Is Curing Cancer Bad For Business?

Ten years ago when the first full human genome was sequenced after a mammoth 14-year effort and a $3 billion effort, we were promised a bounty of cures for the diseases that afflict is. But things haven't turned out quite that way and, in many ways, sequencing the first genome was just the first, superficial question in a much more complex set of problems. Nonetheless it was an important milestone and its true applicability - as opposed to fanciful notions - is starting to become apparent. In the field of cancer research, for instance, there is a growing consensus that it makes more sense to classify and treat cancers not by their location in the body but, rather, by their specific genetic mutations. This is allowing for mutation-specific treatments and personalized medicine, such as the breakthrough drugs vemurafenib and Yervoy, hailed as the "biggest breakthrough in 30 years."


But if the approval of drugs like Yervoy, vemurafenib and Provenge (for prostate cancer) are giving new hope, they also reveal some of the political and economic barriers to cancer treatment and broader anti-aging strategies. The first thing that becomes apparent after the glow of hope that these breakthroughs elicit fades is that they are exceedingly expensive - and profitable. And while they extend cancer free survival they rarely lead to complete regression. This suggests the need for continual and evolving treatment, perhaps in the manner of HIV/AIDS, with a drug cocktail. But, as with HIV/AIDS it begs the question of who can afford the treatment?

"If you convert cancer to a chronic disease, and you've got now people living 10, 20, 30 years with cancer but they're on a polypharmacy, there's no way you can have them with three drugs that each cost $80,000 a year," said LaMattina, now senior partner at PureTech Ventures, a healthcare venture capital firm.

The tragedy of people dying because of lack of access to expensive drugs - a commonplace in parts of Africa where rates of HIV/AIDS remain at epidemic levels - becomes comic when we see the industry's attempt to "solve" this problem by creating package deals of multiple drugs with other companies. This may bring down the price somewhat initially but the jockeying for profit in these "strategic partnerships" leads to that other great past-time of capitalism - litigation. The costs of suits and counter-suits end up built into the price of the drug, along with marketing and other costs unrelated to the ability of the drug to cure the disease for which it is prescribed. From the same article quoted above this is put starkly:

"Almost everybody we are working with is either suing us or we are suing them," Glaxo CEO Andrew Witty told the drugmaker's annual meeting in May. "However, if we refused to work with people who sued us, we would not have any friends at all."

Beyond the price of the drug - and the economic incentive to maintain "addiction", as opposed to cure - there are other side effects of a for-profit model for healthcare, which limits not only cures for diseases like cancer but more broadly effects the possibility of longevity treatments. Most obviously, there is no necessary relationship between the profitability of a treatment and its effectiveness. And where a treatment - no matter how powerful - cannot guarantee significant financial returns, it will not receive research support. An example of exactly this dynamic is seen with a new model of immunotherapeutic treatment for cancer called Adoptive Cell Transfer (ACT) wherein a patient's own killer T-cells are extracted, sometimes modified to specifically target tumour cell proteins, multiplied in the lab and then re-introduced to the patient.  The results of a limited study, released in August 2011, on patients suffering from late-stage leukemia suggest that this treatment can have a dramatic effect in eliminating cancer cells.

Two leukemia patients were cancer-free in three weeks after being treated with genetically engineered versions of their own immune cells, an early finding that could lead to a new approach for treating the blood cancer.
The trial of three patients showed that researchers could reprogram enough infection-fighting T-cells to wipe out malignant cells. The procedure also stimulated cells that defend against the cancer’s return, according to papers published today in Science Translational Medicine and the New England Journal of Medicine...
The third patient was in partial remission and has remained there for seven months, the study showed. All of the patients had previously been treated with cancer drugs such as Biogen Idec Inc.’s and Roche Holding AG’s Rituxan, and Sanofi’s Campath.

These preliminary results suggest that this is a promising area of research that deserves the kind of big money reserved for potential blockbuster pharmaceuticals. And, yet, an April 2011 article discussing the exciting possibilities of ACT notes that there has been little interest from pharmaceutical companies in pushing ACT. This is despite the fact that a study on the effectiveness of ACT in late stage melanoma - without the more recent addition of gene therapy as in the leukemia study - led to a total remission of cancer in 21.5% of the patients. The new breakthrough drugs Yervoy and vemurafenib, mentioned above, only had total remission rates of 0.6 and 2.0 percent respectively. With the above quoted leukemia study researchers were only able to study three patients because neither the pharmaceutical industry nor the National Cancer Institute (USA) would fund the research. How could this be?

It might seem perplexing that the private sector has not pushed for an FDA-approved licensing trial. However a clear path to profitability is still missing in the development of ACT-based immunotherapy for use in the medical marketplace. Not a simple injection or a pill, ACT-based treatments are uniquely tailored for each patient. The cost of entry into the field with a licensing trial includes construction of a specialized facility and the acquisition of highly trained medical and laboratory staff. There may also be a perception that ACT-based approaches lack a clearly defined claim to intellectual property (IP), which entices companies and their shareholders to invest in the development of new treatments. After all, it is not easy to own the “drug” used in ACT—the patient’s own T cells.

Thus in two key ways, the cure for cancer remains elusive. Not only are the drugs outrageously expensive - you could literally die from lack of money to pay for them. But the treatments that have the greatest potential to cure could easily not be developed because there is no clear path to make a profit off of them. Surely, we think, the market will snatch these methods up. It may be messy but the best method always succeeds in the end. Sadly, that's not true. Think of the lowly QWERTY keyboard. It's common knowledge that the Dvorak keyboard is much easier and more efficient to use. It was known back in the 19th century that QWERTY wasn't the best keyboard layout - but the inventors of QWERTY had investors with a lot of money. Capitalism isn't about efficiency or quality, it's about profit.

NEXT: Capitalism Is Killing Healthcare

Repo Men, Social Satire & How Reviewers Are Dumb As Posts

 

The other night I had the pleasure of being deeply disgusted by Jude Law removing a man's liver. Tonight I was disgusted to see that most of the reviewers on Rotten Tomatoes managed to completely miss the point of the film and give it a negative review.

I'm not surprised that a film that (literally) rips apart the brutality of private healthcare in the USA didn't do well. As a species we are more than a little squeamish about watching entertainment that speaks to us about contemporary concerns in a direct way. Witness the near total failure of recent war films about Iraq. The Hurt Locker may have won the Oscar but it didn't make any money at the box office.

But I guess I expect the film reviewers who watch a lot of films would enjoy the pleasure of the satire embedded throughout the piece, the self-referencing of action movies for the purpose of tearing them apart.

Peter Howell from the Toronto Star, for instance, writes: "The film is set in the near future, where a terrible thing has happened. There's been some kind of apocalypse, stripping Hollywood of new ideas. This leaves rookie helmer Miguel Sapochnik, as well as screenwriters Eric Garcia and Garret Lerner, with no choice but to make do with refried plot devices about heartless capitalism and mechanized humanity."

Is Howell dumb as a post? Hollywood has been making the same damn movie for thirty years. There's so little originality in Hollywood that we should shout for joy whenever something appears that isn't a remake of a TV series or film from the 60s or 70s or another Cinderella story. What's more, Repo Men stands in the tradition of satires of the caliber of Robocop. In other words, the action hero form is clearly intentional and satirical. Did these guys not pay attention to the last ten minutes of the film? It's about cultural fantasies of the hero who rescues us all as much as it is about the perils of American-style healthcare. And, frankly, I'll take "refried" plot devices about "heartless capitalism" any day over the usual horseshit about love conquering all or "try and you shall succeed." At least it attempts to engage with the lived reality of millions of people. Cinderella stories engage with fantasies that are meant to mask that reality in a way that is just insipid and stupefying.

Besides, you'd think reviewers would figure out that there was something deeper than a run-of-the-mill action film going on here by the presence of Forrest Whittaker; hardly a typical action hero. There's a strong echo of Gilliam's Brazil here, of the inside man who finds himself on the outside (and it's a reference in more ways than that but I won't spoil it). And the climactic fight scene, which was so over the top stylized and gory that only an idiot wouldn't figure out that it was meant to be a satire - and a set-up for the end of the film. It was a hilarious and beautiful send-up of The Matrix rescue sequence. Likewise the fairly erotic but absolutely bonkers sequence in which Jude Law and his kick-ass, sidekick girlfriend Anna Braga falsify the return of their overdue organs by cutting each other open and then inserting a barcode scanner.

And you can't help but laugh and shiver at the casual brutality expressed by the men whose job it is to physically retrieve the delinquent organs. The darkly comic brilliance reaches its peak when Forrest Whittaker's character borrows a kitchen knife from Jude Law during a BBQ at his house so that he can nip out front and repossess the kidney of a man in a passing taxi.

Somehow, the reviewers missed all this.

The Globe & Mail reviewer Liam Lacey was so asinine as to ask: "Surely an artificial organ could have a remotely controlled off-switch which would avoid the bloody splatter and the reason for this movie." Are you serious? Surely Alice would have broken her neck when she fell down the rabbit hole to Wonderland. Surely a man in red underwear and blue tights can't fly or see through walls. Surely the Marine operation in Avatar wouldn't depend on the ability and loyalty of one man to guarantee a resource upon which the entire earth is dependent. It's called a story as distinct from reality. And the brutal violence that made even a veteran action movie watcher like me wince and turn away was EXACTLY the point of it. It was meant to shock us into seeing the reality of privatized, corporate healthcare (or the real estate crisis for that matter). Newsflash: people die because of it and it ain't pretty. And while Lacey calls the film smirking and dully disgusting, all he betrays is that he is a sneering uptown snob with his title "Does the Hamlet set really want Saw-like gore..." as though such a film as this is beneath people with real cultural taste.

The script itself veers and bounces a bit - but for a good reason - and mostly it follows clear lines of development. The act changes are in the right place, the story is comprehensible and motivated. In the end it's a bit grim but it was so much fun getting to the grimness - wincing and all - that you're able to leave without needing a drink to dull its effects.

No Heart: Why China Isn't Socialist

THERE'S MANY WAYS TO DETERMINE IF A COUNTRY IS SOCIALIST or not. One of them would be democracy. The whole point of the development of the socialist movement in the early 19th century was as a counter to the undemocratic allocation of resources and restrictions on the political franchise. And for Marx, of course, socialism was "the self-emancipation of the working class" - ie. the majority of the population taking control of their lives through their own efforts, rather than it being handed to them by an enlightened elite. That's why Marx and Engels opposed their idea of socialism to the "utopian socialists", people like Fourier and Owen, who thought that they could build communes and win the support of the enlightened wealthy to improve conditions for workers. And it was why they opposed the anarchist Bakunin with his secret conspiracies.
We could certainly find all sorts of tests and criteria to demonstrate that, in fact, China is not now never ever has been a socialist country. Or I could just quote this article on the development of a Chinese artificial heart for those who suffer heart failure.

The artificial heart, including a blood pump and battery, will be available to the public at the price of 600,000 yuan ($87,870) each, according to Xiang Tiangong, director of an artificial heart laboratory in Zhongshan, Guangdong Province.

Chinese wages have grown considerably as the economy has expanded rapidly (though the economy has expanded more rapidly than have incomes). However, the average income in 2006, according to the World Bank, was still $2,025. That means it would take an "average" worker over 43 years to pay for a heart - assuming they didn't need to pay for food, shelter, clothing, etc. As the original article about the heart went on to say:

"It is for the rich," said Lee, who questioned whether the price is a one-time payment or just a down payment on the continuing cost of heart transplants.
Typically, patients must pay the monthly cost of expensive medications to prevent the body's immune system from rejecting artificial hearts and organ transplants.
The Ministry of Health reported over a half-million sudden deaths from heart failures in China each year, the highest heart attack death rate in the world, the Xinhua News Agency reported earlier this month.

Highest heart attack death rate in the world but an artificial heart only available to the richest of the rich. Sounds a lot like the United States healthcare system. And I feel confident to state that the USA is not a socialist country.

The Money Behind Opponents of US Healthcare

This is a very sharp news video about the connections between opponents of US healthcare reform and the "health" industry, including insurance, hospitals, seniors' homes, etc. It's pretty devastating to both big mouth Republicans but also the bought-off weasels known as Blue Dog Democrats. Since the late Sen. Edward Kennedy was perhaps most famous politically for his championing of healthcare reform, this seemed a fitting tribute post.