Catching Formerly Fatal Cancers in Time, Curing the Incurable, All on a Budget?

 

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.

FANTASTIC: Woman’s Advanced Breast Cancer Completely Cured With Her Own Immune Cells

[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.”

Grail blood test shows promise in early detection of lung cancer

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 news seemed to reinforce research from January 2018 at Johns Hopkins [emphasis added]:

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 Healthcare
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  1. dnewlander Coolidge
    dnewlander
    @dnewlander

    A friend from high school just revealed on FB that she has brain cancer, and that she’s supporting “Right to Choose” at a hearing this week.

    I hope Trump wins all these battles.

    • #1
  2. Cato Rand Inactive
    Cato Rand
    @CatoRand

    PEOPLE WILL DIE! (if the damn bureaucrats don’t leave the innovators who are trying to actually solve problems alone)

    • #2
  3. Duane Oyen Member
    Duane Oyen
    @DuaneOyen

    The issue is not pharma innovation being undercut by attempts to control prices of new drugs despite high costs of qualification- it is pharmas playing games with bought-off Congress and “Baptist” regulators to preserve US exclusivity to old, non-patented drugs and expired patent routes of administration to prop up prices in wildly non-market situations.  Most drugs involved have zero remaining US patent coverage, and are sold profitably on world markets at quite reasonable prices. 

    “Reimportation” is not the question- it is “importation”- getting the FDA to stop playing games with expired exclusivity drugs and actually follow the terms of the 2000 law.  The excuse for ignoring it- and Dr. Gottlieb appears to be as bad as his predecessors on this front- is to conflate new drugs with clearly older, world-market settled drugs, at the behest of USA pharmas and the cost of shredding the federal budget.  

    We either believe in actual markets or we don’t; what is at issue are generic drugs here, not the fancy new stuff.  Right now, Congress and the FDA would rather collect campaign cash than serve the, you know, voting citizens.  When the federal budget blows up, the payoffs to the medical-industrial complex (via self-righteous bureaucratic bootleggers and Baptist rationale) will finally stop.

    • #3
  4. Duane Oyen Member
    Duane Oyen
    @DuaneOyen

    Some of the top priorities for NIH research should be cheap, universal, early detection tests for cancers that by themselves do not show up till too late.  Glioblastomas are awful (Sen Kennedy, Sen McCain), but so are pancreatic and ovarian cancers.  Early reliable tests could move treatment from  Stage 4 to Stage 2 with great benefit.

    • #4
  5. Clifford A. Brown Contributor
    Clifford A. Brown
    @CliffordBrown

    Duane Oyen (View Comment):

    Some of the top priorities for NIH research should be cheap, universal, early detection tests for cancers that by themselves do not show up till too late. Glioblastomas are awful (Sen Kennedy, Sen McCain), but so are pancreatic and ovarian cancers. Early reliable tests could move treatment from Stage 4 to Stage 2 with great benefit.

    That is what Grail is in the business of doing. See link in OP.

    • #5
  6. Clifford A. Brown Contributor
    Clifford A. Brown
    @CliffordBrown

    Duane Oyen (View Comment):

    The issue is not pharma innovation being undercut by attempts to control prices of new drugs despite high costs of qualification- it is pharmas playing games with bought-off Congress and “Baptist” regulators to preserve US exclusivity to old, non-patented drugs and expired patent routes of administration to prop up prices in wildly non-market situations. Most drugs involved have zero remaining US patent coverage, and are sold profitably on world markets at quite reasonable prices.

    “Reimportation” is not the question- it is “importation”- getting the FDA to stop playing games with expired exclusivity drugs and actually follow the terms of the 2000 law. The excuse for ignoring it- and Dr. Gottlieb appears to be as bad as his predecessors on this front- is to conflate new drugs with clearly older, world-market settled drugs, at the behest of USA pharmas and the cost of shredding the federal budget.

    We either believe in actual markets or we don’t; what is at issue are generic drugs here, not the fancy new stuff. Right now, Congress and the FDA would rather collect campaign cash than serve the, you know, voting citizens. When the federal budget blows up, the payoffs to the medical-industrial complex (via self-righteous bureaucratic bootleggers and Baptist rationale) will finally stop.

    I don’t get what Baptists have to do with it. It sounds like President Trump is not inclined towards business as usual.

    • #6
  7. Clifford A. Brown Contributor
    Clifford A. Brown
    @CliffordBrown

    Cato Rand (View Comment):

    PEOPLE WILL DIE! (if the damn bureaucrats don’t leave the innovators who are trying to actually solve problems alone)

    Yes, and, thalidomide.

    • #7
  8. TBA Coolidge
    TBA
    @RobtGilsdorf

    Some believe that Trump is creative destruction. I really want to believe.  

    • #8
  9. The Reticulator Member
    The Reticulator
    @TheReticulator

    Duane Oyen (View Comment):
    We either believe in actual markets or we don’t;

    Is this some sort of trick question? (Even though it wasn’t in the form of a grammatical question.)

    • #9
  10. Duane Oyen Member
    Duane Oyen
    @DuaneOyen

    Clifford A. Brown (View Comment):

    Duane Oyen (View Comment):

    Some of the top priorities for NIH research should be cheap, universal, early detection tests for cancers that by themselves do not show up till too late. Glioblastomas are awful (Sen Kennedy, Sen McCain), but so are pancreatic and ovarian cancers. Early reliable tests could move treatment from Stage 4 to Stage 2 with great benefit.

    That is what Grail is in the business of doing. See link in OP.

    Good on them- it takes a lot more than that, because there is no such thing as “cancer”- that’s why you need a lot of government-funded basic research, to deal with the massive complexity.  One company, even with a large scale, long term data acquisition program, can’t do it. 

    For example, take chronic lymphoma, roughly 30 different diseases.  Some are CD-20 positive, some are CD-19.  With about a minimum of 100,000 proteins (CD-20 is a protein) acting and interacting either separately or in combination, the task is huge.  NIH should have a huge proteomics program where individual companies are required to contribute information (proteins are not patentable) in order to have the right to access it or get therapies paid for by Medicare and Medicaid.

    • #10
  11. Duane Oyen Member
    Duane Oyen
    @DuaneOyen

    Clifford A. Brown (View Comment):

    Duane Oyen (View Comment):

    The issue is not pharma innovation being undercut by attempts to control prices of new drugs despite high costs of qualification- it is pharmas playing games with bought-off Congress and “Baptist” regulators to preserve US exclusivity to old, non-patented drugs and expired patent routes of administration to prop up prices in wildly non-market situations. Most drugs involved have zero remaining US patent coverage, and are sold profitably on world markets at quite reasonable prices.

    “Reimportation” is not the question- it is “importation”- getting the FDA to stop playing games with expired exclusivity drugs and actually follow the terms of the 2000 law. The excuse for ignoring it- and Dr. Gottlieb appears to be as bad as his predecessors on this front- is to conflate new drugs with clearly older, world-market settled drugs, at the behest of USA pharmas and the cost of shredding the federal budget.

    We either believe in actual markets or we don’t; what is at issue are generic drugs here, not the fancy new stuff. Right now, Congress and the FDA would rather collect campaign cash than serve the, you know, voting citizens. When the federal budget blows up, the payoffs to the medical-industrial complex (via self-righteous bureaucratic bootleggers and Baptist rationale) will finally stop.

    I don’t get what Baptists have to do with it. It sounds like President Trump is not inclined towards business as usual.

    Trump is not the issue, Congress is, and Dr. Gottleib and Sec’y Azar are doing a few good things, not nearly enough.  And Trump is too policy lazy to take a personal interest. 

    • #11
  12. Duane Oyen Member
    Duane Oyen
    @DuaneOyen

    The Reticulator (View Comment):

    Duane Oyen (View Comment):
    We either believe in actual markets or we don’t;

    Is this some sort of trick question? (Even though it wasn’t in the form of a grammatical question.)

    If you do not understand the issue, learn a bit about it- we are talking here about non-proprietary, non-patented drugs, and the arguments on our side are all about protecting the market opportunities for new patented NCEs.  Richard Epstein can soliloquize for an hour about the cost of the first pill versus the second, but say absolutely nothing about the drugs that are wildly overpriced and well beyond proprietary stages.  Kevin Hassett ruminates about TRIPs as though that is the only issue; that is only a small piece of the problem. 

    Pharma markets are in many important ways utterly non-competitive, and the regulators (Baptists) who purport to “protect” us are typical CYA bureaucrats looking to avoid publicity, while a significant part of Congress accepts cash and BS from every pharma trying to avoid free competitive markets.      

    • #12
  13. Hypatia Inactive
    Hypatia
    @Hypatia

    Cato Rand (View Comment):

    PEOPLE WILL DIE! (if the damn bureaucrats don’t leave the innovators who are trying to actually solve problems alone)

    “PEOPLE WILL DIE!” I looove that; it’s like: “I’m WARNING you! In a few hours the sun will dasapear from the sky!” 

    But y’know, I remember when the  impossible dream was eliminating ” world hunger”.  Done! Obesity is now a bigger problem globally than hunger.  And nobody seems to have noticed (oh, ‘cept thenpeople who complain about other effects of the Green Revolution, who are wailing that PEOPLE WILL DIE…)

    • #13
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