HEALTH CARE/Joan Retsinas

The Fed-Up Contingent: Drugs, Prices and Howard Beale

Do you remember the Howard Beale Show, that fictional television fiasco of the now iconic 1976 movie, Network? A slumping network needed a rabble-rousing show to boost ratings. Enter Howard Beale, the media’s first truly angry man. In front of a live audience, Beale would chant: “We’re mad as hell, and we’re not going to take this anymore.” And the audience, like fans at a pep rally, would chant back their own indignation. Since then, television has embraced scores of angry men (and women), with a cascade of talk-shows inviting viewers to vent their wrath.

Generally, wrath-venting yields nothing concrete. Maybe the venters get psychic, cathartic relief. Maybe they get a headache. But rarely does wrath incite change.

So the tale of drug companies and Sloan-Kettering physicians merits attention.

Briefly, two companies (Sanofit and Regeneron Pharmaceuticals) developed Zaltrap, for treatment of colorectal cancer. The Food and Drug Administration blessed the drug as “safe and effective.” The drug was not a cure-all. Researchers calculated that it, given with other cancer treatments, would prolong a patient’s life by a little more than one month. Of course, many patients would opt for the one month.

The problem was cost. The market for drugs has been skewed: the companies set the price; the insurers pay. Sometimes insurers negotiate a lower price, steering patients to specific drugs in “limited formularies.” Sometimes insurers exclude specific drugs from a formulary, though patients can often appeal an insurer’s “no.”

But cancer drugs are special: the law requires Medicare to cover all cancer drugs that the Food and Drug Administration blesses. Indeed, Medicare cannot negotiate down the price. As for private insurers, they generally follow Medicare’s lead, though they may institute hefty co-pays for expensive drugs.

The “manufacturer’s list price” for Zaltrap came to $11,000 a month, compared to $5,000 a month for another drug regimen, which the Sloan-Kettering physicians judged equally effective. (Some cancer drugs cost even more).

Both prices will strain most patients’ budgets. National Cancer Institute researchers report that once patients survive cancer, they risk bankruptcy. The study’s lead investigator Scott Ramsey, MD, PhD, a healthcare economist and internist at Fred Hutchinson Cancer Research Center, Seattle, reported: “On average, bankruptcy rates increased 4-fold within 5 years of diagnosis.”

Who will object to stratospheric prices?

A politician who tries to wrestle down the price of cancer drugs risks being labeled at best a “rationer,” at worst, a skinflint Grim Reaper, willing to sacrifice constituents’ lives for dollars. A patient who objects has no clout; indeed, since patients are undergoing chemotherapy and or /radiation, they have no energy to band together to fight the cost. And when patients do fight the cost of care, they zero in on the insurers, not the drug companies that set the prices.

So the drug companies live in an economic Eden, free to charge what they will. Admittedly, the costs of research and development, of testing and retesting, of marketing drugs that later turn out to be ineffective and/or unsafe, make the manufacture of drugs a risky proposition. Some drugs will be blockbusters; others, duds. And these companies answer not just to the Food and Drug Administration, but to shareholders, who are betting that blockbusters will outweigh duds.

Yet there comes a point where decency should prevail.

Physicians were the ones to take up the cause. Three physicians from Sloan-Kettering Cancer Center decided “enough.” They looked at the cost versus the benefits of Zaltrap, compared to another regimen, and said “no.” They would not use Zaltrap in their hospital. In an October op-ed in the New York Times, the physicians explained their decision.

Keeping down the escalating costs of drugs is essential to controlling the overall costs of health care. We patients, along with our insurers, often feel impotent to do anything other than get mad. Kudos for physicians for deciding “not to take it anymore.”

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, December 15, 2012