Monday, August 22, 2011

Serving the greater good

I don’t typically set out to be a jerk, so I apologize if my previous post sounded callous. At least one reader let me know that I crossed the line (see comment).
My defense is that I remain skeptical of how cancer care is both organized and funded in this country, and believe that if we’re serious about minimizing the misery and suffering of those with advanced disease, placing our trust in the status quo won’t do. It’s wonderful that some people respond to the new melanoma drugs, and that some may even have durable remissions. Should the time come that I need systemic therapy, I will seriously consider that choice. But I don’t have to like the system that created this option in the first place, given the powerful and (I believe) misguided forces that are in play.
It’s interesting to note that a nonprofit set up by Genentech is offering several options to cover the cost of vemurafenib (trade name Zelboraf) for certain patients who are uninsured, have been denied coverage, or who have concerns about co-pays or out-of-pocket expenses. Genentech is part of Roche, which developed the drug. The company has spent a fortune to get it through the development pipeline, and stands to make billions from its sale. Putting out some cash to help those who are financially strapped is a nice gesture, but won't much impact its bottom line. Drug companies are in business to make a profit, which is fine by me. But they wont soon be confused with the Missionaries of Charity.
Increasingly, nascent pharmaceutical and biotech companies are focusing on developing drugs to treat diseases like advanced melanoma that only a few thousand people have—at an enormous cost per patient. They do this because they know that the FDA will approve such drugs. After 13 years of there being no new drugs for treating melanoma, the government put both Yervoy and Zelboraf on the approval fast-track. The FDA comes off looking like the good guys to a relatively small cadre of patients in desperate need.
By the same token, the industry is increasingly turning away from developing drugs to treat diseases that afflict millions of American, such as diabetes and cardiovascular disease—at a modest cost per patient—because it has become almost impossible to get them approved in the U.S. There is also the abject fear that people have over being diagnosed with cancer. I can vouch to the fact that it's a tough hand to be dealt. Once a person is in its grip, he or she can rationalize that no expense is too great nor treatment too arduous to endure. I beg to differ, but that’s a topic for another day.

My point here is that just because some patients respond to a new melanoma drug doesn’t mean we shouldn’t critically evaluate the broader context in which it will ultimately be prescribed and paid for. I'm grateful for drugs that work for some, but will continue to advocate that our priorities be placed on serving the greater good of all.

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