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Gambling on cancer treatments
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Kai Ryssdal: OK, so would you rather have $5,000 right now? Or the chance at $10,000 if you win a coin toss? Right, gimme the 5,000, right? The bird in the hand. But there are certain situations when even the highly cautious become willing gamblers. Not in the casino -- in the hospital.
From Health Desk at WHYY in Philadelphia, Gregory Warner reports.
Gregory Warner: Here’s a tough question: If you had cancer, which of these treatments would you choose? Traditional chemotherapy that would guarantee an extra year or two of life but no more. Or an experimental drug that could extend your life by at least four years, but had only a 10 percent shot of working.
A study in today’s issue of HealthAffairs asked over a hundred patients that question.
Darius Lakdawalla: And the clear majority wanted to take those hopeful gambles, instead of taking a safe-bet therapy.
Darius Lakdawalla is director of research at the Schaffer Center for Health Policy and Economics at USC. He’s author of the study. He tells me this question isn’t an academic parlor game; it’s a real choice.
Lakdawalla: And in fact it’s the way the world is going. That more and more cancer drugs are designed to benefit select subgroups of patients and to work really really well within those subgroups, but not necessarily for every patient with the tumor.
This brings up one of the most challenging and expensive questions in end-of-life care. Insurance companies are reluctant to pay the full cost of drugs that can run up to a million dollars and help only a small percentage of people. Doctors, he says, also can push patients to traditional therapy where overall the odds are better.
Lakdawalla: They don’t really think about what happens to the luckiest few that might derive the greatest benefit.
But patients do think that way. And most would trade the long slog of chemotherapy for just a slim shot at joining the lucky few. Lakdawalla says if our hospitals reflected the world that patients prefer, we’d see a lot fewer people coming in for chemo -- and a lot more people at home with crossed fingers.
In Philadelphia, I’m Gregory Warner for Marketplace.
You're framing your stats wrong. The thing about cancer is that it has many different biological causes. Chemotherapy is a very broad and non-specific treatment that invented when there was less understanding of how cancers work. These new "wonderdrugs" with low over-all hit rates treat specific subsets of cancer perfectly well. The trick is figuring out what's causing the patient's cancer (what subset the patient is in), and then treating it appropriately. There's even a whole field of work devoted entirely to doing just that, called "theranostics".
The way the story was framed is like complaining that socket-wrenches only work in 10% of household jobs. Wrenches and wonderdrugs work fine, they are just made to fix specific problems.
As is often the case with articles that cover this subject, there is an implicit acceptance of the breathtakingly high prices that exclusive, life-prolonging drugs can command, as if there were some reasonable basis for it being so. If only there were a wider awareness of the true economics behind drugs that cost $10,000 a month in the USA, where each is only available from a single company. In India, where US drug patents are not honored, that same drug is just $240 a month. Who is more vulnerable than a cancer patient being told that there is only one drug that could allow them to go on living?
As a huge fan of Marketplace, I was disappointed at the short-shrifting you gave this topic. What patients don't know is that the placebo effect is 15% or more response--so the overpriced experimental drug example you used is producing a lower response rate (at 10%) than if the patient took a sugar pill. These drugs often have horrible side effects as well--making 90% of the 'subjects' last days sicker. Oncologists trot out these drugs to patients they deem hopeless, and whose insurance will pay. It's about providing human guinea pigs for research, and highly profitable for the oncologist as well.
