October 22, 2007
Positive Thinking Does Not Help Survival Against Cancer
Mind over matter can only work by smart minds figuring out how to better manipulate matter.
A patientís positive or negative emotional state has no direct or indirect effect on cancer survival or disease progression, according to a large scale new study. Published in the December 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study found that emotional well-being was not an independent factor affecting the prognosis of head and neck cancers.
We need immune therapies and gene therapies against cancer. We need more science and more biotechnology. Wishful thinking won't cut it.
Cancer kills a lot of people.
Update: Spending more on therapies don't help increase survival times much either.
A new study finds that survival for elderly patients with lung cancer has changed little despite large increases in healthcare expenditures for lung cancer treatment. The study by Harvard University, National Cancer Institute, and National Bureau of Economic Research researchers, published in the December 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, finds that average life-expectancy rose by less than one month between 1983 and 1997, while costs rose by over $20,000 per patient.
But the study period ended in 1997. The bigger effects of the money come in the longer term.
Lung cancer remains the top cause of cancer death in the United States, with an estimated 160,390 deaths expected to occur in 2007.
The U.S. spends more than five billion dollars a year on detection, determining the disease severity, and treatment of lung cancer. This is a significant increase over the last few decades, mirroring similar increases in general healthcare spending over the same period.
But throwing lots of money at treatments has one really beneficial effect: The lure of that money encourages drug companies and venture capitalists to spend money to develop newer and better treatments. Big markets attract new players. In a way it is disappointing that only $5 billion a year spent on lung cancer in the United States. All else equal I'd rather that the venture capitalists would see lung cancer as a $25 billion a year market. Fortunately the other forms of cancer also cost billions to treat. So we are probably looking at tens of billions a year spent on all forms of cancer. Lots of money for drug companies and VCs to chase.
Err...you make the markets 'bigger' by either increasing the number of sick people, or spending more per person. Since the bank is broke on spending more, and we have enough sick people, I suggest the market may be plenty big... NIH gets the lion's share of government R&D funding in this country already in addition to VC and Pharma funding. And we have the best cancer survival rates in the world because of it. But the healthcare debate is full of questions about what is the proper place to spend a limited resource (money) in the healthcare system. For instance, we are pretty terrible compared to most countries in infant death rates. Should we spend money at the end of life or at the beginning?
"The U.S. spends more than five billion dollars a year on detection, determining the disease severity, and treatment of lung cancer. This is a significant increase over the last few decades, mirroring similar increases in general healthcare spending over the same period."
"treatment of lung cancer"? What does that mean? How many QALYs does "treatment of lung cancer" bring? If it prolongs life by about six weeks, forget it.
Randall, do you think "encourag[ing] drug companies and venture capitalists to spend money to develop newer and better treatments" for lung cancer would also trickle down and provide better treatments for cancer in general? I've look at some chemotherapuetic drugs on Wikipedia and most of them are only approved to treat certain types of cancer. Maybe this money would be best spent on SENS (except WILT).
I hope this triggers healthcare deflation: this means more QALYs per dollar spent.
HellKaiserRyo, (whose name I've yet to decode)
First off, the big push for new treatments against cancer is not focused on chemo. Monoclonal antibodies, vaccines, gene therapy, and even cell therapies are all getting a lot of effort invested in them. Ditto some nanotech particles. Ditto anti-angiogenesis approaches.
While some strategies against cancers are specific to particular cancers many have general applicability. Maybe you make a different monoclonal antibody against lung cancer than you do against prostate cancer. But there's a fair amount of overlap in terms of basic technologies needed to develop and produce monoclonal antibodies and to attach payloads to the antibodies.
As I see it we need SENS and cures for cancer. Also, work on immune therapies against cancer will yield capabilities for making immune therapies against extracellular trash.
As for cell therapies that include telomerase deletion as an anti-cancer approach: It doesn't help us prevent cancer for the cells in our bodies that are already ticking time bombs. Telomerase deletion is not a full substitute for ways to cure cancer.
"Also, work on immune therapies against cancer will yield capabilities for making immune therapies against extracellular trash."
I thought inserting xenobiotic enzymes in, say, macrophages, would also work too.
My inquiry concerns inequality and utilitarianism though, not about the efficacy of new therapies (although it most certainly should be considered), but the cost-effectiveness. One way, in my opinion, is to promote equality of access is to increase the amount of QALYs per dollar. Unfortunately, some cost-effective options that are currently available are not practiced universally such as eating healthy.
Monoclonial antibodies? http://www.nytimes.com/2006/02/15/business/15drug.html?ex=1297659600&en=62aabaec5acffa8c&ei=5090&partner=rssuserland&emc=rss
Read that! Does biotechnology "trickle-down" as in lose patent protection and can be manufactured by anyone (assuming it is just as efficacious as the original and has the same chemical properties) for competition?
"Until now, drug makers have typically defended high prices by noting the cost of developing new medicines. But executives at Genentech and its majority owner, Roche, are now using a separate argument ó citing the inherent value of life-sustaining therapies. "
A utilitarian would accept the development argument, but loathes at the notion of putting value on a human life when the means are available to save it. Of course, it is necessary to respect the right for a company to be adequately reimbursed as this promotes innovation as this is the main utilitarian justification for permitting exorbitant prices. Does anyone know how much does it cost to produce those antibodies or Genentech's R&D expenditure each year? Does Genentech funnel most of the profit into R&D?
I think I overreacted by reading that article...
But increasing the amount of QALYs per dollar would be necessary to attenuate the problems of the health care system. Of course, such a concept would not be tantmount to advocating universal health care over managed care, as it would also help both systems too.
The utilitarian ethic is a consequentialist ethic, although it sometimes acknowledges that a propensity for profit can be inimical towards utilitarian goals, it can be justifed if it increases utility (however defined; in health care the QALY system is probably the best way to define utility).
The best way to increase QALY per dollar spent on health care is to develop far better treatments.
Our problem is that the most expensive therapies are not very effective and for many diseases we have no effective therapy.