Why Preventing Cancer Is Not the Priority in Drug Development
1–10 of 60 posts
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#2The same, often perverse, incentives operate on the potential treatment of aging. Lots of work on tinkering with end states, meaning age-related disease in advanced stages, and next to nothing on prevention, meaning periodic repair of the molecular damage that causes aging.
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#3"There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place.
That’s one of the findings from the work of Heidi Williams, an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner, who studied the problem along with Eric Budish, a University of Chicago economics professor, and Ben Roin, assistant professor of technological innovation, entrepreneurship and strategic management at M.I.T."
I'm damn near 40, and the phrase "there's no money in a cure" has been around as long as I can remember. Heck, Chris Rock did a whole bit about it. [0]
Is this just putting good science behind that phrase? Is there anything new here?
[0] http://anonhq.com/chris-rock-on-big-pharma-no-money-in-the-c...
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#4"There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place. That’s one of the findings from the work of Heidi Williams, an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner, who studied the problem along with Eric Budish, a University of Chicago economics professor, and Ben Roin, as…
It is the broken window fallacy:
http://www.investopedia.com/ask/answers/08/broken-window-fal...
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#5"There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place. That’s one of the findings from the work of Heidi Williams, an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner, who studied the problem along with Eric Budish, a University of Chicago economics professor, and Ben Roin, as…
I was thinking this originally, but as I read it, it seems the referenced paper is much more narrowly focused. The idea is that the studies involved are easier to do on late-stage patients because mortality is the benchmark and people who are in an advanced stage die sooner. You find out whether it decreases mortality much quicker when the patients are closer to the end. Decreased testing time increases the time when the patent is both active and FDA approved (i.e. years they can make money on it).
The usual reasoning behind "there's no money in a cure" is that you can squeeze a lot more money out by treating patients for years than by selling them a cure once. That's still a reasonable cynicism, but it's not what this paper was looking into.
Edit: another way of thinking about it is that if a company is maximally evil (economically rational), they would want to research early-stage cancer treatments because that would allow them to milk the patient much longer. Even with this incentive, they still don't do it, they research treatments that are faster to verify efficacy for.
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#6This logic is just dumbfounding. How do the people saying stuff like this explain the existence of things like vaccines?
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#7A drug to treat cancer only has to be taken by people diagnosed with that cancer, for as long as they're diagnosed with it. A drug to prevent cancer has to be taken by everyone at risk for the cancer (which might be the entire population), for as long as they're at risk (likely decades). Hence, a treatment drug can be expensive and can have some nasty side-effects, while a prevention drug would have to be cheap with minimal side-effects. That's a much tougher constraint to work under.
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#8This logic is just dumbfounding. How do the people saying stuff like this explain the existence of things like vaccines?
What about vaccines? Those are quite easy to make, and are made using existing disease-causing viruses. We know the mechanism, it applies to the whole population, and it's relatively simple and cheap to produce.
The logistics are not the same with cancer preventing drugs at all.
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#9This isn't a great representation of the issue. Everyone loves to hate the drug companies.
First of all, the basic science is lacking. The vast majority of animal models in no way resemble the normal process by which humans develop cancer. The models are designed to grow aggressive cancers extremely fast so you can test drugs rapidly, publish your paper and get the next grant. Even more than that, what actually takes place in the years before a cancer becomes clinically relevant is quite speculative. So a long term commitment to funding prevention research is needed from governments and funding bodies, because pharma can't fund this kind of basic science.
The other problem is that to do a good prevention trial, you need to identify people at risk. We aren't really that good at doing this (eg we screen ALL women above the age of 50 for breast cancer, we screen EVERYONE above the age of 50 for bowel cancer). There is some debate about whether screening in this manner is actually as worth wile as it has been made out to be, because it leads to over diagnosis without a survival benefit. So you have to be careful not to design an intervention that only prevents cancer in those who weren't going to be affected by it anyway. This is why you can't use surrogate end points - at the end of the day, for prevention, mortality is what matters. Are we going to give hundreds of millions of women drug X and make them suffer niggling side effects for 20 years because it reduces the rate of diagnosis of breast cancer? Definitely not - overall mortality is what matters (and quality of life).
It's not even a given that you can actually identify people at risk - some researchers think cancer is just bad luck (ie it is not predictable at all, or the predicting factors are unknowable). Even if this is wrong however, cancer risk probably involves weak effects from hundreds or even thousands of factors. We are very far from working all of this out.
A drug is probably not what we want. Actually a drug is really not what we want. They are too expensive and too much effort to distribute and monitor. Drugs also always produce health inequalities within and between nations. A holistic approach to improving our health and well being would be preferable, at least incorporating nutrition, exercise and psychology. Unfortunately the nutritional, exercise and psychological sciences are not hitting home runs in that regard, which is not surprising because they miss out on the billions we spend fighting an incredibly wasteful war on cancer.
Re: Why Preventing Cancer Is Not the Priority in Drug Development
#10This logic is just dumbfounding. How do the people saying stuff like this explain the existence of things like vaccines?
What about vaccines? Those are quite easy to make, and are made using existing disease-causing viruses. We know the mechanism, it applies to the whole population, and it's relatively simple and cheap to produce. The logistics are not the same with cancer preventing drugs at all.
Considering that there are no wide spread generic cancer prevention drugs how would you know?