March 28, 2024

Cancer Physicians Attack High Drug Costs

The doctors and researchers, who specialize in the potentially deadly blood cancer known as chronic myeloid leukemia, contend in a commentary published online by a medical journal Thursday that the prices of drugs used to treat that disease are astronomical, unsustainable and perhaps even immoral.

They suggested that charging high prices for a medicine needed to keep someone alive is profiteering, akin to jacking up the prices of essential goods after a natural disaster.

“Advocating for lower drug prices is a necessity to save the lives of patients” who cannot afford the medicines, they wrote in Blood, the journal of the American Society of Hematology.

While noting that the cost of drugs for many other cancers were just as high, the doctors focused on what they know best — the medicines for chronic myeloid leukemia, like Gleevec, which is enormously profitable for Novartis. Among the critics is Dr. Brian Druker, who was the main academic developer of Gleevec and had to prod Novartis to bring it to market.

Novartis argues that few patients actually pay the full cost of the drug and that prices reflect the high cost of research and the value of a drug to patients.

Gleevec entered the market in 2001 at a price of about $30,000 a year in the United States, the doctors wrote. Since then, the price has tripled, it said, even as Gleevec has faced competition from five newer drugs. And those drugs are even more expensive.

The prices have been the subject of intense debate elsewhere as well. The Supreme Court in India ruled recently that the drug could not be patented, clearing the way for use of far less expensive generic alternatives.

Prices for cancer drugs have been part of the debate over health care costs for several years. But the decision by so many specialists, from more than 15 countries on five continents, to band together is a sign that doctors, who are on the front lines of caring for patients, are now taking a more active role in resisting high prices.

Some of the doctors who signed on to the commentary said they were inspired by physicians at the Memorial Sloan-Kettering Cancer Center in New York, who last fall refused to use a new colon cancer drug, Zaltrap, because it was twice as expensive as another drug without being better.

After those doctors publicized their objections in an Op-Ed column in The New York Times, Sanofi, which markets Zaltrap, effectively cut the price in half.

What impact the new commentary will have remains to be seen. The authors, however, call merely for a dialogue on pricing to begin.

The leader of the protest is Dr. Hagop M. Kantarjian, chairman of the leukemia department at the prestigious MD Anderson Cancer Center in Houston.

Many of the roughly 120 doctors who were co-authors of the commentary — about 30 of whom are from the United States, the — work closely with pharmaceutical companies on research and clinical trials. They say they favor a healthy pharmaceutical industry, but think prices are much higher than they need to be to ensure that.

“If you are making $3 billion a year on Gleevec, could you get by with $2 billion?” Dr. Druker, who is now director of the Knight Cancer Institute at Oregon Health and Science University, said in an interview. “When do you cross the line from essential profits to profiteering?”

Gleevec’s sales were $4.7 billion in 2012, making it Novartis’s best-selling drug. A newer Novartis leukemia drug, Tasigna, had sales of $1 billion.

Novartis said in a statement released Thursday: “We recognize that sustainability of health care systems is a complex topic and we welcome the opportunity to be part of the dialogue.”

It said that its investment in Gleevec continued after the initial approval, expanding the drug’s use to other diseases. It also said that it provides Gleevec or Tasigna free to 5,000 uninsured or underinsured Americans each year and to date has provided free drugs to more than 50,000 people in low-income countries.

Novartis and the manufacturers of the other drugs for chronic myeloid leukemia say the prices reflect the value of the drug. While many cancer drugs with equally high prices extend life by only a few months on average, it is widely agreed that Gleevec and rivals are near-miracle medicines that essentially turn a death sentence into a chronic disease like diabetes.

“It is a little surprising that their focus is in a cancer where the small molecule medicines have had the greatest impact on long-term benefit,” said Dr. Harvey J. Berger, chief executive of Ariad Pharmaceuticals, which sells the newest and most expensive of the leukemia drugs, Iclusig.

Dr. Berger said the price of Iclusig was $115,000 a year, not the $138,000 a year cited in the commentary. Pfizer also said the price of its drug, Bosulif, also was overstated in the piece. The manufacturers cite the price at which they sell to wholesalers, while the authors of the commentary were referring to a price they say better reflects what is charged by a pharmacy to patients. 

The other drugs for chronic myeloid leukemia are Sprycel from Bristol-Myers Squibb and Synribo from Teva.

Article source: http://www.nytimes.com/2013/04/26/business/cancer-physicians-attack-high-drug-costs.html?partner=rss&emc=rss

Square Feet | The 30-Minute Interview: Thomas Z. Scarangello

The company is known for skyscrapers and sports facilities; its projects have included 11 Times Square, the new Meadowlands stadium, and Yankee Stadium. It was also hired for the Kingdom Tower in Saudi Arabia, billed as the next building to be the world’s tallest.

Q According to your bio, you’ve spent your entire career at Thornton Tomasetti.

A It was my first job out of school — I was hired as an entry-level engineer. I didn’t think I would be there for the rest of my career, but I got lucky that two things occurred: that structural engineering turned out to be my passion, and that the firm grew the right way for me. I never hit a wall; if I wanted to try something new, there weren’t barriers.

Q And that has included forensic work.

A One of my first projects was at the Hartford Coliseum, which collapsed in the late ’70s. More recently, we got a call to help start the investigation into the stage collapse at the state fair in Indianapolis.

Sometimes the work is in a disaster area, and sometimes a building is just in distress. From every natural disaster, and even man-made ones, you always come out with lessons.

Q Do you know yet what happened in Indianapolis?

A Clearly there was strong wind that precipitated something. Whether it was a level of wind that no one anticipated or some flaw, that’s why we get called in to get a better understanding and avoid these things in the future.

Q Switching to New York, how did the city’s high-rise buildings hold up during the recent tropical storm?

A They held up well. Building curtain walls also fared well, with a few exceptions of leaks from wind-driven rain. It would take a much stronger event to significantly impact the high-rise building stock.

Q One of Thornton Tomasetti’s specialties is skyscrapers. How do you ensure that these buildings are safe and secure from an engineering standpoint?

A You look at the strength characteristics — you want all the structural components of the building to be strong enough to respond to the largest forces, whatever that might be. In certain parts of the world the dominant force may be seismic forces, and in other parts it might be hurricane winds or other events. So we have to determine what’s the largest force that this building is going to feel. There’s a whole series of checks that we have to do.

We also work very closely with geotechnical engineers who test the soil conditions, and we do borings and other things. And we’re constantly evaluating different materials, whether it’s steel or concrete.

Q Have you ever worked with an architect who got too carried away in his or her designs?

A I hate to say it, but that’s the challenge. That’s what we love. We don’t do a lot of very standard 20-story rectilinear buildings.

Q How many projects are you working on right now?

A Well over 100. Our project starts are up around 20 percent over the same time last year.

New York is probably around 5 percent of the projects. I’m the engineer of record for the Barclays Center in Brooklyn. And I’m working on the Hudson Yards right now.

Q Let’s talk about Hudson Yards.

A We’re working with Related and KPF, the architect. Things are definitely ramping up, so we take that as a positive sign.

We’ve been kind of on and off working on the site since the mid-’90s. We studied that site for a baseball stadium. We were on when the Jets talked about doing their stadium there. And then we worked with the city when they started doing the whole planning for the yards, helping them, because it’s a complicated site with the building over an active rail yard, so there’s a lot of structural challenges.

Q How big is your sports stadium business?

A It’s probably about 15 percent of what we’re doing. The first sports project that I worked on was in 1990 — it was an arena in Anaheim, Calif. — and I probably personally worked on 20 to 30 between the time we did that project and we did the recent ones in New York.

In New York, we had all these older stadiums that hadn’t been renovated, so when they finally started to come online, people would walk in and go, “Wow, look at this!” Well, you should have gone to Pittsburgh, Cleveland, Anaheim or San Francisco…

Q Do you have a favorite project?

A A boy from the Bronx who gets to be the engineer of record for Yankee Stadium — it doesn’t quite get better than that!

Article source: http://feeds.nytimes.com/click.phdo?i=9d2b6113c6a3cb81e6c7cb63841d8737