Self Magazine published an article in their October issue titled “How Much Is A Life Worth?” written by Roxanne Patel Shepelavy. The article is a detailed analysis of the cost of heavy duty cancer-fighting drugs, who pays, and who profits. Michelle Diekmeyer’s story is highlighted in the article, and it would make anyone cringe. She was diagnosed in 2004 with stage IIIB inflammatory breast cancer, and has endured the familiar regimen of surgery and chemo that most most breast cancer patients undergo. But in her case, the best – and perhaps only – chance of survival hinged on the use of Herceptin, a cutting-edge cancer drug manufactured by Genentech. Every three weeks, she had an infusion of the life-saving drug, and every three weeks her out-of-pocket cost for the treatment was another $1500. That was her 30% portion after her health insurance paid the rest. Her costs for the Herceptin alone came to over $25,000. Her total out-of-pocket expenses for the treatments she got to save her life was $36,462. She and her husband led a comfortable life before cancer – but very few of us have the means to shell out an additional $1500 every three weeks for drugs, plus all the other expenses from surgeries and chemo. During the darkest times of her life, when she didn’t know if she would live another year, she also had to worry about losing her house.
It’s a decision nobody should ever have to face. Pay the mortgage or pay for a life-saving medication? The pharmaceutical industry – like any publicly traded one – is driven by profits. It costs bio-tech companies an average of $1.2 billion to develop a new drug like Herceptin. Once the drug hits the market, the company wants to recoup costs and start making a profit for shareholders. This is understandable and there’s a good argument that without the financial incentive, the research and development for new drugs would grind to a halt. So much for the altruistic nature of the medical research community.
But does there need to be such a large financial incentive? Avastin was originally developed to treat colon cancer, but Genentech discovered that it is also successful in treating lung and breast cancer. The prediction is that by 2009, Avastin will generate $7 billion a year in sales. If it cost the average of $1.2 billion to develop, Genentech recoups their losses in two months. The rest is gravy.
Most seriously ill patients and their loved ones are willing to pay whatever it takes to fight their illness. And it seems that the pharmaceutical industry is well aware of this. They can charge more for a drug and know that people will pay the higher price because the alternative is dying. The ethical issues here are staggering. Genentech announced last fall that they would cap the price of Avastin at $55,000 for a year of treatment, even for breast and lung cancer patients who need twice as much of the drug as colon cancer patients. This was after they had initially said that the treatment would cost $100,000. OK, so they cut the price down to $55,000 – but that is still pretty steep, especially when there are so many other pieces of the treatment puzzle that have to be paid for. If your health insurance requires you to pay 25% of the cost of high-end drugs, you’ll still be out almost $14,000 for a year of treatment, plus any other coinsurance costs you have from the rest of the treatment.
Diekmeyer is cancer-free now, and although she and her husband went through all of their savings, sold some possessions, and cut out all non-essential expenses, they still owe money from her treatment. And yet her words sum up the thoughts of many cancer patients: “I know the pharmaceutical companies are profiting off my illness, but I’m so grateful they came up with this drug. How can I also be angry that they’re charging so much?”
Diekmeyer’s gratitude to the pharmaceutical companies is well-founded, as she would likely not be alive without Herceptin. But anger at the price tag would be justified as well. In 1946, Winston Churchill said “For with primacy in power is joined an awe-inspiring accountability for the future.” The pharmaceutical companies hold one of the keys to winning the battle against devastating illnesses. This is a great power. And with this power comes a tremendous responsibility to humankind. I’m not suggesting that they donate their time or incur debt to provide medications below cost. But when the medications in question are the only thing between a sick patient and death, the pharmaceutical companies have an obligation to curtail their profits.