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Editorial: Cancer doctors taking the lead

When the subject is the fight against cancer – from UNH track athlete Cameron Lyle’s selfless decision to give up his final months of competition to donate marrow for a leukemia victim, detailed last week in the Monitor, to a breakthrough in cell therapy that could save thousands of similar patients, detailed last month in the New York Times – the cost of these treatments rarely comes up.

It needs to, for the sake of cancer patients themselves as well as the health of our health-care system. That’s why it’s heartening that cancer doctors themselves are beginning to take the lead.

Last October, three specialists at the Memorial Sloan-Kettering Cancer Center in New York City wrote an essay in the Times explaining why they were refusing to prescribe a new cancer drug called Zaltrap to their patients: It was twice as expensive as an existing drug, and no more effective.

“In most industries something that offers no advantage over its competitor and yet sells for twice the price would never even get on the market,” they wrote. “But that is not how things work for drugs.”

Instead, they wrote, federal regulators approve drugs based solely on safety and effectiveness. Then federal law requires Medicare to cover every approved cancer drug, with a 6 percent cushion on top of the manufacturer’s price. What’s more, they added, “medical culture” equates new with better, creating pressure on doctors to prescribe the latest.

After the publication of the essay, Zaltrap’s maker cut the drug’s price in half.

We can only hope that another article, published last week in the medical journal Blood, has the same effect.

In the new essay, 100 cancer specialists from 15 countries joined in arguing that the cost of drugs is “too high, unsustainable (and) may compromise access of needy patients to highly effective therapy.” Of 12 cancer drugs approved by U.S. regulators in 2012, they wrote, 11 cost more than $100,000 a year.

In countries with universal health coverage, they noted, individual patients are shielded from these costs – but not in the United States, where patients can be responsible for as much as 20 percent of the bill. In other countries, they added, governments actively negotiate better prices. A year’s worth of an effective leukemia drug called Imatinib costs $92,000 in the United States, $54,000 in Germany and $33,500 in Great Britain.

The doctors who signed on to the article are specialists in a particular cancer called chronic myeloid leukemia, or CML. In a country such as Sweden, they said, where access to the best drugs is widespread, the 10-year survival rate for CML patients is about 80 percent. In the United States, they said, where higher costs lead to lower usage, the survival rate is about 60 percent.

These doctors didn’t offer a prescription for the problem, saying they hoped only to begin a meaningful discussion. But in an interview with the Times, the lead author, Dr. Hagop Kantarjian of the M.D. Anderson Cancer Center in Texas, said it was necessary to speak out. “Pharmaceutical companies have lost their moral sense,” he said.

We all have an interest in the continued development of more effective drugs, and without the promise of substantial profits, pharmaceutical companies would have no incentive to risk the many millions required to develop them. But when some of the world’s best doctors join in saying our system for pricing life-saving medicines has become sick, we should pay attention.

Dr. Kantarjian says: " pharmaceutical companies have lost their moral sense". I would say that it's not just pharmaceutical companies. It's medical device makers, health insurance companies and politicians too. And what is behind all this? Unquenchable thirst for profit, particularly by Wall Street financiers and shareholders.

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