This is definitely a week when the media's spotlight has been shining on cancer. Each evening between Monday and Wednesday, PBS has been running a compelling Ken Burns documentary on the long, arduous efforts to develop successful treatments for this deadly, ancient scourge. On Sunday, 60 Minutes ran a double segment about researchers at Duke University's Tisch Brain Tumor Center who have made encouraging progress using a gene-altered poliovirus to treat glioblastoma multiforme, a pernicious form of brain cancer.
But on Monday, Arlene Weintraub published an article in Forbes (a tool for vulture capitalists) where she raised an issue so disheartening, it dissipated much of the hope raised in the 60 Minutes and the Burns reports.
Weintraub started her article admirably by providing some important context. She noted, for example, that the idea of using "oncolytic viruses" to treat cancer dates back to the 19th century. She went on to point out that today, a good handful of companies are developing genetically engineered viruses for this purpose. They include biotech superstar Amgen along with smaller companies such as Oncolytics Biotech, DNATrix, and Oncos Therapeutics. Amgen's treatment, for example, derives from the herpes virus.
But then Weintraub introduced a point apt to make most readers sick to their stomachs.
Some of the virus-based cancer treatments, she writes, "including Amgen's, are administered to patients on an ongoing basis. But others—the Duke treatment, for example—are designed to work with just one dose." She points out a one-dose-and-done treatment is a problem because, "How can a company make money on a one-time treatment?"
Oncolytic viral therapy as a business proposition is in jeopardy, according to Weintraub, because it's not yet clear how any of the pharma companies "will scale-up the production of the personalized therapy in a way that will prove profitable."
Now, there you have it. In its concise essence, that's the dirty secret at the heart of American health care. Forget about developing an effective treatment for cancer or anything else if someone can't first figure out a way to profit from it.
That sentiment isn't necessarily Weintraub's. She is a science journalist with twenty years worth of experience writing about various aspects of health care for Businessweek, the New York Times and other, top-tier media outlets. So it seems likely she was reflecting concerns she had picked up from people on Wall Street or inside the pharma companies. Still, it is astonishing that she reported their point with a straight face and did not even remark on the enormous conflict that can exist between profit über alles and curative medicine.
The notion about the preeminent importance of profit is not only morally repugnant, it's also way off base.
Weintraub, for example, mentions the oncolytic virology work at the University of Pennsylvania where researchers remove white blood cells from cancer patients, modify the cells with an altered HIV virus, and then introduce the amended cells back into the patient. There they attack the tumor and stimulate the body's natural immune system.
Novartis, the world's second largest pharmaceutical company, based on 2014 sales, sponsors this research at Penn, known as chimeric antigen receptor T-cells (CARTs). The Swiss-based Novartis intends to file for FDA approval of Penn's CART treatment next year and it defies belief to think that a major pharma has advanced the program this far without assessing the potential profits.
That's not to say that Novartis or any of the other companies developing oncolytic viruses necessarily expect to make an immediate windfall on their current products in this space. In the 1980s, for example, some of the same, where-are-the-profits concerns were raised about efforts by pharma companies to develop cures for AIDS. Some bean counters said there isn't enough money from a one-and-done course of treatment. Others in that crowd said pharmas should only develop HIV medications that require lifelong dosing. One greed-is-good segment of the industry claimed the key to profit demanded developing an HIV vaccine that everyone would want to take.
To its credit pharma and its researchers disregarded most of the advice from these trolls. The industry's research and the resulting HIV cocktail regimens brought in good profits and their scientists learned a lot about virology that helped generate impressive treatments for hepatitis C and other viral conditions. In the process pharma was able to help transform HIV from a death sentence to a chronic condition that doesn't preclude a normal life.
So instead of worrying first, last and always about how it can generate even larger profits, perhaps pharma should reconnect with the better aspects of its collective character and work on the premise that if they can help advance curative medicine, profits will follow as a matter of course.
George Merck once wrote something to that effect and so did Josiah Lilly, Jr., but that was a long time ago, back when Jonas Salk said he wouldn't take out a patent on his polio vaccine because that would be like patenting the sun.
Is it wildly naive to think that the industry could ever return to that tradition? Probably so. Today's pharma leaders possess neither the integrity nor the wisdom of those predecessors.