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The Problem and the Incremental Solution
An Op-Ed in the Sunday New York Times in the past few weeks pointed out that important cancer drugs are being rationed by companies that have simply interrupted production. (See Ezekiel Emanuel, “Short Changing Cancer Patients” NYT August 6, 2011). As a result, many cancer patients can’t get the drugs they need.
Dr. Emanuel is an oncologist and a health policy wonk who was most recently an adviser in the Obama White House. In his article the good doctor details the current shortage of commonly-used cancer drugs and what he sees as possible solutions to the problem. He clearly understands deeply the issues of cost reimbursement and the cost interaction between generics and patented drugs. He believes that the best way to get the missing drugs back on the market is to make generics of the drugs that are in short supply more profitable.
Capitalism and Health Care: Not a Good Mix
The article got me thinking once more about whether capitalism and health care are concepts that make any sense together, and about how cancer and ALS are different, yet the same.
In his op-ed, Dr. Emanuel says, “You don’t have to be a cynical capitalist to see that the long-term solution is to make the production of generic cancer drugs more profitable.”
I see the situation differently: you don’t have to be a raging socialist to see that the solution to the drug access and cost problem is to nationalize the pharmaceutical industry. We can pass laws until the cows come home to try to get pharmaceutical companies to behave in ways that will not harm patients while keeping their profits intact. But the goal of companies that make drugs is to make money, and that goal will always trump the needs of patients when the two conflict. Sadly, you can bet your life on it.
As long as we insist that health care must provide a profit for the drug companies and that this profit must not be subject to regulation our health will be short-changed.
Meanwhile, the shortage of cancer drugs is dire and getting worse as patients await the arrival of prescribed medicines so they can start or continue the treatment that may extend or improve their lives.
Cancer and ALS: Different Diseases, Similar Issues
That cancer treatment situation is terrible. Equally, but differently, bad is the situation in ALS, where there is only one drug approved to treat the disease. That drug is Rilutek. If it works – and it doesn’t work for everyone – it delays progression of the disease for up to 9 months. It does nothing to make you feel or function better and nothing to extend your life.
The absence of ALS drugs is in part the result of the fact that the market is so small: because, relative to cancer and some many other diseases, so few people have ALS. That means there is not as much profit to be made from ALS drugs. But that doesn’t mean that the research resources are so limited that we can address only the diseases for which drugs can be profitably made. It simply means that there’s not enough potential profit in ALS drugs or drugs to treat other relatively untreatable diseases (like pancreatic or head and neck cancers, to name just a few) to make the research attractive to private companies.
Potential profit will continue to be an incentive to develop drugs for diseases that are relatively wide spread. What we need are incentives to push the research also in the direction of, if you will “less profitable” diseases that need treatments. What would happen if national policy required drug development for diseases that are always or nearly always fatal, and for which there are very few if any good treatment options? I’m sure there are many people who would take issue with this standard, but maybe we should have the conversation and think about whether and how it might work.
In my opinion, it’s time to get away from niggling around the edges of how to make capitalism and drug development (or health care in general) work together. Maybe it’s time to put patients’ needs first. Isn’t that a nifty idea?
© Barbara A. Brenner 2011