Hospitals

#JPM15: Ezekiel Emanuel talks health care costs – and why many cancer drugs just aren’t worth it

Ezekiel Emanuel didn’t talk death-at-75 at this week’s J.P. Morgan conference – he talked money. Namely, the costs associated with health care – what counts as appropriate expenditure, and what’s egregious. Personalized medicine was on his hit list, as he rattled off some of the chinks in the U.S. health care cost structure. The reason, he […]

Ezekiel Emanuel didn’t talk death-at-75 at this week’s J.P. Morgan conference – he talked money. Namely, the costs associated with health care – what counts as appropriate expenditure, and what’s egregious.

Personalized medicine was on his hit list, as he rattled off some of the chinks in the U.S. health care cost structure. The reason, he says, that U.S. healthcare outstrips the rest of the world in costs: Higher salaries for health workers, more expensive drugs, pricier hospital stays, and surgical interventions that are higher margin and more frequent.

Emanuel’s skeptical about any savings that could come from personalized medicine. Sure, it’s a targeted approach that will present fewer side effects in a small population – but these drugs are expensive. And will remain so, if the number of people the specialized drugs treat remains small.

Gilead’s Sovaldi is a good example of a costly but widely beneficial drug – it’s a “very efficacious drug that can go to millions of people, as opposed to few thousand per year.” It helps elongate and improve the lives of those with Hepatitis C, he said.

Conversely, most oncology drugs run yearly costs of $250,000 per year – and many of these only extend a cancer patient’s life by a few months.

“It’s very hard to justify,” Emanuel said.

In the meantime, an important way to keep the cost structure efficient: U.S. healthcare systems need to beef up their management teams, and find better ways to incentivize doctors, he said. And while for a number of expensive, common diseases – he rattled off cancer, COPD, asthma and hypertension – the U.S. has good guidelines:

“The challenge now is standardizing practices,” Emanuel said.

Notably, Emanuel projects that just as cancer’s the hot-button issue of this decade, mental health – “the big black cesspool we tend to ignore” – will be front-and-center in the next. Physical conditions are hugely exacerbated when a patient’s mentally ill, he said, yet there remains a poor infrastructure to treat these issues at their root. By fixing this system, many of the downstream health costs will be allayed, he said.