarks, making the measurements (much less using them) is fiercely resisted by physicians.

  4. Your post is excellent, and serves to highlight the extent to which there are a myriad of avenues to reducing overall healthcare costs. To date, cost reduction has pretty much exclusively consisted of reducing payments to physicians and hospitals. But we’ve exsanguinated that particular turnip. Truly focussing on where the costs are, and seeking ways to make care more efficient — among other things, by finding which doctors generate less cost while getting equivalent or better results compared to others, and looking at the reasons — is where the real reductions will occur. Someday. Maybe.

  5. Test Identifies Patients who Benefit from Targeted Cancer Drugs
    The needed change in the “war on cancer” will not be on the types of drugs being developed, but on the understanding of the drugs we have. The system is overloaded with drugs and underloaded with the wisdom and expertise for using them.
    Cancer patients usually undergo four or five courses of chemotherapy before medical oncologists can tell whether the treatment is having an effect. By that time, the tumor may have grown so large that it is too late to switch to another chemotherapy regimen or the patient may be so weakened by the treatment that trying another approach is not immediately feasible. Medical oncologists treat a lot of patients but they don’t know going into treatment if it’s going to work.
    A major obstacle in controlling cancer growth and metastasis in patients is the widespread inappropriate use of anti-cancer drugs. As the increasing numbers and types of anti-cancer drugs are developed, oncologists become more and more likely to misuse them in their practice. Between 2002 and 2004, 395 cancer drugs were submitted for clinical trials. It would be highly desirable to know what drugs are effective against your particualr cancer cells before these cytotoxic agents are systemically administered into your body.
    The Weisenthal Cancer Group announced that clinical data published at the annual meeting of the American Society of Clinical Onoclogy (ASCO) show that a new laboratory test it has developed accurately identifed patients who would benefit from treatment with the molecularly-targeted anti-cancer therapies Iressa and Tarceva. The new test, called the EGFRx (TM) assay, predicted accurately for the survival of patients treated with the targeted drugs.
    The finding is important because the EGFRx (TM) test, which can also be applied to many emerging targeted cancer drugs, could help solve the growing problem of knowing which patients should receive costly, new treatments that can have harmful side-effects and which work for some but not all cancer patients who receive them.
    The EGFRx (TM) assay holds the key to solving some of the problems confronting a healthcare system that is seeking ways to best allocate available resources while accomplishing the critical task of matching individual patients with the treatments most likely to benefit them. Not only is it an important predictive test, it is also a unique tool that can help to identify newer and better drugs, evaluate promising drug combinations, and serve as a “gold standard” correlative model with which to develop new DNA, RNA, and protein-based tests that better predict for drug activity.

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