More than half a century ago, when I was somewhere around age 20, I worried a lot about cancer. I was terrified of it in the way of people who are not old enough yet to have become sanguine about what they cannot control.
In those days, hardly anyone survived cancer but I was astute enough to notice that most of them were old, past 50 or 60 or 70.
So I tamped down my fear and consoled myself with the thought that by the time I was that old, there would be a cure or a vaccine.
That was not a pie-in-the-sky idea then. It had not been long since everyone in the United States had lined up for their polio-preventing sugar cube.
In addition, during my childhood and in the few years following, science conquered whooping cough, diphtheria, smallpox, mumps and chickenpox, among others.
We were on such a roll in eliminating disease that had previously killed hundreds of thousands of people a year, it seemed inevitable that cancer wouldn't be far behind, and certainly before I reached the average (old) age for it.
Yet here we are 50-odd years later without much advance in cancer research beyond a few poisonous drugs that ravage the bodies of victims before they die anyway.
Cancer is still the second leading cause of death in the U.S. (584,881 in 2013) according to the Centers for Disease Control and Prevention. Why should that still be?
In between my youthful fear and now, we have invented the pacemaker, had continued success with heart and other organ transplants, made laser surgery for cataracts commonplace, mapped the human genome, invented a variety of high-tech diagnostic tools along with robots that do precise, miniature surgeries and made interesting advances for the blind and physically disabled.
There is more but maybe you, as I, are suitably impressed by that small list. Except – what happened to cancer?
About 18 months ago, the New York Times launched a fascinating and informative new column, “The New Health Care” that they describe as follows:
“Informed by research, Austin Frakt and Aaron Carroll explore and explain the changing landscape of health care.”
I've already learned a lot from these guys and a week or so ago, Mr. Frakt provided some daylight on cancer research in a story titled, Why Preventing Cancer Is Not the Priority in Drug Development.
If, before reading this article, I had ever put more than a second's worth of thought to why cancer is still such a scourge, I would have twigged to the answer immediately. It is what it always is in this country: profit. What else is new.
”There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months," writes Frakt, "than in drugs that would prevent cancer in the first place."
Frakt's story is reporting on a newly published study from Heidi Williams (and two others), an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner.
He provides a lot of wonky detail about the Food and Drug Administration drug trial requirements, patent extension, early and late stage drug effectiveness and this shocker:
”Use of surrogate endpoints with no known or strong relationship to survival is controversial. For example, the prostate-specific antigen [P.S.A.] test level — assessed with a blood test — is correlated with the amount of cancer in the prostate but has limited value in predicting prostate cancer survival.
“So, though they may be lucrative to drug companies, one would have little confidence that drugs approved based on P.S.A. test results would confer survival benefits.
“A recent systematic review found that most surrogate endpoints examined in cancer drug trials are weakly related to survival. Though most cancer drugs in recent years have been approved on the basis of surrogate endpoints, a majority of them have unknown or no beneficial survival effects.”
“No beneficial survival effects.” But drugs are nevertheless created, approved and sold at high prices based on them anyway. Instead of investing the time and effort to prevent cancer, big pharma repeatedly goes for the quickest bang for their buck. No wonder, as Frakt reports:
“Ms. Williams's study estimated that the commercialization lag's incentive to invest in drugs of shorter duration benefit led to 890,000 lost life-years among American patients found to have cancer in 2003 alone.”
Among Ms. Williams's suggestions for change, reports Frakt, are to pass legislation that will speed up drugs' path to market and/or to extend the period of “market exclusivity” before drugs go off-patent.
Yeah, right. Like big pharma will trip all over themselves to develop a cancer vaccine in exchange for another six months or year of patent protection.
What puny, useless solutions.
But the bigger question - the most awful-to-contemplate question - is why a society leaves the health and wellbeing - the fact of actual suffering and life or death - of its citizens to the whims of corporate profit?
What kind of government, corporate, philosophical monsters build such a society?
Let them charge anything at all for a television set - whatever they can get away with. No one will die. Who cares if a pair of shoes costs $5,000 (as some do). Fifty thousand for dinner at a restaurant? Why not? It isn't my - or society's - concern how billionaires spent their cash.
But it is unspeakable to withhold cancer research for no reason but to enhance profit. Read this grotesque sentence again:
”There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place."
Frakt is writing about cancer. I suspect the same could be said about Alzheimer's, diabetes, Parkinson's, stroke, heart disease, etc. And because elders contend with these diseases and conditions in far greater numbers than younger people, we should at least understand how we are being killed.
As long as the United States applies the profit motive even to matters of life and death, nothing will change. Read the story in full at The New York Times.