A recent editorial in the New York Times delved into some overarching issues around coverage of cancer medicine. While the paper raises some interesting questions, it unfortunately missed a few key considerations in trying to come up with answers.
First, the drug development process, with rare exception, is one of incremental advances. More often than not, a new medicine represents a step forward in the medical progress continuum, building on past successes (and failures), providing improvements over prior practice, teaching us something about what doesn't work and, hopefully, inspiring further insights and possibly more effective new treatments down the road.
HIV/AIDS is a good example. Just last month, we recalled the 30th anniversary of the first publication of a medical journal article on the disease. Then, there were no treatments and a diagnosis was essentially a death sentence. Ten years later, a handful of treatments provided limited relief to some patients but there were still few medical options. Thirty years later, a range of effective treatments are available and HIV/AIDS is a chronic condition for many patients.
It is a similar story with cancer. Year by year, new treatments are helping us cut cancer death rates and even turn some cancers into chronic conditions. New advances not only offer help some patients today, but help pave the way for the next generation of even better treatments. For example, a study published in 2010 by Boston Healthcare
illustrated how our understanding of the full value of cancer therapies evolves over time. It found, for example, that initial evaluation of docetaxel for head and neck cancer would have underestimated impact on survival by more than 4.5 years.
Second, the Times points to "median survival time" for patients treated with medicines. While conceding how important a few months can be to patients and their families, the Times failed to explain that "median survival time" also means that many patients' lives are extended well beyond that timeframe. Aside from the benefits to patients and their loved ones, researchers learn a ton from how patients respond to a medicine - information that is a key part of the development process.
Finally, the Times gives short shrift to the importance of ensuring that treatment decisions are left to healthcare providers and their patients. This remains the very essence of good medical practice. Every patient - including those who rely on Medicare or Medicaid - deserves the best treatment options available. Unfortunately, the solution advocated by the Times could end up limiting patient access to the latest medicines to only those able to bear the full cost of a treatment.