How Billions are Wasted on Cancer Drugs
As an aspiring healthcare provider, this is perhaps the hardest pill to swallow (no pun intended). Our capitalist economy has unquestionably contributed to the immense rate of technological and scientific progress over the years. Everywhere you turn a new device, innovation, or application is springing up to make our lives easier. But is this the correct method to solve the indisputable healthcare crisis that has enveloped the United States? Or more importantly, is it moral to profit from those who are suffering from sickness? It's a simple question that reveals the complexity underlying the US biotech industry.
Drug Companies Are Businesses
It's been shown over and over again - America has the highest healthcare costs per capita and the some of the poorest health outcomes in the developed world. And the rising cost of pharmaceuticals only exacerbates this problem for many families.
Take Lauren Baumann, a single mother who relies on the drug Gleevec to manage her chronic myeloid leukemia - a type blood cancer. Her co-pay (the amount of money she pays after insurance kicks in) is $2,200 per month. Even with a full-time job, she has been forced into bankruptcy in order to pay for her medication. Once upon a time, this drug only cost a third of what it costs today. How did this happen?
Gleevec is manufactured by the pharmaceutical giant Novartis which rakes in $5 billion a year from this drug. In 2001, Gleevec cost $2,600 a month for patients. Now, it's around $9,200 per month. The company justifies this increase by stating that the money is going toward the research and development of new drugs. A noble effort for sure, but one that's difficult to fully believe given the $12 million compensation of Novartis CEO Joseph Jimenez in 2015 alone.
Let's look into one fascinating reason why cancer drug prices are skyrocketing.
It's All About Serving Size
Herceptin is an effective targeted therapy developed by Genentech and administered via blood infusion at hospitals for the treatment of breast cancer, the leading cause of female cancer mortality. Prior to 2017, the drug would come in a 440 milligram shareable vial which could be distributed between multiple patients as needed.
In May of this year, Genentech announced that it would be discontinuing the larger, shareable vial for a smaller,150 milligram single-use vial. It may not be obvious right away, but this change resulted in a huge money drain for patients and an equally large profit margin for Genentech.
The amount of Herceptin a patient needs is determined by their bodyweight. One hospital administrator in California calculated that the average patient needed about 340 milligrams per infusion based on their bodyweight. But since the vials are single-use and come in 150 milligram increments, the average patient would need 3 vials (450 milligrams total) and waste approximately 110 milligrams per infusion. At $9 per milligram, that's roughly $1,000 wasted per infusion! And each patient needs multiple infusions every week for up 64 weeks. The amount of money wasted here is sickening. And the unused drugs remaining in the vials can't be reused, so they're discarded. But the patient gets billed all the same as if they used every drop.
And it's not just cancer drugs that are wasted in droves, even the way that generic eyedrops are packaged make us use more than we need.
Once again, justification was provided by Genentech for their use of smaller vials. The change in vial size would help their worldwide supply chain become more reliable and thus distribute the life-saving medication more easily. Even if that were true, Genentech is grossly overlooking the financial burden they are placing on these patients and enjoying greater profits as a result. You would think that regulatory agencies like the FDA might have something to say about this. But they are tasked with the safety and efficacy of these drugs, not the cost or method of distribution. So this behavior continues unchecked.
The Solution Is Simple, Changing Your Philosophy Is Not
Studies have demonstrated how wasteful these single-use vials are among other senseless practices of pharmaceutical companies. A 2016 publication by Dr. Peter B. Bach, a physician at the Memorial Sloan-Setting Cancer Center, concluded that 10% of the top 20 cancer drugs were thrown to waste in 2016. How much did those wasted drugs cost for patients and their insurance companies?
Yes, with a B. In a single year.
Reverting back to shareable vials would almost immediately fix this problem. So why haven't we done it? Because the philosophy driving these giant pharmaceutical corporations prevents them from doing so. Those $1.8 billion aren't wasted for Genetech, Novartis, and the like. For them, this is a huge positive. They are selling more drugs and making more money, which is excellent news for their executives and shareholders.
And herein lies the crux of the entire issue.
Who should the companies that operate in the field of healthcare be accountable to? Their CEO's and top ranking officers? Their shareholders? Or the people who need their product to stay alive?
In today's world, our insurance companies, pharmaceutical companies, and many treatment centers hold their bottom lines on a higher a pedestal than their patients. Of course, without money these organizations couldn't provide healthcare. But at some point a line must be drawn to prevent the entire field of healthcare from slipping into a landscape that is dominated by capitalist forces. A 2004 publication by a Bay Area news organization reported that the top 5 paid executives at Genentech were compensated a total of around $63 million. The line, in my humble opinion, was crossed long ago.
A company decides it needs to improve the efficiency of its supply chain, but as result, throws thousands of patients into insurmountable economic distress. This simply is not fair. This simply is not just. Healthcare giants must transform their philosophies to protect these vulnerable populations. It's not a question of profit versus loss, it's a question of right versus wrong.