EDITORIAL: What price life? Pushback by OHSU's Brian Druker against high drug costs should prod review
Oregonian (Portland, OR)
April 29--It's one thing to be told you have cancer and a few years to live. It's entirely another to be told Wait, you do have cancer, but a medication that will extend your life by several years is available for $100,000 a year.
Reasonable people would scoff at the sum, even though insurance might reduce the out-of-pocket co-pay to, say, $1,400 a month -- for many, another mortgage. But being told you'll die is calamitous on its face and does not produce entirely reasonable behavior. Doing anything to gain those precious years, including selling one's house or canceling retirement, might look necessary if not sane. That's to say nothing of those without insurance or a house or a planned retirement.
Stratospheric drug prices are pushing a lot of ill people into impossible situations -- and woe betide the patient who chooses a less-promising, one-time surgery to save money. The ball-and-chain consequence to everyone, meanwhile, is that sky-high drug prices threaten to topple a health care system whose costs already are out of control -- hence, in part, Oregon's efforts at cutting costs by changing the model of health care delivery for folks on the Oregon Health Plan.
More than 100 cancer specialists published a paper last week in the hematologic journal Blood, arguing cancer drugs cost too much money and that high prices threaten patients and the health care system. One name among the specialists stood out: Brian Druker, director of the Knight Cancer Institute at Oregon Health & Science University.
Druker's research in the 1990s is largely responsible for bringing to market the cancer-stopping drug Gleevec, priced in the early 2000s under $30,000 a year and now costing about $100,000 a year. Gleevec's development, it was assumed then and since, had made Druker a darling of the drug's maker, Novartis, which has profited handsomely from manufacturing and marketing the drug.
In 2009, upon receiving the prestigious Lasker Award for his research breakthroughs associated with Gleevec, Druker told The Oregonian: "We are well on our way to making effective and non-toxic therapies a reality for all cancer patients."
On Monday, Druker was no less optimistic but rueful about a system that creates unbridled profits but out-of-reach prices for many: "We must have a healthy drug industry. But the issue is this: When are you making enough money to stay in business?"
Gleevec is now but one of several effective but expensive cancer-busting drugs. And there are wildly expensive drugs for diseases other than cancer: A multiple sclerosis medication is estimated to cost $50,000 a year while a new and lauded cystic fibrosis drug approaches a whopping $200,000 a year.
A clinician as well as a researcher, Druker is palms to the sky about prescribing to a patient the equivalent of bankruptcy. "Thank you very much," he says of the new miracle drugs. "What would you suggest we do?"
But Druker goes on to ask: "If it currently costs $1 billion to develop a drug, what would happen if it only cost $100 million? A large part of that $1 billion includes numerous failures to get to a success.... As we get smarter about targeting specific populations of patients, the number of failures should decrease and the numbers of patients needed to show benefit should be smaller. Large innovations should be quickly rewarded -- and this is where the U.S. Food and Drug Administration needs to have a role."
There could be a way out, after all, though it won't happen by federal regulation alone. The collaboration between research institutions and pharmaceutical companies must become more efficient and agile -- and the FDA more quickly responsive throughout -- if the sometimes extortionist pricing of patented drugs is to be reined in.
Patients offered the option of living shouldn't have to worry whether they can afford to. Neither should a nation have to worry whether it can afford its own health care system.
That Druker pushes back on the prices of the lifesaving drugs he and his colleagues help to create is exemplary. His message and the argument published in Blood need to be heard by other-than-cancer specialists as well as drug-makers and the Congress.
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