President Obama announced in his State of the Union speech Tuesday that he would launch a “Precision Medicine Initiative,” aimed to cure things like cancer and diabetes. Of course, that sounds like a stellar goal, but some critics, or at least observers, are having a hard time wrapping their minds around how this is feasible, cost-wise.
First, what is precision medicine in terms of this initiative? David Kroll contributed to Forbes on the subject:
The goal of precision medicine is to give the treatment to the patients most likely to benefit because we now know the precise cause, at the genetic level, for this disease in a group of people.
Inherent in this definition is that the drug is not given to people with the disease who do not share the same precise defect, thereby avoiding waste of a drug on someone not only won’t benefit, but would only experience side effects.
Advances in genetics and biochemistry will be the integral part of identifying subsets and make precision medicine affective. So where do the economics come into play?
Kroll mentions Kalydeco, a revolution drug created for a small percent of cystic fibrosis patients that can cost around $300,000 a year per patient.
As medicine becomes more precise in classifying diseases into their discrete, genetic subtypes, the patient populations benefiting from a given drug are reduced. The result is that we are developing more effective drugs with dramatically greater effectiveness, but for a market of a few thousand or even hundreds of patients.
Although The Human Genome Project has made tremendous strides, it does come with a price. “We as a society must come to terms with the fact that prices in the tens of thousands of dollars per year will become the norm, with certain drugs commanding six figures per year,” Kroll says.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Will patients and taxpayers be willing to pay for specified care even if it costs more?
Ezekiel J. Emanuel, who advised the White House on healthcare reform, piped in on the subject when he appeared Wednesday on CNBC’s Squawk Box from the World Economic Forum in Davos, Switzerland. Concerning the new initiative, he referenced President Nixon’s “War on Cancer” in the early 70s and the fact that the war is far from won.
While there have been great strides in cancer treatment, and things like electric health records and mapping the human genome, the cost factor is a concern for Emanuel.
“I would be skeptical that precision therapy will be how we control costs,” Emanuel said. What’s his solution for healthcare and lowering costs? “We need to exercise more and eat better.”
If only it were that simple.
