Cancer Cost and Choices

Why does our country embrace cancer? We don’t? Then why do we allow our choices in science, in society and in medicine to dictate our attitude towards cancer? Why do we allow ourselves to be led into thinking that treatment is more important than prevention? Why do we go all out in buying, and I mean literally buying, a few more months of life at any expense after we get cancer, yet refuse to spend a little time and effort in cancer prevention and wellness care? Because current cancer trends in science and society are misleading you.

Cancer as a Single Entity
First, we think of cancer as one entity, as a single disease to fight. We even had a war declared on it. You are allowed to think of cancer, of disease in general, as a single entity. Thus, we are looking for single bullets to win the war against disease – a silver bullet. Actually, a platinum covered diamond encrusted solid gold bullet. Private companies are spending millions and millions of dollars to research these single bullets and they are not finding them.

Yet the public is being misled into believing these bullets exist or will be found soon. Drugs are developed that poison the cancer and along with that the body. These drugs sometimes buy a little time. Weeks, maybe months. At what cost? We are spending over $200 billion a year in the treatment of cancer. It is estimated that within the next 10 years that cost will rise to $1.82 trillion (NCI Cancer Bulletin May 13, 2006 Vol 5, No. 10).

The Cost of Treating Cancer
Treating cancer has never been cheap. The average cost for a single course of the breast cancer drug Perjeta used in a combination with Herceptin costs approximately $188,000 and delays advanced cancer growth by an average of 6 months. The cost of four injections of Yervoy, is approximately $120,000 and buys a person with melanoma about four months. Avastin, a drug targeted for metastatic colon cancer, costs approximately $10,000 a month and increases the lifespan of the patient by about four months. The price of each new treatment seems to be higher than the one before, with little to show for efficacy. Price rarely matters to patients, to people afflicted with their specific cancer. Honestly, it does not matter to their doctors either. Moreover, more emphasis is placed on treatments and drugs than developing more advanced methodologies in cancer wellness care and prevention.

Back to the cost, though. Why the cost? Private drug companies say they need to charge these high prices in order to recoup their costs for research and development and manufacturing along with payment for scientific creativity. This has been disputed by healthcare providers who believe pricing is being driven by what the market itself can bear. In other words, prices are high because they can be. The seller seems to have all the control. It seems social responsibility for healthcare is being solely placed on the individuals who get sick rather than the providers of drugs and treatments. Did you know 62.1 percent of all US bankruptcies in 2007 were related to medical expenses and that 78 percent of those were from individuals who had health insurance? (The American J. of Medicine 2009 Himmelstein D.U., Thorne D. et al.)

With our aging population and the rise of many of these cancers, the rapid rise of our country’s obesity rate is a serious risk factor for cancers – and with the continued rise of medication costs, who is going to pay for these medications? Who determines the cost and why they cost so much in the first place? Now that we will be mandating healthcare as a right to everyone in this country, who is going to pay for these costs? New drugs only offer marginal extensions of life and very few cures.

Who Determines the Value of Cancer Treatment?
Serious questions to consider: Who or what entity is going to determine the value of these drugs to the individual who wants them? What will be the cost of insurance in 10 or 15 years? If people choose not to take care of themselves, is society obligated to pay for their care? If people chose to take care of their health and stay healthy, are they obligated to pay for those who do not? In the UK, it was determined that their universal healthcare system would not cover Avastin for advanced breast cancer. In Australia, the melanoma drug Yervoy is not approved for coverage. In the United States, we have no true government control of such decisions. In fact, we have this false pretense that there is a wider access to these types of drugs. How long will we be able to afford this?

Our society must be rid of some assumptions:

1. Cancer is NOT a single entity with a single drug that can cure or even control the disease.

2. The price of a drug should not be determined by what the market can bear. Rather, it should be determined by its effectiveness and its usefulness in treating a disease.

3. If you do not take care of yourself and make poor health choices, you should not expect others to pay for those poor choices.

4. There is no true inalienable, substantive or egalitarian right for healthcare. The Constitution states that its purpose is to “promote” the general welfare, not “provide” it. However, the moral obligation for the government to provide universal healthcare is justifiable. But there is a high cost, and the responsibility for that cost must be clearly delineated before it is mandated.

5. The best cure for a disease is not a specific drug or surgery, it is prevention and a more positive attitude towards wellness care. That is the most basic understanding that is ignored by the politicians and insurance companies, and many private healthcare providers.

A quick note: This was a short discussion of a very complex situation in context of the cost of cancer, the number two killer in the U.S. Not the cost of the number one killer, heart disease. Nor is it a discussion of any other on the list of the top killers in the U.S:  strokes, chronic lower respiratory disease and obesity, a risk factor for all the previous diseases listed. Think about it (National Vital Statistics Reports 2009 Vol 60, No. 3).