Ranjana Srivastava (medical oncologist and author based in Melbourne) pours cold water on the good news:
What would the world’s largest cancer conference be without the declaration of a miracle? The latest from Chicago is about new blockbuster drugs that can manipulate the immune system to “con” cancer cells. This year the focus has been on melanoma, where a combination of two drugs has been shown to be highly effective in a subset of patients.
Great news, yes? Well…
We must work collectively to help the world’s poorest countries to reach an acceptable level of equity in cancer care.
As a privileged doctor working in a rich country, I know my patients are likely to realise the promise of new discoveries. Talk of miracles has no place in our evidence-based profession and I will keep telling them that advanced melanoma remains incurable but that incremental gains will help them live longer and better. Who knows, for a small percentage, melanoma may eventually become a chronic disease.
But as a global citizen, I struggle with the implications of mind-bogglingly expensive drugs that are at best associated with modest benefits in the vast majority of patients. I think about the societal responsibility we bear to ensure that cancer suffering is reduced not only in our direct vicinity but for the millions of invisible and forgotten patients in poorer countries too.
Oh, right. You feel guilty that this expensive trial drug, costing millions of pounds in development costs, isn’t immediately available to people in Third World slums?
The medical profession has traditionally failed to face this elephant in the room. For a long time we have believed that the patient before us is the only one who matters and that it’s the job of bureaucrats to tussle with big pharma to work things out.
Newsflash, sweetheart – the patient before you should indeed be the only one who matters. It’s why you swear an oath, ffs!
The conversation about what is sustainable and appropriate when it comes to exorbitantly priced drugs that will benefit only a select group must involve individual doctors and patients.
Nice of you to include patients! I guess that’s only if they have the ‘right’ opinions, though..
How much easier it is to herald another “cure for cancer” than grapple with the ethical challenges posed by the advent of increasingly costly drugs. Yet it is a conversation we must have. The portrayal of cancer in the popular press presents a challenge. Like many oncologists, I am realising that one patient’s miracle is another’s blow.
There’s no ‘ethical challenge’ here at all. You can’t expect a company to spend millions on R&D and then give away their product for less than cost price.