Guest guest Posted July 12, 2005 Report Share Posted July 12, 2005 I thought this might be of interest. It isn't entirely off-topic, as the high cost of treatments sends many people searching for alternative therapies, or as the article states: " In some cases, patients are discontinuing treatments or taking other drastic steps, doctors say. " Cancer Drugs Offer Hope, but at a Huge Expense By ALEX BERENSON, NY Times, July 12, 2005 Ten thousand dollars once seemed a lot to pay for a few months' supply of a drug. No more. Avastin. Erbitux. Gleevec. Herceptin. Rituxan. Tarceva. These are among the first in a wave of new drugs giving hope to millions of cancer patients by treating the disease in new ways, like blocking the blood vessels that feed tumors. But they are all highly expensive, up to $100,000 for a course of treatment that lasts a few months. That is hundreds of times the cost of older, more toxic cancer drugs, and several times the annual cost of AIDS drugs, whose prices caused widespread anger during the 1990's. And except for Gleevec, a leukemia drug from Novartis that has produced spectacular results, the new cancer drugs help most patients only marginally, prolonging life by a few weeks or months. For now, the high-priced cancer drugs are a relatively small part of overall medical spending. But some doctors warn that with more new drugs coming, the use of superexpensive therapies may further fuel the runaway costs of the health care system. Dr. Leonard Saltz, a colon cancer specialist at Memorial Sloan-Kettering Cancer Center in New York, said patients might face rationing of care if costs continued to rise. " I don't know how much money there is in the till to pay for all this, but I have to be worried there isn't enough, " Dr. Saltz said. " There is a limit as a society to how much we'll be able to spend on each patient. " Health care economists say the rising costs of the new cancer treatments and other drugs will force difficult questions on doctors and policy makers. Should patients be guaranteed access to drugs no matter what their cost? And should physicians be encouraged to consider cost when they decide on treatment - something most doctors in this country now say they do not do? Drug companies say many factors drive the pricing of their drugs, including the high cost of research and development, complex and expensive manufacturing processes and the value the drugs provide for patients. As doctors learn how to use combinations of new drugs in treatment, the therapies will extend the lives of more and more patients, said Dr. Susan Desmond-Hellmann, president for product development at Genentech, a biotechnology company in South San Francisco, Calif. The company makes several of the new drugs, including Avastin, that are widely considered the most promising. A year's supply of the drug for an average colon cancer patient costs $54,000. " It's a very reasonable thing to ask about the cost of therapies, " Dr. Hellmann said. " But I just don't want people to lose sight of how meaningful the changes in treatment are. " For now, most patients are able to obtain the new drugs, either through insurance coverage or assistance programs. Lung cancer was diagnosed in Shawnette Treat, 37, early last year and she was told her life expectancy was less than two years. She now takes Tarceva, which costs almost $90 a day, or $31,000 a year. Ms. Treat, who lives with her husband and two children in Melbourne, Ark., has private insurance, which covers 80 percent of Tarceva's cost. But she stopped working in March after undergoing a double mastectomy when the cancer spread. She said she could not afford her insurer's $500 monthly co-payment for Tarceva. " My husband's the only one working, and we have bills and stuff that we have to pay, and it takes all he makes for us to make it, " Ms. Treat said. " Five hundred dollars is a lot to us a month. " The Patient Advocate Foundation, a nonprofit group based in Newport News, Va., that helps people obtain medical care, is covering the monthly payment, Ms. Treat said. " I wouldn't be able to take it if they didn't pay my co-pay. " But the foundation covers only a few kinds of cancer and does not directly assist people who are uninsured, said Beth Darnley, the foundation's chief program officer. Those patients must apply to Medicaid or to the companies for discounted drugs. In some cases, patients are discontinuing treatments or taking other drastic steps, doctors say. Dr. Angela Dispenzieri, an oncologist at the Mayo Clinic who specializes in treating a blood cancer called multiple myeloma, said she avoided discussing a drug called Thalomid with patients who could not afford it. The drug costs $25,000 a year and will not be covered by Medicare until next year. " I don't want them to feel bad, " she said. If history is any guide, health care professionals say, patients, doctors and lawmakers will not want to confront questions about how the medical system should deal with the cost of the new drugs. " There's not really any incentive in the system to be more rational, " said Dr. John Hornberger, an adjunct clinical professor of medicine at Stanford University and a practicing physician who studies drug costs. Policy makers in the United States, unlike those in Britain and some other countries, do not measure the cost-effectiveness of new drugs, Dr. Hornberger said. The government does not control drug prices, and Medicare is prohibited from making coverage decisions based on cost; it must base its decisions solely on the drugs' performance. In terms of the cost per life saved, cholesterol-lowering drugs like Lipitor, which reduce heart attacks and strokes, are probably far more effective than cancer drugs, Dr. Hornberger said. But cancer is a uniquely frightening disease, and people will pay almost any price for treatments. Also, most cancer drugs do not have good substitutes; if a drug works - even marginally - patients and doctors clamor for it, and insurers have little choice but to cover it, Dr. Hornberger said. While some of the new drugs are difficult to make, their prices are unrelated to their manufacturing costs, said Geoffrey Porges, a biotechnology analyst at Sanford C. Bernstein & Company. Drug makers charge what they think the market will accept, he said. " It's sort of one of those things where everyone looks over their shoulder at everyone else, says, 'He started it, it wasn't me,' and it builds, " Mr. Porges said. Advocacy groups for cancer patients have been mostly silent on drug prices because pressing drug makers might discourage them from making the billion-dollar investments necessary to find new drugs. Doctors also do not want to consider cost, said Dr. Eric Nadler, a researcher at Harvard Medical School who has studied the attitudes of oncologists on the issue. In his study, about 80 percent of cancer doctors said they would prescribe a drug costing up to $70,000 if it would extend a patient's life just two months longer than the standard treatment. In fact, the way doctors are reimbursed for cancer drugs gives them an incentive to prescribe the most expensive treatments. The drugs are generally given intravenously in a hospital or doctors' office, and Medicare pays doctors for the cost of the drug plus a slight extra fee to help cover their overhead. The higher the price of the drug, the greater the extra fee. As a result of these forces, drug makers have faced only scattered opposition to the rising prices of new cancer treatments. The upward spiral started in 1992, when Bristol-Myers Squibb began charging $4,000 a year for Taxol, a breast cancer treatment that was among the first so-called targeted drugs, which are aimed at destroying tumors without the side effects of traditional chemotherapy. At the time, some lawmakers and patient advocates complained, noting that Taxol had been invented at taxpayer expense at the National Cancer Institute. But Bristol held firm. Then in 1998, Genentech began charging $20,000 a year for Herceptin, another targeted therapy for breast cancer. The price attracted notice, but little criticism. Four years later, Bristol and ImClone Systems began charging as much as $100,000 a year for Erbitux, a drug for advanced colon cancer. (Because different patients have different treatment cycles, these prices are averages, as computed by the companies or financial analysts.) For drug makers, the high prices have been a boon. Shares of Genentech have quadrupled in the last two years. Dr. Hellman of Genentech noted that the company began researching Avastin in 1989, at a time when many scientists doubted it could work. Genentech spent hundreds of millions of dollars researching the drug, and decided to build a plant to manufacture it years before receiving approval to sell Avastin in 2004. Considering the expense and risk Genentech incurred - as well as the costs of similar treatment - Avastin is fairly priced, Dr. Hellman said. " It's a giant breakthrough therapy, " she said. " The value to patients is very high. " Cancer drugs will be the fastest-growing part of the drug market for the next five years, with costs rising 20 percent a year, more than double overall drug spending, analysts say. Every major drug maker is now investing heavily in oncology, rushing to capitalize on new research about the way cancer cells reproduce. Most of the new drugs attack the proteins that help tumors grow, and most are produced by specially engineered bacteria, unlike the older drugs which can be chemically synthesized. Cancer drugs are not the only expensive new treatments; some drugs for rheumatoid arthritis cost more than $10,000 a year. But the gap between performance and cost is especially pronounced for the cancer treatments. A Genentech study of colon cancer patients showed that a combination of Avastin and standard drug therapy extended the life of the average patient less than 5 months - to 20.3 months from 15.6 months - compared with the standard treatment. With the notable exception of Gleevec, from Novartis, which has been widely praised for prolonging the lives of leukemia patients, most other drugs show even smaller improvements in survival. Some oncologists are beginning to question cancer drug prices publicly. Dr. Saltz of Memorial Sloan-Kettering Cancer Center said doctors must consider drug cost when they discuss treatments with patients. " We'd like to feel that it's wrong to put a value on human life and that we as a society won't do it, " he said, " but we do it every day. " Copyright 2005 The New York Times Company Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2005 Report Share Posted July 13, 2005 Thanks, Brian, for posting that! It sure helped to put things in perspective. I tend to feel bad when I have to charge more than the price of red clover and dandelion (both abundant and free where I live). Let's hope that more people get desperate enough to start doing their due diligence and finding out about the many alternative cancer treatments. Nothing works all the time for everyone. But natural substances such as Essiac, Reishi mushrooms, Noni, the new broccoli-based extracts, Ambrotose, and Graviola, to name just a few, all have a pretty decent track record of having worked at least for some people. Ien in the Kootenays ************************* Healing Body, Mind and Planet with Wild Whole Foods http://wildhealing.net ************************* Quote Link to comment Share on other sites More sharing options...
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