Wednesday, May 22, 2019

Big Pharma, Innovation and Cancer Care

Image of white and blue pills that spell out the word cancer
I have the deepest respect and admiration for medicine. It is through arduous and painstaking research and experiments that medicine has reached a pinnacle in our lives: The field of medicine is not only making our lives more livable by improving quality of life and helping deal with numerous chronic and debilitating conditions, but, more importantly, it is also capable of saving lives.

How many innumerable lives have been saved through penicillin, anesthesia, and vaccinations, and how many more with emergency procedures and surgeries. In many ways, medicine has moved from the dark ages of superstition, prayer and wishful thinking into an age where many diseases have come under its domain and control.

There is something essentially noble and beautiful in the fact that medicine can save lives. This is the child suffering from high grade fever who is saved by antibiotics or another one suffering from cancer who has been miraculously cured. The gratitude from all those who have been afflicted with these pangs of pain and suffering is boundless. We hug the surgeons, doctors, and, in our heart, we silently thank the researchers who made all this possible through continuous work and effort.

Furthermore, medicine helps keep us safe. In human history, we have had and continue to have epidemics that have the inherent potential to wipe out strands of humanity. This has ranged from the threat and outbreak of Ebola that has been dealt with, at least for now, through quick emergency actions and measures, and, to some extent, the AIDS epidemic, with the latter being now much more in control thanks to advances in modern medicine. Nonetheless, the next silently but steadily growing epidemic is going to be associated with obesity and cancer.

During the Public Engagement sessions that I had the pleasure to attend some weeks ago, I was privy to important information alongside facts about cancer. First off, we are living in a time of crisis in relation to cancer. In his talk, Dr. Malcolm Moore, the president of BC Cancer, gave us two definitions of the word crisis and both strongly imply the importance and necessity of immediate action: Crisis is both a “time of intense difficulty, trouble or danger” as well as a “time when a difficult or important decision must be made.”

As I discussed in a previous post, 1 in 2 people in my province will develop cancer, while 5 % of the population are already living with a diagnosis of cancer. However, the most astounding and frightening piece of information was in relation to the Cancer / Silver “tsunami” that is heading our way: The number of cancer cases will increase by 50 % in 2035. 

The projected cancer burden in British Columbia will increase by 39 % from about 28,000 cases in 2017 to around 39,000 incidences of cancer by 2030. Most of this change, in fact more than half, will be due to the aging population of people over 65; in other words, people living longer will significantly drive up the diagnosis of cancer.

In fact, in the US only, 3.6 million people of 85 years and older were diagnosed with cancer in 1975, but in 2016, there were 15.5 million people, while it is projected that in the year 2040 that number would increase to 26.1 million people among that age group. Better health care and longevity have driven up the cases of cancer, and this would represent a growing burden on health care and society as more and more younger people would have to support the health costs of the elderly. 

This is also evident in the lack of cancer care and facility; in Vancouver, there are currently barely enough chemotherapy chairs available, and since cases of cancer will steadily increase, we would need an additional 400 chemotherapy chairs by around 2040 to keep up with those rates.

Fortunately, there are different solutions available for this crisis. One of them is to promote and increase prevention. As more and more people can be potentially saved from being diagnosed of cancer, the incidents would then decrease by a significant amount. This would also mean that there would be more availability of resources for those who shall need treatment.  

Secondly, there could be more advances in treatment. More efficient and cost-effective treatment could then ensure that people will receive the care they need. The current methods of treatment are mostly effective, but they are far from perfect. About thirty years ago, very few people survived cancers like breast cancer, but today about 60 % of patients can survive over five years, while over 80% of children can survive. 

However, that also indicates that 40 % of adult patients and 20 % of children will NOT survive. At the same time, some of them who end up surviving must deal with significant side and after-effects and their quality of life will be dramatically decreased over that time period.

Thirdly, there could be advances in research that would not only focus on treatment but rather on the actual cure of cancer. Since cancer is a complicated disease, and in fact represents up to thousand variations of the same disease, there is no single silver bullet capable of curing all the strands of this disease. Yet through person-centered and targeted cancer care, we should be able to successfully eradicate at least certain cancers.

What are the obstacles then? In the first one, i.e. prevention, there is a mix of either lack of information, misinformation, or plain complacency. Many people underplay, ignore or deny the active role they have when it comes to their own health. They often blame their genes, environment, personal circumstances etc. 

Although these could be valid reasons, at least to some extent, we all have more control over them than we tend to acknowledge or realize. For instance, obesity may contain genetic components, but we could keep symptoms and potential complications under much better control with a healthier lifestyle and a more balanced nutrition.

There are various innovative treatments that have been approved by the Food and Drug Administration (note that approval by the FDA only means that they are safe for human consumption and does not imply effectiveness); these treatments, such as gene therapy, then undergo clinical trials, which are mostly funded by pharmaceutical companies.

These new approaches are using modern technology to treat cancer in a more effective, targeted and less painful manner. The quality of life of patients can substantially increase, while there can also be potentially higher success rates. Finally, if our aim is not so much alleviation of symptoms but rather eradication of the root cause of the disease, we would have the chance to cure significantly more patients.  

Yet the biggest stumbling block comes in the way of Big Pharma, the conglomeration and monopoly of a handful of pharmaceutical companies. Although I had heard and was somewhat acquainted with the issue of corporate greed in relation to drugs and medicine, the problem is much deeper and much more systemic than initially assumed or even feared.

In my opening paragraphs, I praised the potential healing power of medicine. But this same power can also be exploited by money-driven and power-hungry and greedy corporations. Big Pharma is situated firmly and squarely in the US as well as certain parts of Europe. It is indeed this monopoly of pharmaceutical companies that sets the drug price in the US and decides and weaves control over the global market.

Since medical drugs are of such vital importance for patients, the latter become vulnerable to an abusive system that prefers on one hand to drive up prices for medication, and on the other hand to restrict research for a cure of the same disease. If a given disease can be cured, then there would be no need for further medication, hence the profit margin of the pharmaceutical company could essentially decrease.

The same can be said about alternative forms of medicine as they often do not depend on pharmaceutics and are beyond the reach and control of Big Pharma. Hence, alternative medicine is, regardless of its effectiveness, generally discouraged and discredited in consumer societies. Although one should keep in mind that some companies indeed do the opposite and attempt to exploit certain people by offering fraudulent products that are ineffective, counterproductive, and even dangerous.

Nevertheless, one of the main problems here is that pharmaceutical companies are given free reign and have little to no regulation in their practices. There were various cases where vital drugs had undergone significant and unreasonable (not to mention highly unethical) increases only to ensure higher profit margins for those companies. The fact that the US government does not (chooses not to?) interfere due to their powerful lobbies and their economic weight and impact has made matters only worse over the recent decades.

The main problem is that lives are at stake and that they could be potentially saved. Unfortunately, Big Pharma has taken a noble endeavor and profession and turned that into a money-making scheme. Although a certain margin of profit is more than acceptable, the current amounts are inordinate and unreasonable. It should not cost a patient almost half a million dollars to have effective treatment for their life-threatening disease, which is the current charge for gene therapy. In BC alone, 300 to 400 million dollars of a $1.7 billion budget are spent annually on cancer drugs with drug costs ranging from $50,000 to $150,000 per patient.  

Furthermore, any advances and breakthroughs in research by universities have either been funded via Big Pharma or are taken up, appropriated and managed by them in forms of patents. The pharmaceutical companies would then use the research of hard-working scientists (in this, the University of Pittsburgh has led the way over the past decade or so) to fund their own clinical trials, which would then lead to production of drugs and treatments. In the end, most, if not all the major decisions end up falling squarely into the hands of the powerful few. And in times of crisis like ours, making the right and ethical decision is of the utmost importance!

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