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
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.