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We live in an amazing time. Despite all the disputes and anxiety about the health care delivery system, research still brings new miraculous cures. So, can we get the goose to keep laying golden eggs at something more like chicken feed, rather than kale, prices?
Recent news points towards early detection of cancers which usually are not detected until it is too late, and techniques to get a patient’s body to effectively recognize, attack and destroy cancer.
[A] 49-year-old woman whose breast cancer had metastasized through her body so far that she was planning her own death has been [cancer free for two years after] treatment that used her own immune cells to destroy the cancer cells.…
Laszlo Radvanyi, scientific director of the Ontario Institute for Cancer Research, was amazed, saying it was “an unprecedented response in such advanced breast cancer. We are now at the cusp of a major revolution in finally realizing the elusive goal of being able to target the plethora of mutations in cancer through immunotherapy.”
News from a major annual cancer research meeting last week included a “liquid biopsy” cancer screening blood test. A biotech start-up named Grail is pushing ahead with testing.
The data presented so far is from about 1,800 patients who have cancer and 580 who do not. These come from a 15,000-patient study (so far, 12,000 are enrolled) aimed at training its machine-learning algorithms. A second study of women with cancer, which will be used to verify results from the first, has enrolled 60,000 of a planned 120,000 participants. Other huge studies may be needed as Grail tries to develop blood tests for many types of cancer at once. This is where all that venture capital money is going. In each case, Grail is collecting blood samples from patients and then following them for years.
The test was evaluated on 1,005 patients with nonmetastatic, stages I to III cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung or breast. The median overall sensitivity, or the ability to find cancer, was 70 percent and ranged from a high of 98 percent for ovarian cancer to a low of 33 percent for breast cancer. For the five cancers that have no screening tests—ovarian, liver, stomach, pancreatic and esophageal cancers—sensitivity ranged from 69 percent to 98 percent.
Such innovation is a product of the golden-egg laying goose of American medicine, not yet gutted and cooked by federal bureaucrats and the #LabCoatLeft. There is real potential for saved lives and saved money.
Note that neither the British National Health Service nor the Chinese medical bureaucracy has leveraged their captive, subject populations for such advanced studies. Somehow, such innovation has not made it into the NHS five year plan. A recent story about the British government proposing “AI” as the answer to disease detection reveals the political problem:
The Guardian has learned that Prime Minister Theresa May will commit “millions of pounds” in funding for research toward AI that can diagnose cancer and chronic diseases at an early stage.…
In order for AI to diagnose cancer, the country’s National Health Service would submit reams of genetic and medical information to internet companies familiar with combing over data at a large scale. In other words, they could be profiting directly from handling sensitive personal data normally managed by a government body….
The funding pledge could easily produce a mixed reaction, for that matter. It could save both people and money, but critics may argue that the NHS doesn’t receive enough funding for its existing operations. Why spend large sums developing uncertain technology when there are hospitals that could use those funds right now?
American medical innovation, through the much maligned “Big Pharma,” has led to effective treatment for formerly debilitating conditions, like psoriatic arthritis. There are even competing drugs to cure Hepatitis-C:
So many companies have developed such increasingly effective medicines, such as those that treat more hep C strains with far shorter treatment regimens, that Gilead—a pioneer in the field with Sovaldi and Harvoni—is projecting $3.5 billion to $4 billion in U.S. sales from these kinds of drugs in 2018, a dramatic drop from nearly $13 billion in 2015. AbbVie’s rival Mavyret, for instance, carries a nearly 60% list price discount per month compared to Gilead’s drugs and requires one less month of treatment.
Drug prices are in the news again, with President Trump insisting that there will be real reform, with significant price reductions, in the near term. This appeared in his opioid strategy speech, along with his call for the “right to try” legislation, which he has already signed. It seems that the pharmaceutical industry and health care lobbyists have decided they had better get to the bargaining table.
It’s a departure from tactics employed in the past decade when the pharmaceutical lobby effectively killed most unfavorable policies through expensive ad campaigns across key congressional markets and grassroots advocacy efforts with industry-backed patient groups.
“The policy of trying to deal with this by defending the high prices, that’s not going to cut it anymore,” Kenneth Kaitin, director of the Tufts Center for the Study of Drug Development, said in a recent interview. “All the stars are aligned right now for something to happen and the industry realizes they have to be part of the solution or they are going to end up with something they are not happy with.”
The challenge is in balancing prescription costs with the kind of innovation Americans have come to expect. President Trump’s disruptive style of both focusing on fulfilling promises, and using public communication to both mobilize support and rhetorically destroy targets, may open the way to a successful balance. He may get the pharma-goose to keep laying golden eggs at something more like chicken feed, rather than kale, prices.Published in