Cancer medicine generates enormous revenues but marginal benefits for patients

BIG PROBLEM, BIG BUSINESS, BIG HYPE

By John Horgan on 12 February 2020

Source:  https://blogs.scientificamerican.com/cross-check/the-cancer-industry-hype-vs-reality/

Basic Facts

• Cancer is the second most lethal disease in the U.S., behind only heart disease.
• More than 1.7 million Americans were diagnosed with cancer in 2018, and more than 600,000 died.
• Almost four out of ten people will be diagnosed in their lifetime.

Big Business

• Cancer has spawned a huge industrial complex involving government agencies, pharmaceutical and biomedical firms, hospitals and clinics, universities, professional societies, nonprofit foundations and media.

• The costs of cancer care have surged 40 percent in the last decade, from $125 billion in 2010 to $175 billion in 2020 (projected).

• Total research spending since Richard Nixon declared a “war on cancer” in 1971 exceeds a quarter trillion dollars.

Big Bluff

• Cancer-industry boosters claim that investments in research, testing and treatment have led to “incredible progress” and millions of “cancer deaths averted,”

• Cancer experts and the media often describe new treatments with terms such as “breakthrough,” “game changer,” “miracle,” “cure,” “home run,” “revolutionary,” “transformative,” “life saver,” “groundbreaking” and “marvel.”

• There are 1,200 accredited cancer centers in the U.S. They spent $173 million on television and magazine ads directed at the public in 2014.

• 43 of the 48 top spenders “deceptively promot[ed] atypical patient experiences through the use of powerful testimonials.” A 2014 studyconcluded that cancer centers “frequently promote cancer therapy with emotional appeals that evoke hope and fear while rarely providing information about risks, benefits, costs, or insurance availability.”

Little Net Progress After 90 Years

What’s the reality behind the hype?  Azra Raza, an oncologist at Columbia, in her book The First Cell: And the Costs of Pursuing Cancer to the Last wrote:

• No one is winning the war on cancer, Claims of progress are mostly hype, the same rhetoric from the same self-important voices for the past half century. 

Azra Raza, an oncologist at Columbia. She  has watched too many people die from cancer — her patients and her husband, also a cancer specialist.

New Treatments Yield Small Benefits, Big Costs

• Pharmaceutical companies keep bringing new drugs to market. But … 72 new anticancer drugs approved by the FDA between 2004 and 2014 prolonged survival for an average of 2.1 months.

• Most cancer drug approvals have not been shown to, or do not, improve clinically relevant end points, including survival and quality of life … the FDA may be approving many costly, toxic drugs that do not improve overall survival.

• Costs of cancer treatments have vastly outpaced inflation, and new drugs are estimated to coston average more than $100,000/year.

• More than 40 percent of people diagnosed with cancer lose their life savings within 2 years.

Immunotherapy

Immune therapies, which seek to stimulate immune responses to cancer, have generated enormous excitement.

Drugs firms aggressively market immune therapies, and patients are “pushing hard to try them, even when there is little to no evidence the drugs will work for their particular cancer.”

Oncologists Nathan Gay and Vinay Prasad estimated that fewer than 10 percent of cancer patients can benefit from immune therapies, and that is a “best-case scenario”.

Immune therapies trigger severe side effects, and they are also extremely expensive, costing hundreds of thousands of dollars a year.

Subsequent hospital stays and supportive care can drive the total costs to a million dollars or more … If widely prescribed, immune therapies could bankrupt the American health-care system.

Corruption In The Cancer Industry

The American approach (to cancer treatment) fosters corruption.

Many cancer specialists accept payments from firms whose drugs they prescribe. This practice leads us to celebrate marginal drugs as if they were game-changers. It leads experts to ignore or downplay flaws and deficits in cancer clinical trials. It keeps doctors silent about the crushing price of cancer medicines.

Top officials at Sloan Kettering Cancer Center “repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care.