Cancer Cures and Blockbuster Drugs: Who Can Handle the Truth?
by George L Gabor Miklos PhD and Phillip John Baird MD PhD
George L Gabor Miklos and Phillip John Baird are Director and CEO, respectively, of Secure Genetics and Integrated Diagnostic Pathology. The former is a molecular genetics-based data evaluation company, the latter a clinical diagnostic pathology company. Neither is affiliated with, nor receives any monetary compensation, gifts or other payments in lieu, from pharmaceutical companies, government funding bodies or private institutions in the cancer or drug development areas.
In the movie A Few Good Men, there is a heated exchange between the military characters portrayed by Tom Cruise and Jack Nicholson, an exchange which is relevant to the War on Cancer.
Jessep: You want answers?
Kaffee: I want the truth!
Jessep: You can’t handle the truth!
The distinction between answers and truth is perfectly illustrated in the cancer arena where competing interests form a volatile mix. The patients want cures, the media want stories, the researchers want grants, politicians want votes, the doctors want to save lives and the pharmaceutical companies want to sell drugs.
The War on Cancer has become a global industry where fact and fiction have become indistinguishable and where the truth often goes missing. Some truths are airbrushed out, leaving doctors to deal with the fears and financial predicament of their patients. What do the front lines in cancer treatment and management really look like?
To better appreciate them, we attempt to provide the latest facts. The medical ones can be checked at the National Cancer Institute, (http://seer.cancer.gov), the American Cancer Society, (www.cancer.org), the Armed Forces Institute of Pathology, (www.afip.org) and in the referenced scientific articles. The business figures are from The Wall Street Journal, BusinessWeek, Forbes, CNNMoney and pharmaceutical companies.
THE FRONT LINES OF CANCER
Dina Rabinovitch, author of Take off your party dress; when life’s too busy for breast cancer, reveals the day to day traumas of a breast cancer patient with an advanced form of the disease (1). The cancer has spread to other organs and her third different drug treatment is underway. It began with chemotherapy and intravenous doses of the blockbuster drug Herceptin (2) and when the cancer returned, Omnitarg was prescribed. Now the regimen is; five pills per day of the latest miracle drug Tykerb, plus eight daily tablets of the chemotherapeutic agent Xeloda every two weeks out of three, plus two morphine tablets and a diclofenac every morning and evening.
She states bluntly; "My cancer keeps recurring. Nobody can tell me why. I did the genetic screening and I don’t, apparently, carry the faulty genes. So angry and increasingly so cynical about these doctors in whom I have to put complete trust."
The costs of anticancer drugs
In 2007, the costs per patient for major anticancer drugs were summarized in the Journal of the National Cancer Institute (3). If used for a full year, the two blockbusters, Herceptin for breast cancer and Avastin for lung cancer, would cost $36,000 and $106,000, respectively. For colorectal cancer, Erbitux and Vectibix would cost $120,000 and $96,000, respectively, while for breast cancer Tykerb would amount to $35,000. Cancer drugs represent 40% of all Medicare drug expenditures.
These skyrocketing costs place doctors in the position of having to advise their patients about whether the clinical benefits are worth the financial burden. Nearly a third of them report discomfort in telling patients about costs and another 20% do not consider it to be their role. Many physicians say they are not health policy persons and just want to do the best job for the patient (3).
Physicians are trained to save lives and have little time to evaluate the effectiveness of a blockbuster drug or genetic test. Furthermore, cancer genetics has moved so rapidly that most doctors do not have the specialist molecular and statistical knowledge to make informed decisions about molecular tests, the clinical claims of which are usually overstated and often have little validity (4-8).
Patient time and incentives
The director of the American Society of Clinical Oncology, Dr Peter Eisenberg, states that the system does not value a doctor’s time with patients (9). The system also provides incentives to prescribe drugs with the highest profit margins and many doctors follow the money, after all, oncology is a business (10). Dr Richard Deyo of the University of Washington points out that; there are plenty of patients for whom there’s little hope, who are terminally ill, whom chemotherapy is not going to help, who get chemotherapy (11). What choice do oncologists have? By ending treatment the doctor would be acknowledging that hope is gone. Treatments therefore go ahead.
In 2006, the breast anticancer drug Herceptin and the colorectal anticancer drug Avastin generated $2.6 and $1.7 billion in sales, while Erbitux generated $1.1 billion in the colorectal market. Worldwide, anticancer drug sales are expected to rise nearly 20% per year through 2010 to reach between $60 and $70 billion (12). All large pharmaceutical companies strive to produce new anticancer drugs. GlaxoSmithKline, for example, predicts it will launch five new anticancer drugs in the next three years (13).
The public’s desperation for cancer cures distorts its perceptions of breakthroughs and miracle drugs. With headlines such as "Breakthrough liver cancer treatment found" (14) and the spectacular but completely incorrect, "US scientists have cracked the entire genetic code of breast and colon cancers, offering new treatment hope" (15), it is a wonder that oncology wards are not completely deserted. Unfortunately they are working at full capacity. Breakthroughs have become totally devalued and are accepted uncritically by the public, charitable organizations, politicians and the media.
The fascination with cancer cures is illustrated by the media’s attention to celebrities. In the 1970s it was Betty Ford and Happy Rockefeller with breast cancer. In the 1990s, it was General Norman Schwarzkopf and Time magazine Man of the Year Andy Grove, both with prostate cancer. Currently it’s Elizabeth Edwards whose breast cancer has spread to the bone marrow and White House Press Secretary Tony Snow, whose colorectal cancer has spread to the liver. Snow’s message is that "...a lot of conditions... are now curable or people are racing toward cures" (16). Celebrities serve as pillars of hope, but their comprehension of cancer cures conflicts with clinical reality. Cancers that have spread are quite unlike diabetes and heart conditions where people live for decades by taking fairly harmless drugs (17).
Far away from the frontlines of the War on Cancer, the directors of various institutions vigorously defend the progress in curing cancer. No matter how implausible, almost anything is said to attract more funding. The previous director of the National Cancer Institute, Andrew von Eschenbach, outlined an extraordinary goal; eliminating death and suffering from cancer by 2015 (18). This statement was so misleading that senior scientists were aghast at such overt distortions of scientific reality (19). It is also a very dangerous statement as it provides false hope to patients. Some cancer sufferers, believing it to be true that death and suffering from cancer will be eliminated by 2015, could delay seeking treatment in the hope that a pill will soon be available to cure their cancer.
When it’s all said and done, where are all the promised cancer cures since Richard Nixon signed the National Cancer Act into law on the 23rd of December 1971?
In terms of the fiery exchange that began this essay, do we wish to face the truth, or not? The choice is an intensely personal one. If readers prefer not to know the facts, they should read no further.
(Part II, "Do Not Listen to What They Say — Go See," should appear tomorrow. --Dean)
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