Got CANCER? Uh, Can You Wait 50 Or 60 Years For A "CURE"?
spicpussy
INDUSTRIES ...
they've had since the late-1940s to "find" a cure, but all they've
FOUND is that CANCER TREATMENT is where the money is!
And the "CEOs" of those groups? They make up to $6 million a year
PLUS bonuses.
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"Fighting a smarter war on cancer"
By John L. Marshall
Sunday, November 29, 2009
IN MY PRACTICE as an oncologist specializing in gastrointestinal tract
cancers, a recent week was fairly typical. I saw 50 patients, ranging
in age from 32 to 87, equally divided between men and women. Though a
couple of them have inherited a gene that may have caused their GI
cancers, I have no explanation for why most developed their disease.
It is as if they were simply struck by lightning.
My patients seek state-of-the-art therapy, access to clinical trials
and new treatments, all of which we provide at our institution. Almost
all of them have insurance, and most have some form of prescription
drug coverage; their access to care is virtually limitless. We employ
the latest diagnostic tests, targeted chemotherapy, minimally invasive
surgical techniques and incredibly precise radiation. Yet, despite the
many recent advances in detection and treatment, of the 50 patients,
40 of them are likely to lose the fight.
In the extensive debate over health-care reform, we have heard little
discussion about the enormous cost of cancer care. (Some of the only
voices to broach the subject are those fearing "death panels.") But at
this moment, when a significant shift in the health system in this
country is possible, we must ask some difficult questions: Does it
make sense to support cancer care at the current levels in the United
States? Who should determine the value of care?
At the moment, there is a giant disconnect between patients, the cost
of care and the clinical benefit of the treatment -- a disconnect that
has caused us to lose perspective. When it comes to cancer care, we're
not getting what we pay for.
Cancer medicine is often regarded as an area of significant progress
and clinical research, so we should be able to tell without much
difficulty what kinds of treatment are valuable and what kinds aren't.
But given that 80 percent of my patients will die of their cancer,
it's clear that we have not found an "optimum" therapy.
In 1971, President Richard Nixon declared war on cancer, with the
charge to "cure" the disease. Since then, billions of dollars have
been spent on research, yet we have made only minor real progress. The
most common approach to treatment involves exposing large populations
of patients to highly toxic poisons in the hopes that the treatment
will kill the cancer cells and not the patient.
This strategy has succeeded with several types of less-common cancers,
curing some patients with leukemia, lymphoma, testicular cancer and
most childhood cancers. But it has not worked for more common forms of
the disease, including breast, prostate, lung, colon, pancreas,
stomach and ovarian cancers. These cancers represent an enormous
public health problem, consuming the majority of our cancer-specific
health-care costs and research dollars.
In many ways, we have quit trying to win the war on these diseases.
Few cancer clinical trials are designed to "cure" patients. They are
commonly aimed at detecting small differences between the treatments
being compared: an extension of average survival from 5 months to 6
months, for example. These trials typically cost millions of dollars
(often including taxpayer support), take years to complete and can
involve thousands of patients. It is this kind of care that many
Americans are afraid they will lose access to as a result of health-
care reform.
Globally, cancer care is a medical luxury. With some diseases such as
colon cancer, the treatments alone cost more than $15,000 a month, yet
on average add only a few months to survival. Most poor countries do
not support any cancer care; most developed countries highly restrict
it because of its cost and limited effectiveness. The United States is
the only place on Earth with relatively unfettered access to cancer
care, including the latest medicines, sophisticated scans and high-
tech radiation, all of which are very expensive. But despite their
more limited access, cancer patients in other high-income nations may
live longer and with a higher quality of life than patients in this
country.
If the Obama administration were to call on oncologists to help choose
which cancer treatments would be included in a public option plan and
which would fail to meet some "value" standard, we would have no
guidelines to follow. The Food and Drug Administration uses safety and
efficacy as standards for drug approval, but neither of those
considers the magnitude of benefit or cost. I frequently ask my
students and peers if there is a cancer drug today that they would pay
for out of pocket if they had to. We all have patients who lack
insurance but have some financial means, making this an exercise that
is played out regularly in our clinics.
After a long pause, someone invariably will say "Gleevec," a pill that
treats a terrible disease called chronic myeloid leukemia. Gleevec, a
brand name for imatinib, costs up to several thousand dollars a month,
but it makes this leukemia "go away" for a long time with very few
side effects -- a true magic bullet. Very few cancer drugs can be
described as having this kind of value. "Thank God for my insurance"
is a common line from patients.
In cancer medicine, fewer than 5 percent of all patients in the United
States enter clinical trials. That means more than 95 percent are
treated with the "standard of care" -- a legal term denoting a minimum
level of care for an ill or injured person.
How did we end up here? The answer is simple: Cancer patients are
scared for their lives and will accept what is offered, and we
oncologists want to offer improved outcomes and recommend the best
treatments we can. Insurance will pay for these treatments. A portion
of fees collected by cancer doctors and hospitals is based on how much
chemotherapy we administer. So the more drugs we give, the more
radiation we give, the more we collect from health insurance. The
incentive system makes it less lucrative to talk to patients -- to
counsel them, to help with their decision-making -- than to treat
them, regardless of the value of the treatment.
A major focus of health-care reform is for doctors to practice
evidence-based medicine: to offer therapies that have been proven to
help patients live longer or, at least, live better. The problem in
cancer medicine is that we have very little evidence to support what
we are doing. Because so few of our patients enter clinical trials, we
have no way of tracking their outcomes collectively, and we learn
almost nothing from them. Our understanding of cancer therapies comes
from the 5 percent of patients who enroll in trials, a tiny database
when we consider the highly variable nature of the disease. In fact,
most of our evidence has not come from clinical trials performed in
the United States but from nations where patients have little access
to advanced care except through participation in such trials.
In this country, the highest hurdle we must leap is our patients'
expectations. Cancer patients facing death want treatment; they want
hope that they will be cured, even if they have been told that they
cannot be cured. They will try toxic treatments over and over, hoping
to extend their lives. We physicians are co-conspirators. Of course,
we also want to believe that the next treatment will help more than
the last, even though we know that is rarely the case. What if we had
to pay for all this out of our pockets? Would we pay that much for
some possible hope?
I believe we can invest more in actual hope. To do so, we must further
explore the genetic makeup of patients and their cancers. We can no
longer diagnose cancers using only a microscope. We must profile them
at a molecular level to determine precise treatments, instead of using
our current trial-and-error approach.
To assess a patient's specific genetic problem, we must understand all
the possible permutations and patterns. This will come only from a
comprehensive clinical database -- a high priority of the
administration's reform plans. For example, we know there are at least
four different types of breast cancer; they look exactly the same
under a microscope but are very different diseases. The repeated
biopsies and blood tests that are needed, none of which is covered by
most health insurance plans, will become critical to finding our
answers.
The future of cancer care will rely on personalized medicine. This
requires a significant change to our medical system, which is built
around one size-fits-all treatment and seemingly unrestricted access
to care. The system answers our emotional needs and provides some hope
for a cure, but moves us forward only a few yards at a time.
Oncologists are optimists, and I am proud to be among them. I truly
believe we can cure cancer. I care greatly for my patients and am
doing everything in my power to improve and lengthen their lives. When
I offer a clinical trial to a patient, I am hopeful that it will be
better than the standard treatment. I am optimistic that health-care
reform will not simply provide everyone with insurance that will cover
the "standard of care" but will also force us to determine the true
value of treatments.
There is nothing that focuses the mind more than a cancer diagnosis. I
can assure you that all of my patients have very clear vision and have
shifted their priorities. We as a country must do the same on their
behalf. Health-care reform -- and a better understanding of what we're
paying for when we treat these terrible diseases -- will help focus
our approach to caring for cancer patients and finding a cure.
John L. Marshall is the director of the Otto J. Ruesch Center for the
Cure of Gastrointestinal Cancers at the Lombardi Comprehensive Cancer
Center at Georgetown University.
http://www.washingtonpost.com/wp-dyn/content/article/2009/11/25/AR2009112503408.html