Unintended Consequences of Expensive Cancer Therapeutics—The Pursuit of Marginal Indications and a Me-Too Mentality That Stifles Innovation and Creativity : The John Conley Lecture
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Abstract
Cancer is expected to continue as a major health and economic problem worldwide. Several
factors are contributing to the increasing economic burden imposed by cancer, with
the cost of cancer drugs an undeniably important variable. The use of expensive therapies
with marginal benefits for their approved indications and for unproven indications
is contributing to the rising cost of cancer care. We believe that expensive therapies
are stifling progress by (1) encouraging enormous expenditures of time, money, and
resources on marginal therapeutic indications and (2) promoting a me-too mentality
that is stifling innovation and creativity. The modest gains of Food and Drug Administration-approved
therapies and the limited progress against major cancers is evidence of a lowering
of the efficacy bar that, together with high drug prices, has inadvertently incentivized
the pursuit of marginal outcomes and a me-too mentality evidenced by the duplication
of effort and redundant pharmaceutical pipelines. We discuss the economic realities
that are driving this process and provide suggestions for radical changes to reengineer
our collective cancer ecosystem to achieve better outcomes for society.