The Unsustainable Economics of Cancer Drugs

In New York magazine, Steve Hall lays out the good, bad, and the ugly of cancer-drug economics. Warning: it is mostly bad and ugly.

The pharmacist e-mailed the numbers, and Saltz stared at the figures on his computer screen. Zaltrap, the drug that was extremely similar to Avastin, cost roughly $11,000 a month. (And because that extra 42 days wouldn’t be possible without taking the drug for, say, seven months before—which was roughly what was happening in clinical trials—the price for that six-week life extension could be as high as $75,000.)

“Wow,” he said to himself, “that’s a deal-changer for me.”

That may not seem like a heretical statement, but the unspoken rule in American health care is that doctors should never consider the cost of a medicine that might be beneficial to patients. When the FDA approves a new cancer drug, it analyzes safety and effectiveness only. Medicare is obliged to reimburse payment for the drug, and private insurers in most states must cover the cost. Any doctor who considers cost—or the value of a costly drug—risks being accused of “rationing” health care.

Has the Pill Led to an Increase in Prostate Cancer?

That is the possibility raised in a new paper published in BMJ Open and summarized in Science Daily. The presumptive culprit would be environmental estrogen exposure. Add this to the bulging files of Unintended Consequences of Birth Technology (the theme of a recent podcast called "Misadventures in Baby-Making.") First, from the paper:

Prostate cancer (PCa) is the most common male malignancy in the Western world, and risk factors associated with this cancer remain ill defined.1 The only acknowledged risk factors thus far are: age, ethnicity and family history.1 Several studies have suggested that oestrogen exposure may increase the risk of prostate cancer,2–4 while other studies have not found an association.5 6

The Silver Lining of More Cancer Deaths

A National Post graphic does a good job showing causes of death across Canada by percentage, and notes that, for the first time, cancer is the leading cause in every province, responsible for about 30 percent of all deaths. That is a heartbreaking number, not least because cancer is a disease (or set of diseases, really) about which so much is still unknown.

As we wrote in a section of SuperFreakonomics called "We're still getting our butts kicked by cancer," seeing cancer statistics like this might naturally lead one to conclude that the "war on cancer" has been a dismal failure. That, however, would be an overstatement. While it's true that we are, as one oncologist told us, "still getting our butts kicked," there is somewhat of a silver lining in the cancer death rate.

Aspirin and Cancer: A Seriously Cost-Effective Measure

At Freakonomics, we're all about finding cheap, easy solutions to life's big problems. And judging by the results of a new study published in The Lancet, a rather large one just came down the pike. Turns out that aspirin may be one of the most effective measures to combat colon cancer. The study found that taking two aspirin pills a day for two years reduced the risk of colorectal cancer by 63 percent in a group of 861 people who have Lynch syndrome, and are therefore at a high risk for the disease.

Though there have been previous studies that suggest aspirin may effectively reduce the risk of cancer (like this one from 2010), according to the BBC, this most recent study was the first randomized control trial specifically for aspirin and cancer to prove it. So, while we've spent what probably amounts to tens of billions of dollars in pharmaceutical R&D trying to come up with an effective cancer drug, one of the best methods may have been already sitting in our medicine cabinet, at just a few bucks a bottle.

Dogs Can Smell Lung Cancer

A new study by German researchers apparently shows that "sniffer dogs" can reliably smell lung cancer on the breath of patients. The finding could significantly improve early detection methods of the disease, which is the deadliest form of cancer worldwide. The research was published in European Respiratory Journal. Here's the abstract:

Patient prognosis in lung cancer (LC) largely depends on early diagnosis. Exhaled breath of patients may represent the ideal specimen for future LC screening. However, the clinical applicability of current diagnostic sensor technologies based on signal pattern analysis remains incalculable due to their inability to identify a clear target. To test the robustness of the presence of a so far unknown volatile organic compound in the breath of patients with LC, sniffer dogs were applied.

Exhalation samples of 220 volunteers (healthy individuals, confirmed LC, or COPD) were presented to sniffer dogs following a rigid scientific protocol. Patient history, drug administration and clinicopathological data were analysed to identify potential bias or confounders.

LC was identified with an overall sensitivity of 71% and a specificity of 93%. LC detection was independent from COPD and the presence of tobacco smoke and food odors. Logistic regression identified two drugs as potential confounders.

What Does a Sick C.E.O. Do to His Company?

When Steve Jobs was diagnosed with pancreatic cancer in 2003, Apple waited until after his surgery to tell the public and shareholders — yet company stock only fell 2.4 percent on the next trading day. But Jobs’s gaunt appearance while speaking at the Worldwide Developers Conference in June and the speculation about his health that […]

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