4.3.15 | Bloomberg Business
By Steve Brozak
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It’s almost mandatory that any documentary or news segment describing a new treatment for cancer must pulse with the twin themes of tragedy and hope. The camera follows patients through hospital corridors and rooms as their narratives unfolds within the story of a potential cure. The audience waits with the family and patient, hoping for a positive outcome while hooked into the drama of personal catastrophe. Doctors appear in their obligatory white coats, either interacting with patients or seated in carefully staged studies. The latest Ken Burns documentary, Cancer: The Emperor of All Maladies, captures and surpasses these hallmarks of the genre.
As an analyst of the health-care industry, I am continuously reminded that real scientific discovery is wonderfully random and human behavior is exactly the opposite in how woefully predictable it is. Viewing the PBS series this week left me without what I believe is a current real-world assessment of the state of cancer. Viewers get only a fragile hope for a positive future.
The statements by experts recorded for the series try to instill a tone of mortal combat in their efforts, but the reality of military efficiency in the so-called “war on cancer” is unfortunately missing in action. Instead we face dispassionate decisions made by clinicians to justify clinical trials where patients receive the perception of treatment to measure a drug’s efficacy.
Three well-known axioms of science and medicine are overlooked or glossed over in this documentary series.
1. Most advances in cancer therapy are incremental.
That means patients have cancer-free intervals or see overall survival extended by months. To defeat cancer, however, more than incremental change is necessary. A novel approach and perspective is critical, and Ken Burns includes several breakthrough narratives that have a common theme: “Young” researchers with brilliant new concepts who defy conventional wisdom and battle the system until their views become the accepted norm. This scenario unfortunately flies in the face of how cancer research is now funded. According to National Institutes of Health studies, research funding for scientists and physicians under age 35 has declined by almost 85 percent since 1980 while funding for research by those over age 66 has increased by 700 percent. Innovation may not be the sole province of the young, but even the Director of the N.I.H., Francis S. Collins has been critical of the folly in this trend.
2. Cancer is a mega-business that resists change.
The world of cancer is a medical-industrial complex of pharmaceutical and biomedical companies, physicians, nurses, hospitals, and even charitable organizations. The financial costs of cancer are also crushing. According to the NIH, cancer cost the United States an estimated $263.8 billion in medical costs and lost productivity in 2010. The sums are so huge that the participants in the cancer complex protect themselves and each other with precision. The notion of waiting for better and cheaper treatments defies the reality of the business of cancer, which has little if any incentive to bring down costs that would result in slower revenue growth.
If you don’t believe me, just look at what is happening with chemotherapies. Older, cheaper drugs that are still used as our primary tool against cancer are completely unavailable in some parts of our country due to a vast drug shortage. No matter what new therapy comes out on the market, chemotherapy is usually the first treatment given to patients. Despite their age, chemotherapies are unfortunately the best weapons we have to initially knock out cancer in a patient’s body. None of the companies presented in the Burns documentary want to make chemotherapies because the drugs are so old that they can only charge hundreds of dollars a dose, far from the tens of thousands of dollars commanded by a new drug. Manufacturers can’t make enough money off of essential chemotherapy drugs to justify making them.
3. Mergers, acquisitions, divestitures and corporate relocations are a big part of the cancer story.
Completely missing in the PBS series is acknowledgement of the impact corporate structures have on R&D. The frequent reorganizations and restructuring of businesses often disrupt research funding, with promising programs delayed and sometimes shut down completely. This pattern plays out when a small biotech announces a promising new therapy and is acquired by a larger biotech or pharma. The same may occur when a university announces a clinical breakthrough and licenses the program to a large pharmaceutical company, only to have it lost or shelved amongst hundreds of other once promising therapies.
The Burns documentary does devote some attention to how we apportion the majority of cancer funding to late-stage treatments that have little promise of efficacy. Such a fiscally irresponsible approach would not be tolerated in any other discipline or business. The series highlights the drama of massive interventional therapy that culminates in the rejoicing of a lucky few survivors, while offering almost boring descriptions of routine diagnostics, which identify cancer in its early or even formative stages and gives treatment options the best chance of success.
The series concludes with a few suggestions, one of which was that we might ameliorate the mortal threat of cancer by transforming it into a manageable chronic disease, which would be a source of even greater predictable revenue for the cancer industry. Even if turning cancer into a chronic disease is the inevitable future for cancer treatment, the prospect ignores the reality that achieving such a metamorphosis is an insurmountable and unresourceable approach to managing the disease given the state of our health care system.
I believe that rather than focusing on the noble quest of a few scientists and physicians, we must face the real issues of cancer, which are scientific, economic and social. We need to acknowledge that cancer is a business, that the present excitement about immunotherapy is another example of scientists jumping on a bandwagon with the hope that a cure is just around the corner. And we must question the amount and allocation of funding on the prospect for success if a radically new therapy shows promise. Only by focusing a public discussion on difficult issues such as these can we turn the present fragile hope for a positive future into a realistic prospect for a better outcome for all of us.