The cure for cancer has remained an elusive Holy Grail in medicine, with billions of dollars being spent on research hoping to find a way to prevent or treat this often fatal disease.
With the National Cancer Institute combining forces with former Vice President Joe Biden’s Cancer Moonshot program, efforts have been made to coordinate resources across the federal government to speed progress in cancer research in the areas of prevention, detection, and hopefully a cure.
As a result of this intense focus on curing cancer, advances have been made in the field of cancer genomics — researching the specific genetic abnormalities that cause a mutation in the genetic code, and result in cancer cells in the human body.
The results have been surprising. Cancers in areas thought to be completely unrelated to one another have been found to have the same genetic mutation, and thus can be treated with the same type of medication. Melanoma, lung and colorectal cancer, for instance, are both found to be associated with the B-RAF mutation, now a target for treatment with Zelboraf, the brand name for Vemurafenib.
Drug companies are controlling both cancer diagnostic testing and treatment, which is driving costs up.
Cory Lum/Civil Beat
However, the problem arises with the cost of these treatments. Zelboraf costs $13,000 a month with the total cost for a full course of treatment estimated at over $200,000. Although the federal government is involved in the funding of many of the initial discoveries leading to precision medicine’s advances, once the technology is sold to private companies, the costs can go up exponentially, even with competition in the market from other medications.
Could curing cancer become so expensive, we can’t afford it?
The pharmaceutical industry has quietly begun to monopolize the process of cancer detection, genetic analysis and treatment with no control on the prices they charge for their proprietary services. Roche pharmaceuticals has purchased Foundation Medicine, a company that does the analysis of biopsy specimens to determine the genetic analysis to see if there are “targetable mutations” for treatment — genetic abnormalities for which new forms of immunotherapy can be considered.
Who makes the immunotherapy? Well, Roche of course.
Roche also purchased Flatiron Health, the company known for doing real-world studies, now recommended by the Food and Drug Administration, especially for drugs which are fast tracked to market.
With the clear financial incentives to find mutations that their products can treat, who can put a ceiling on the cost to diagnose and treat cancer?
At the moment, there is no overarching organization that controls the cost of care for cancer patients. Average cost for genetic analysis on a biopsy specimen can run into the thousands of dollars. Average cost for the treatment: up to several hundred thousand dollars.
No one wants to see the research into the cure for cancer be stopped before it’s found. But as further advances lead to advanced genomic testing and other treatment options, the commercialization of the diagnosis and treatment have led to such high costs that the system may not be sustainable much longer.
Presently, if a patient is diagnosed with cancer, and they have medical insurance, the cost of much of their care is covered. However, as more and more treatments are developed, and the monopoly of the diagnostic and therapeutic testing is owned by just a few of the major pharmaceutical companies, the cost of care is going to be greater than even any insurance company can bear. Premiums will rise, and fewer people will be able to afford insurance at all.
What happens next is unknown. In the Medicare system, the taxpayers would have to pay for the cost of care. Same in the Medicaid system, where the joint funding from the federal government and each state would have to be great enough to cover the costs. The amount of money that is spent on health care in the United States is already almost 18 percent of the GDP. Many states can’t afford a huge increase in the cost of Medicaid spending.
Anyone without insurance who doesn’t qualify for government programs is at the mercy of their own finances, or perhaps gofundme campaigns to pay for their care. Some people may not even pursue treatment due to cost.
But given the fact that much of the research is being done with federal funding, shouldn’t there be some limitation on the cost of the testing and treatment, even if the discoveries are sold to private industry? Taxpayers are funding the research, why are they being double-charged through their payment for Medicare, Medicaid, and their own private insurance to pay for the same discoveries that they helped fund?
Something has to limit the extent to which the pharmaceutical industry sets the cost for both the testing and treatment of cancer.
Ignoring this lack of cost control will make the treatment of cancer unaffordable, and the overall cost of care unsustainable. People with cancer should not have to go broke to survive, or die because they can’t pay for the very treatments their tax dollars helped fund.
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Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.