The controversy arises when we start to examine the effectiveness of these newer medicines. For example, the metastatic colorectal cancer drug Erbitux certainly represents an innovative breakthrough in the war on cancer--- use of a monoclonal antibody that specifically targets the Epidermal Growth Factor Receptor, thereby slowing the progression of the disease--- but unfortunately it only adds about about 6 weeks to a patient's life when compared to placebo. Tarceva, the pancreatic cancer drug which targets a specific enzyme on the EGFR protein, improves survival by a mere 12 days compared to those who do nothing at all. At a cost of $3500/month.
Now that's just astounding. And I find it a little unsettling as well. The insidious inference is that these drugs are being offered to people who are vulnerable and bereft of hope. The oncologist tells them they have an incurable disease but this carrot is dangled before them. Try this fancy new drug. We can't guarantee it will prolong your survival or make your life better. But it may. And the flicker of light that such a conversation can elicit gives birth to a billion dollar industry. This exploitation of the dying is reason enough to look harder into the motivations and efforts that go into the creation of these new therapies.
The other reason is that it brings us full circle back to this concept of "Comparative Effectiveness". What the hell does this actually mean? How are we going to define it? Effectiveness has to mean much more than "treatment A leads to better outcomes than treatment B" irrespective of costs, side effects, and the degree to which it is more effective. From the Times article:
“As long as the marketplace does not distinguish between modestly effective drugs and dramatically effective drugs, there won’t be an incentive to shift resources to a greater emphasis on a larger benefit,” said Dr. Neal J. Meropol, an oncologist at the Fox Chase Cancer Center in Philadelphia who has been studying drug prices.
Ezra Klein has a surprisingly weak take on this issue in the WaPo. His stance is that the federal government should just use its muscle to bargain down the prices of these newer therapies, being careful not to compromise the innovation benefits that patients receive from them. Which of course is a convoluted, incoherent argument. Moreover it simply avoids the entire point of asking whether or not it is worthwhile for the pharm industry to invest so much time and money into the development of marginally effective cancer treatments.