HPHWD

Williams reports on what oncologists say about cancer drugs in “The Price of Drugs for Chronic Myeloid Leukemia (CML); A Reflection of the Unsustainable Prices of Cancer Drug.” The article, which was published in the journal Blood, includes candid comments from more than 100 experts They tell us that:

• Many costly treatments aren’t worth the money
• New treatments with tiny orno benefits often cost a multiple of existing therapies
• Despite their reputation for penny-pinching, health plans are often not aggressive in negotiating price
• Patients are already suffering mightily from high costs –and it impacts quality of life and survival as well as financial health
• Society as a whole cannot afford to pay the high prices charged for so many of the new therapies

(I’m reminded of “A Very Open Letter from an Oncologist published on HealthBeat in 2009.) It’s encouraging to see more oncologist stepping forward to telll the truth about cancer drugs…).

As Williams observes these insights “come from people who know what they’re talking about and who have traditionally been sympathetic to drug makers and unperturbed about costs.”

If you thought U.S. doctors would never accept evidence-based medicine, consider this: Just last week, in a stunning about-face, the American Urological Association(AUA) announced that it no longer recommends routine annual PSA testing for men under 55.

One of the metrics used to measure health outcomes is the five-year survival rate… what proportion of patients are still alive five years after they are diagnosed with breast cancer? Said differently, we are interested in the length of time between the time of diagnosis and the time of death. There are two ways to improve this metric, by delaying the time of death, or by moving earlier the time of diagnosis. The former is difficult to achieve, and requires genuine progress in medication. The latter is very easy! If we screen younger people, we will move the time of diagnosis earlier. Without any medical progress, we will make the five-year survival rate fall. This phenomenon is known as lead-time bias.

Expanding screening to younger and less vulnerable populations has another effect, which I discussed in Chapter 4 of Numbers Rule Your World. The marginal person who gets diagnosed will be less ill than the average person - Orenstein tells us that the form of disease most commonly diagnosed in younger women (DCIS) ought not even to be called “cancer”. Add less ill people to the population of ill people will automatically improve the survival rate, again without any medical progress. This phenomenon is known as length bias.

There are broader lessons to be learned from what we’re seeing in the world of breast cancer.

Firstly, Americans are bad at statistics. When it comes to breast cancer, they massively overestimate the probability that early diagnosis and treatment will lead to a cure, while they also massively underestimate the probability that an undetected cancer will turn out to be harmless. They’re bad at pathology: they’re easily convinced that something called ductal carcinoma in situ (DCIS) is a form of cancer, for instance, partly because the cancer industry insists on referring to it as “Stage Zero” cancer. They’re bad at biology: they think that it’s physics, basically, and that cancers are discrete, localized growths which start small and get bigger, and that the earlier you find and treat them, in large part by physically cutting them out of the body, the more likely you are to be cured.

Humans do not do a good job of figuring out how to effectively use resources to screen for and manage disease. And as we see in this study, humans do not always make better decisions with better information. This is why we need good models of disease and its treatment. With those models in place, we can explore how to effectively target limited healthcare resources at the patients who most need them.

The Indian supreme court has rejected a new patent on a “slightly altered” version of Glivec, a cancer treatment drug developed by the pharmaceutical company Novartis. They concluded that the Novartis’s changes were an attempt at ‘evergreening’, making small changes in order to gain a new patent.

Médecins Sans Frontières (MSF) said that the ruling will “save a lot of lives across the developing world”, and the Cancer Patients Aid Association in India (CPAA) said it is “a huge victory for human rights”.

Après sept ans de bras de fer, la Cour suprême indienne a rejeté la demande de brevet déposée par Novartis pour son produit vedette, le Glivec. Depuis 2006, le groupe suisse souhaitait faire breveter en Inde la nouvelle version de cet anticancéreux, comme il l’a fait dans près de quarante pays, dont les Etats-Unis, la Russie et la Chine.