Resisting the pull of cynicism since 1969.

Monday, January 29, 2007

The cancer cure Big Pharma won't let you have? Maybe not.

The story's long gone cold by now, but I was very interested to read the posts from a little over a week ago about a potential cheap cure for cancer that Big American Pharma was ostensibly going to keep from us. "Very interested" because my very own partner is a cancer vaccine researcher at the National Cancer Institute in Washington D.C. (as well as a lefty Canadian who has no great love for Big Pharma), and she hadn't mentioned word one of this to me.

We had a bit of a back-and-forth about it, but in the end I decided that it would be better to let her guest-blog what she had to say than try to come up with a coherent post about something about as far from my area of expertise as, say, zero-gravity hockey for gerbils. So without any further ado, it's over to my girl. You can call her Christie. Oh, and I've told her you guys don't bite, so please don't make a liar out of me!



There's been a lot of discussion over the past few days about the cheap, readily available, putatively safe, potential cancer treatment, dichloroacetate (DCA). Never having heard of the compound, I did the first thing I always do when word of a new cancer 'cure' hits my Inbox and headed straight for my beloved Google Scholar.

DCA did shrink some tumours in mice. It did not, however, eradicate those tumours and its mechanism of action is such that it will frequently leave behind cancer cells to cause recurrences. In addition, the mechanism of action makes DCA largely ineffective against small metastases and it's the metastases that kill the majority of cancer patients.

The safety profile of DCA also requires more study. Peripheral neuropathy is extremely painful and is only a minor side effect if the alternative is death. I'd far rather lose my hair, vomit on multiple occasions, and deal with decreased blood cell counts--side effects of currently used cancer treatments--than experience peripheral neuropathy. In addition, DCA exposure is linked to both kidney and liver damage, the latter potentially leading to liver cancer, so patients might end up right back in the oncologist's office.

Leaving aside for the moment whether or not this is actually a viable cancer 'cure', it seems that some people are up in arms over their belief that Big Pharma will refuse to work towards getting DCA into the clinic because it's off-patent and they can't get even richer off of it. If that's what they end up deciding to do, it's a perfectly reasonable choice for those companies to make.

It costs a not insignificant amount of money to get a drug approved for use in the U.S., even when the drug is already being used for another condition or being used elsewhere in the world, and why should any company spend the money when every other company will start selling the drug as soon as it's approved, without making the same kind of investment?

Business owners, would you be willing to make a large financial outlay that all of your competitors will profit from, to the detriment of your bottom line? Would any of you be willing to pay to build a house and then let all your neighbours move in and live rent-free while you and your family camp out in one room? If so, you're a better person than I am.

It's also not automatically true that Big Pharma will stay clear of DCA. For one thing, the PR value of 'curing cancer' cannot be underestimated. Being able to claim to be the company that 'cured cancer' is worth money in the bank, even if everyone else will eventually be selling the same product.

Furthermore, if there is one thing drug companies excel at, it's finding ways to redesign drugs in order to extend a patent or to get a new one.

Most importantly for cancer patients and the people who love them, if there is any value at all to DCA in the treatment of cancer, the drug companies will go right to work creating new chemical compounds that work on the same pathways, only more effectively and with fewer side effects. Any one of those new compounds could prove to be a real cure for cancer and I trust that very few people who have been raising a fuss about DCA and the pharmaceutical companies will refuse the cure if they have need of it.

Finally, there's one very important point that I feel is being left out of this discussion: telling medical researchers what they must research can be as bad as telling them what they must not research. (*cough* stem cells *cough*) Perhaps I'm just taking this too personally, though. I'll tell you what I'll do: you can come over to my lab and tell me what to research next, if I can come over to your place of work and tell you how to do your job.

18 comments:

skdadl said...

Thanks very much for the clarifications, Christie, especially of DCA's mechanism of action. I suppose I could google "peripheral neuropathy," but could you describe its relatively more serious consequences in this context? Is there, eg, a risk of eventual dementia?

Also, just a loose observation from an amateur: Marcia Angell's writing leads me to think that a good deal of the investment in drug research is in fact public money (because the researchers are working at publicly funded universities and such); but the researcher who makes a discovery is free at that point in the U.S. to incorporate himself, patent the discovery, and then sell it to a Big Pharma company, thus enriching them and himself at the public's expense.

That has been one of the major concerns of critics of Big Pharma. Another arises from looking at the pharma corps's budgets, wherein managerial, marketing, and PR budgets dwarf allotments for getting drugs approved.

Are we off base, in your view, to hold those critical beliefs?

Mike said...

Good investigating IP...always good to remain skeptical of things, even if they agree with your personal political view point...

Christie said...

skdadl,

Peripheral neuropathy involves pain and tingling, the location of which depends on where the nerve damage is. I've had some experience with nerve pain- it's extremely unpleasant and no medication I've tried has lessened the pain. The cause of the peripheral neuropathy is demyelination, or loss of the outer insulating layer, of the peripheral nerves. It appears to be eventually reversible after the medication is stopped, but further study is needed. The only effect centrally is sedation, which can be severe; there does not appear to be any significant risk of dementia. It's hard to state that for sure, though, because the only patients to receive this drug so far are extremely sick and separating out effects of the drugs from effects of their illness is difficult.

It's true that the public funds the early stages of development of some drugs through university funding and research grants to researchers outside of the pharmaceutical companies. In Canada, a researcher at at a university who develops a patentable product shares any financial proceeds with the university that employs them. In that way, the public sees a return on their investment. I'm not certain about the rules in the U.S.

I would like to point out, though, that the purchase of a discovery generally happens very early on in the process. The public may be paying for the first studies discovering a drug and showing the potential usefulness but, once the drug company buys it, the drug company takes on the financial burden of getting the drug approved for use in humans. They're also taking the risk that it won't ever get approved. So it isn't as if the public is funding most of the process and then the drug companies are reaping all the rewards.

As for the budgets of drug companies, well, there we're getting into one of the areas where I can't possibly defend them!

Idealistic Pragmatist said...

Mike,

Thanks! But I do think Christie deserves allll the credit for this one--all I'm doing is standing there and looking pretty. ;-)

West End Bound said...

Christie,

Thanks for the "rest of the story" - You sound as pragmatic as IP, and that's a good thing!

Hope you're discovering that we really don't bite . . . . :)

Now, about that zero-gravity hockey for gerbils thing . . . .

Scott Tribe said...

Without getting into the debate of whether or not your partner is giving a completely biased-free account or not (since she's in a field where she would be naturally sympathetic toward Big Pharma), I will point out to you that my 2nd post you linked to (ethical pharmaceuticals) isn't really to do with DCA, but more to do with the fact researchers are now able to bypass the patents that Big Pharma has on medicines that make it prohibitively expensive to hand out to the Third World or other places where ther are poor people.

Idealistic Pragmatist said...

Scott,

Without getting into the debate of whether or not your partner is giving a completely biased-free account or not (since she's in a field where she would be naturally sympathetic toward Big Pharma)

Ah, so it's sorta like "without getting into the debate over whether Stéphane Dion is really for sound environmental policy (since greenhouse gases went way up while he was Environment Minister)", then! Well, all right.

Seriously, though, you're jumping to some pretty whopping conclusions. For one thing, I outright stated in my intro that she wasn't sympathetic to Big Pharma--do you think I was lying? Besides, Christie is a postdoc who hopes that her next job is at a Canadian university, where she would have very little, if anything, to do with Big Pharma. And even in her present job, nobody from Big Pharma tells her jack about what to research or what not to research. (The NIH kinda rocks that way.)

Is that really all you have to say about the post, though? Really?

Scott Tribe said...

I'll take your word for it then that she's taking a view not affected by any sympathy or vested interest in defending Big Pharma.

I'll point out to your partner though that while she gives the "its reall expensive for drug companies to invest their money in research" bit, she completely ignores what I pointed out at my postings about the fact that Big Pharma's have far greater expenditures in promoting their drugs as the greatest thing since sliced bread, as well as investing in other lovely activities like showering local Congresspersons or government officials with gifts in order to keep their uh.. sympathies with Big Pharma's position. I'd be much more sympathetic toward Big Pharma if they actually spent a large majority of their budget on actual research, but they don't.

The points she raises about DCA, I'll have to go see if her points are valid or countered by others.

Speaking of the 2nd article you linked to on ethical pharmaceuticals, I would be interested to hear her take on that particular specific development of researchers being able to develop copies of medicines cheaply and without running afoul of patent law in order to get the medicine to people who desperately need it that Big Pharma wont even take a 2nd look at normally.

(I know.. It sounds like I am trying to out-socialize the socialist here).

Idealistic Pragmatist said...

Scott,

I admit I was curious when Christie emailed me her post whether you would buck the trend you seem to have never to acknowledge that you might be wrong about something. Glad to see you're still predictable! *grin*

The points she raises about DCA, I'll have to go see if her points are valid or countered by others.

*eye roll* I'm sure she'd be happy to recommend some medical articles for you to read.

(I know.. It sounds like I am trying to out-socialize the socialist here)

Did Christie define herself as a socialist? Musta missed that part!

As for the rest, I'm way, way out of my depth, so I'll leave it to her. I'm sure she'll respond when she has a moment. (If she doesn't, I'll poke her again.)

Christie said...

Scott,

First of all, you know nothing about me and can't possibly make any reasonable decision about any biases I may possess without a lot more background information than you have. I would actually argue that I am in exactly the right field to have a well-informed, inside view of the negative aspects of pharmaceutical companies, as anyone who has heard me ranting about the subject could attest to. Furthermore, if I was on the side of Big Pharma, I would be making approximately 4 times my current salary, happily employed by whichever of the companies was recruiting at the moment when I was looking for a new position. Discounting everything I say bceause of imaginary biases is not a useful response to the points I make in my post.

Second, please do not pretend to quote me by putting your paraphrase of what I said into quotation marks. That's a pet peeve of mine.

Third, I was not attempting to construct a comprehensive response to every point made by everyone who has commented on any issue related to pharmaceutical companies recently. I was simply outlining some points of view that have been missing from the discussion about DCA. It would be interesting if we could engage in discussion about what I said rather than what I did not say.

To address your specific points:

It's true that drug companies spend a great deal of money on promoting their products and on various other expenditures that I do not personally approve of. I do not see what that has to do with my argument that drug companies should not have to spend money on something which will benefit their competitors as much as it benefits them. Just because R&D isn't the biggest item in their budget, they don't get to spend that money in a way that brings them profits? That seems unreasonable.

That factoid about drug company budgets also does has nothing to do with my points about why I feel that drug companies will not stay away from DCA.

I do not know enough about the concept of ethical pharmaceuticals to comment knowledgably about it. I did enjoy reading the post you wrote about it and I look forward to learning more about the issue.

jeanruss said...

I found her take on this typical of most doctors and researchers in today's medical environment. Having recently lost my young daughter to cancer(18 years old) I found modern medicine obsessed with money and disinterested in helping patients get well. In fact, there is considerable hostility to anyone who dares to change the status quo of current cancer traetment. Doctors who discover new ways to handle cancer are harassed and thrown out of their professions if they dare to try something that Big Pharma can't exploit. If you want to try a treatment in another country, you lose custody of your child. Medicine in America is very Fascist in its nature, especially regarding cancer. Doing research for my dsughter turned up many instances where the government intervened in potential cures at the behest of pharmaceutical interests. This has been going on for at least 70 years. The exploitation of cancer patients will only come to an end when lawsuits start getting filed for suppression of important reasearch to end this scourge. I hope to be a part of it. It couldn't happen to a more deserving group of greedy hypocrites as oncologists.

Christie said...

jeanruss,

The last 12 years of my life have been dedicated to researching better treatments for cancer. I work long hours for less-than-generous wages, making considerably less than I could in other professions because this is what I want to do with my life.

I've dragged myself out to the lab while ill with influenza and pneumonia, while in debilitating pain that caused blackouts, while under physical threat from a co-worker, because I feel that the work I do is crucial.

I despair when the treatments I test don't work out in practise. I rejoice when something I've worked on helps real patients. I've never seen so much as a dime for any therapy I've worked on.

Barring some discoveries that render cancer research unnecessary, I anticipate spending the next 30 years the same way.

I find your assumptions about me incredibly hurtful and insulting.

I'm very sorry for the loss of your daughter; I can only begin to imagine your pain. But you do not get to judge me without knowing me.

Christie said...

west end bound,

No bite marks as of yet.

And I have to say, I'm with you on wanting to hear more about zero-gravity hockey for gerbils!

Scott Tribe said...

First I didn't say Christie was a socialist... I was referencing that "out-socializing the socialist" toward you, ID. Sorry if I didn't make that clear enough.

2nd - to Christie.. you're right. I don't know enough about you to make a judgement on your biases.. for that I apologize for making that statement.

3rdly.. I'm drugged out at the moment over this topic. I'm not conceding any of my points made on Big Pharma or how I feel about them. I just don't want to start a long distance blog war.

I will look forward however to your (Christie's) further thoughts on the Ethical Pharmaceuticals post and the patent workaround that has been developed.

Idealistic Pragmatist said...

Scott,

I was referencing that "out-socializing the socialist" toward you, ID.

Well, setting aside for the moment the fact that I've never claimed that label, either--you do remember I didn't write this post, right? I'm just standing on the sidelines looking cute and perky this time around (and feeling very outclassed by my fabulous workaholic partner). So I don't see how arguing with Christie could be seen as be "out-socializing" me!

As for your last two paragraphs, is there any way not to read them as: Christie, I'm not going to comment on what you've said because I don't feel like arguing, but I won't concede that you might be right, either. But I still expect you to comment on my ethical pharmaceuticals post even though you've said you don't know enough about the topic to comment. ?

Scott Tribe said...

Gee whiz ID. I apologized for my pre-judging of her, and all I said was I would be interested to hear her opinion on those articles once she DID read it. I didnt say ANYTHING about expecting or demanding a comment from her.

When did the Spanish Inquisition start over here? Did I miss the announcement? ;)

Idealistic Pragmatist said...

Scott,

all I said was I would be interested to hear her opinion on those articles once she DID read it.

Except that she had already said she read the post but didn't know enough about the topic to comment. I suppose I may have misunderstood, but it's difficult to read a subsequent comment from you about looking forward to what she says about it as anything but: "I'm still expecting a comment from you about it, eventually."

Benedict 16th said...

Thought this discussion might interest you?

Benedict