Allysia Finley’s August 18, 2017 story in the wsj.com @AllysiaFinley – How HIV Became a Cancer Cure – was, perhaps, revelatory of a changing pharmaceutical research landscape that could portend a cheaper cancer therapy. In her article, she quotes Penn professor Dr. Carl June (@PennMedicine) as stating that: “There are at least 40 companies right now making CAR T-cells… and they are incentivized to make it more cheaply.” Cheaply is the operative word, here, and it’s not usually associated with, in this case, a revolutionary new therapy. An exception to this is the expectation that the soon-to-debut Therapoid.net platform that will enable like-minded users engaged in similar research to work in an open source environment that could actually produce drugs and therapies more cheaply.
Finley writes about an exciting new breakthrough in cancer immunotherapy citing Dr. June’s patient outcomes in which …more than 90% of pediatric patients with acute lymphoblastic leukemia in a subsequent clinical trial went into remission after being infused with Dr. June’s CAR T-cells (the acronym stands for “chimeric antigen receptor”). Last month an advisory committee of the Food and Drug Administration unanimously approved the therapy to treat acute lymphoblastic leukemia. The FDA is likely to give final approval within weeks.
The point is, even if you incentivize researchers to come up with faster, cheaper way to process therapy, what is the inducement to make it cheaper? This is an industry where profits are wildly disparate, so why would this be different, particularly for a high-stakes cancer therapy? Many would reach the cynical conclusion that “we’ll believe there’s a ‘cheaper way’ when we see it.”
In an online article by Elizabeth Rosenthal, Editor-in-Chief Kaiser Health News (@RosenthalHealth), in Medium titled “How Economic Incentives have Created our Dysfunctional US Medical Market,” she lays out a list of 10 Economic Rules that appear in her new book“ An American Sickness: How Healthcare Became Big Business and How You Can Take it Back.”
Among them are that:
A lifetime of treatment is preferable to a cure. Medically this sounds crazy. But financially this is a no-brainer: Type 1 Diabetes is a lifelong serious disease — as well as the basis of an industry worth billions, providing pumps, monitors and ever-more-expensive versions of insulin. Pharma has little incentive to finance research for cures to a disease that has created such a lucrative market. The book outlines the travails of Harvard Professor Dr. Denise Faustman, whose lab is researching a cure using a generic drug. Pharma declined to fund her work. “They said, ‘It’s really interesting but we’ve got a problem: Tell us how it will ever make us money?’” From the manufacturers’ standpoint, if diabetes could be cured there was no need for insulin, pumps, and monitors — all extremely lucrative products.
Prices will rise to whatever the market will bear. The mother of all rules! Jeffery Kivi had long gotten monthly outpatient infusions of a drug to treat his autoimmune disease for about $19,000. But when his rheumatologist moved her affiliation to another hospital, 20 blocks uptown, infusions of the very same drug were billed at up to $132,000. And the still bigger shocker for Mr. Kivi was that his insurer came through with almost all of the cash, close to $100,000. “I was stunned when the first infusion bill finally showed up on my account,” Mr. Kivi wrote to me. “I couldn’t believe my eyes!! This was for the same drug at the same dosage as I’d always gotten. Nothing had changed.” Prices rise to whatever the market will bear.
In some countries, people believe that patent infringement of drugs and therapies is perfectly fine, because life-saving treatments and cures should belong to everyone. That’s certainly not in line with free-market principals or the legalities of patent infringement, but there has to be a better alternative to what we have now. Let’s hope that what Dr. June says is true.