April, 10, 2015, 1:58
The following commentary is contibuted by
Andrew Nemechek, MD, Head & Neck Specialist and Member CCRP Board of
Directions. It was featured on 4/9/2015 at 12:01am, in the Denver
Post. The article is courtesy of Stephen Brozak, Bloomberg News.
"David Bauder's editorial below is written with
excellent prose and much bravado, to be sure, but devoid of the optimism
that cancer patients, families, and caretakers much htat to embrace and
prevail each day." - Andrew, Nemechek, MD
Brozak: The three things Ken Burns got wrong about cancer.
It's almost mandatory that any documentary or
news segment describing a new treatment for cancer must pulse with
the twin themes of tragedy and hope.
The camera follows patients through hospital
corridors and rooms as their narratives unfolds within the story of
a potential cure. The audience waits with the family and patient,
hoping for a positive outcome while hooked into the drama of
personal catastrophe. Doctors appear in their obligatory white
coats, either interacting with patients or seated in carefully
staged studies. The latest Ken Burns documentary, "Cancer: The
Emperor of All Maladies," captures and surpasses these hallmarks of
As an analyst of the health-care industry, I am
continuously reminded that real scientific discovery is wonderfully
random and human behavior is exactly the opposite in how woefully
predictable it is. Viewing the recent PBS series left me without
what I believe is a current real-world assessment of the state of
cancer. Viewers get only a fragile hope for a positive future.
The statements by experts recorded for the
series try to instill a tone of mortal combat in their efforts, but
the reality of military efficiency in the so-called "war on cancer"
is unfortunately missing in action. Instead we face dispassionate
decisions made by clinicians to justify clinical trials where
patients receive the perception of treatment to measure a drug's
efficacy. Three well-known axioms of science and medicine are
overlooked or glossed over in this documentary series.
Most advances in cancer therapy are
incremental. That means patients have cancer-free intervals or see
overall survival extended by months. To defeat cancer, however, more
than incremental change is necessary. A novel approach and
perspective is critical, and Burns includes several breakthrough
narratives that have a common theme: "young" researchers with
brilliant new concepts who defy conventional wisdom and battle the
system until their views become the accepted norm. This scenario
unfortunately flies in the face of how cancer research is now
Cancer is a mega-business that
resists change. The world of cancer is a medical-industrial complex
of pharmaceutical and biomedical companies, physicians, nurses,
hospitals, and even charitable organizations. The financial costs of
cancer are also crushing. According to the NIH, cancer cost the
United States an estimated $263.8 billion in medical costs and lost
productivity in 2010. The sums are so huge that the participants in
the cancer complex protect themselves and each other with precision.
The notion of waiting for better and cheaper treatments defies the
reality of the business of cancer, which has little if any incentive
to bring down costs that would result in slower revenue growth.
According to National Institutes of
Health studies, research funding for scientists and physicians under
age 35 has declined by almost 85 percent since 1980 while funding
for research by those over age 66 has increased by 700 percent.
Innovation may not be the sole province of the young, but even the
Director of the N.I.H., Francis Collins, has been critical of the
folly in this trend.
If you don't believe me, just look at
what is happening with chemotherapies. Older, cheaper drugs that are
still used as our primary tool against cancer are completely
unavailable in some parts of our country due to vast drug shortage.
No matter what new therapy comes out on the market, chemotherapy is
usually the first treatment given to patients. Despite their age,
chemotherapies are unfortunately the best weapons we have to
initially knock out cancer in a patient's body. None of the
companies presented in the Burns documentary want to make
chemotherapies because the drugs are so old that they can only
charge hundreds of dollars a dose, far from the tens of thousands of
dollars commanded by a new drug. Manufacturers can't make enough
money off of essential chemotherapy drugs to justify making them.
Mergers, acquisitions, divestitures
and corporate relocations are a big part of the cancer story.
Completely missing in the PBS series is acknowledgement of the
impact corporate structures have on R&D. The frequent
reorganizations and restructuring of businesses often disrupt
research funding, with promising programs delayed and sometimes shut
down completely. This pattern plays out when a small biotech
announces a promising new therapy and is acquired by a larger
biotech or pharma. The same may occur when a university announces a
clinical breakthrough and licenses the program to a large
pharmaceutical company, only to have it lost or shelved amongst
hundreds of other once promising therapies.
The Burns documentary does devote some
attention to how we apportion the majority of cancer funding to
late-stage treatments that have little promise of efficacy. Such a
fiscally irresponsible approach would not be tolerated in any other
discipline or business. The series highlights the drama of massive
interventional therapy that culminates in the rejoicing of a lucky
few survivors, while offering almost boring descriptions of routine
diagnostics, which identify cancer in its early or even formative
stages and gives treatment options the best chance of success.
The series concludes with a few suggestions,
one of which was that we might ameliorate the mortal threat of
cancer by transforming it into a manageable chronic disease, which
would be a source of even greater predictable revenue for the cancer
industry. Even if turning cancer into a chronic disease is the
inevitable future for cancer treatment, the prospect ignores the
reality that achieving such a metamorphosis is an insurmountable and
unresourceable approach to managing the disease given the state of
our health care system.
Rather than focusing on the noble quest of a
few scientists and physicians, we must face the real issues of
cancer, which are scientific, economic and social. We must
acknowledge that cancer is a business, that the present excitement
about immunotherapy is another example of scientists jumping on a
bandwagon with the hope that a cure is just around the corner. And
we must question the amount and allocation of funding on the
prospect for success if a radically new therapy shows promise.
Only by focusing a public discussion on
difficult issues such as these can we turn the present fragile hope
for a positive future into a realistic prospect for a better outcome
for all of us.
Stephen Brozak is president of WBB Securities,
an investment bank and research firm specializing in biotechnology,
pharmaceuticals and medicine. To send a letter to the editor about
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