what happens if it's physical vs. fiscal
February 17, 2010 3:24 PM   Subscribe

I've heard it said that (in theory) the advent of a cure for cancer would cause a serious financial crisis because of the vast scale of the healthcare complex devoted to current treatments. So, the obvious question: Is there any credible evidence that promising (not woo-woo) therapies for diseases such as cancer and diabetes have been derailed because of the sheer scale of financial and institutional resources invested in the status quo?
posted by dacoit to Health & Fitness (41 answers total) 12 users marked this as a favorite
 
This sounds like a variation of the "the 200 mpg carburetor conspiracy."

Not a direct answer, but a thread to help in your search, maybe.
posted by rokusan at 3:26 PM on February 17, 2010 [1 favorite]


Sounds like a conspiracy theory.

In the developed world, other diseases which have historically been more prevalent, but which have more or less been eradicated, such as measles, have not bankrupted pharmaceutical companies or hospitals.

Just because a given disease has been eradicated or even if a cure for it has been found doesn't mean there are lots of other diseases out there for which there is a demand for the development of drugs.
posted by dfriedman at 3:28 PM on February 17, 2010 [1 favorite]


I really really doubt this, if only because a cancer cure, or more accurately, the patent rights on such a drug or technology, would bring the patent holders immense fortune.
posted by applemeat at 3:29 PM on February 17, 2010 [2 favorites]


The last sentence of my comment above needs some editing:

Just because a given disease has been eradicated, or even if a cure for it has been found, doesn't mean that there are lots of other diseases out there for which there is a demand for the development of drugs.
posted by dfriedman at 3:30 PM on February 17, 2010


Best answer: You may want to look up "creative destruction." The theory says, in part, that any time something really awesome is invented (for example, the lightbulb), there is some group of previously very powerful people (for example, candle manufacturers) who lose a lot of influence and money because they're invested in the old technology. However, there's no evidence that even the largest scale innovations have been detrimental to the economy as a whole.

If you're asking whether kooky conspiracy theorists like Kevin Trudeau are right that "they" are hiding the sooper sekret cure for cancer from us, the answer is no. If you're asking whether any cure, once discovered, will bankrupt the economy, the answer is also no.
posted by decathecting at 3:32 PM on February 17, 2010


Response by poster: Just to clarify, this is not at all meant as a leading question -- I'm wondering if there's any -credible- evidence out there. If no-one is aware of any, that's a perfectly good answer.
posted by dacoit at 3:33 PM on February 17, 2010


Best answer: I'd find this extremely unlikely, if for no other reason than "a cure for cancer" is a strawman. There are a lot of different types of cancer; there's not going to be one magic bullet for all of them.

That having been said, I am aware of one treatment for leukemia and lymphoma which, despite its UNBELIEVABLE effectiveness (73% five year remission rate for patients who had already FTR to chemo twice) has not been approved for clinical use. But that's not because it would bankrupt the status quo, it's because it involves injecting the patient with a curie of I-131 and then isolating them in a hot cell for three weeks. I was a tech on the protocol, which is the only reason I know about it. It was super cool, involved labeled antibodies, but totally impractical for any real-world application.
posted by KathrynT at 3:33 PM on February 17, 2010 [13 favorites]


Oh, but if you're asking whether large and powerful interests, such as pharmaceutical companies and the FDA, have delayed the introduction of life-saving treatments for other reasons (mostly because the approval process is so darned expensive and everyone is so darned risk-averse), the answer is probably.
posted by decathecting at 3:41 PM on February 17, 2010


The financial incentive for any one player to suddenly dominate the market is too great - secret cabals wouldn't hold together.
posted by phrontist at 3:41 PM on February 17, 2010


Applemeat has it. Rokusan too.

Assuming that it's true that it would be financially beneficial for the pharmaceutical industry as a whole to suppress a cure-all for major diseases, the value of it to any single manufacturer is still enormous. The temptations to cheat on any agreement would be very high, and you couldn't control for the fact that there will always be companies and other researchers outside your agreement who stand to win the prize.

Despite what people say about 200 miles-an-hour engines that run entirely on water, I'm not aware of any true historical examples of this magnitude, which tells me that this kind of conspiracy doesn't ever really exist.
posted by gabrielsamoza at 3:42 PM on February 17, 2010 [1 favorite]


Best answer: Also, while there's plenty of money going around, an awful lot of people involved in cancer treatment are in it at least in part because it's cancer treatment - they might panic later, when realizing they're out of a job, but in the short term would be much more likely to great "hey, here's a cure!" with wild cheering and fists pumped into the air.
posted by Tomorrowful at 3:46 PM on February 17, 2010


Best answer: Any time there's a revolutionary change, entrenched powers will fight to preserve their position. It's happened over and over.

...and if the change really is good enough, the entrenched powers lose. That's why your camera doesn't use film any more. And you don't ride a horse to the store.

In medicine there will be resistance to change, just like there is anywhere else. But it won't rise up to the level of tinfoil-hat conspiracy to outright suppress the advance.

If you want an example of a revolutionary change in treatment protocols, look into ulcer treatment. Up until the mid 1990's they used beta blockers, and all sorts of elaborate stuff, and even surgery. Then one researcher proposed that ulcers should be treated with antibiotics. It worked. It's faster and more effective and much cheaper. And now that's the standard approach.
posted by Chocolate Pickle at 3:47 PM on February 17, 2010


I really really doubt this, if only because a cancer cure, or more accurately, the patent rights on such a drug or technology, would bring the patent holders immense fortune. -applemeat

There are a lot of different types of cancer; there's not going to be one magic bullet for all of them. -KathrynT


Both of these are incredibly powerful reasons for the conspiracy theory to be false.
On top of that, I would also add that the persons who do find molecular targets for cancer therapies are not typically the same persons who perform the actual cancer treatments.
So do I, as a scientist, want to give up fame and fortune by hiding the cure I have discovered, in order to keep the oncology industry afloat?
posted by Knowyournuts at 3:50 PM on February 17, 2010 [1 favorite]


Best answer: Think about it. What would you pay for a cure for a cancer that threatens to cut your life tragically short? If not for yourself, then for your spouse or child? The answer is, of course, everything you have, plus everything you can possibly borrow, and your very soul if you can find a buyer. There is no lack of profit to be had.

A more feasible conspiracy theory is that such cures are being held back by governments due to the incredible social upheaval that near-immortality (which is what "a cure for cancer" amounts to) would bring.
posted by kindall at 3:50 PM on February 17, 2010 [1 favorite]


A social worker I work with described a similar theoretical paradox.

Childhood abuse and family violence and poor mental health and chronic poverty go together, and are generational. Good outcomes for social workers are ones which produce further good outcomes in a client's life and their childrens' lives, and break cycles of abuse and need. In theory, in the long term, therefore, social work and social policy will reduce the need for social workers; the nature of their job is to try to eliminate the causes and effects of the behaviours they work with. Taken to its (ridiculous) logical extent, social workers ought to try to increase the incidences of abuse and violence and homelessness, and so on, so they'll always have something to do.

In practice, though, no.
posted by Fiasco da Gama at 3:56 PM on February 17, 2010


There will always be something for the "healthcare complex" to work on. Pfizer knows this, Merck knows this, GSK knows this, etc... That's why if any of them discovered the cure for cancer tomorrow, they'll be more than happy to make the billions right away and move on to curing the next thing that pops up.

Cancer itself hasn't always been a huge problem for us. When people used to die around 30-40 due to infections and other diseases for which there are many readily available cures today, not many people lived long enough to be bothered by cancer. Penicillin didn't kill the healthcare complex, and neither will the cure for cancer. Anyone who thinks there's a conspiracy to hide it is nuts.
posted by reformedjerk at 4:00 PM on February 17, 2010 [1 favorite]


Best answer: Anything that doesn't kill you leaves the opportunity open for something else to do the job. If the pharma companies could get your money for the cancer cure, and then later more money for cholesterol medication, they'd do it.
posted by borkencode at 4:03 PM on February 17, 2010 [2 favorites]


I can't think of any examples like this. The closest I can think of is the fight over AC vs. DC power distribution that Edison waged. He lost and rightly so. I can think of lots of counter examples though where inferior but strongly established technology got bulldozed aside by newer technology.

As for cancer: We probably will never cure it as every cancer is damn near unique.
posted by chairface at 4:10 PM on February 17, 2010


There cannot be a single cure for a disease class that has literally hundreds of types and subtypes in the first place. It's like asking why there isn't "a cure" for infectious disease or autoimmune disease.
posted by scody at 4:24 PM on February 17, 2010


Notwithstanding the incredible amounts of money that a "cure" for any type of cancer would bring to the inventor, this is also one of those conspiracy theories that would require a huge cover-up by a mind-boggling amount of people. Not only would literally tens of thousands (oncology drug trials ain't small things) of individuals have to be in on the gig and in agreement to stay silent, but they would be doing so in direct opposition to their own personal interests.

First, biochemists at the drug companies would have to be deliberately sabotaging their own work and producing a sub-standard product, thereby depriving themselves of both fiscal and social acclaim (say goodbye to the Nobel prize!). Similarly, every doctor involved in the clinical trials of these new drugs would also have to be fabricating data; every clinical drug trial has very specific rules for when to stop the trial prematurely, and having a new drug not work as well or better than current treatments is one of them. It even has a fancy name: futility-stopping rule. Finally, if the treatment does get approved, then doctors treating the general still have to be convinced to use it. I can't say for sure what the reaction of an oncologist would be if you asked/bribed them to use a sub-standard treatment, but -- judging from the ones I know -- it would involve massive amounts of indignation and moral outrage with a healthy dose of derisive laughter.

In short, it's possible this conspiracy theory could work, but it's more likely that cancer is actually tiny mogwai, and patients would avoid water and stop eating after midnight it would neither spread nor turn malignant.
posted by Panjandrum at 4:28 PM on February 17, 2010 [1 favorite]


Best answer: It seems unlikely that a cure for (some types of) cancer would ever be developed by a single biochemist toiling away in his basement lab. It's far more likely to be a combination of grindingly dull research by thousands of scientists coupled with one or more therapeutic breakthroughs and flashes of insight. The odds of evil big pharma being able to permanently squelch this research- without needing to clandestinely murder thousands of cancer scientists to keep them quiet- are extremely slim.
posted by jenkinsEar at 4:31 PM on February 17, 2010 [1 favorite]


I've heard it said that (in theory) the advent of a cure for cancer would cause a serious financial crisis because of the vast scale of the healthcare complex devoted to current treatments.

Yeah, these theories all seem based on a seriously naive view of how biomedical research and oncology works. Cancer is many diseases, not one, and "cure" is not a clinical term.

I know people who have been in remission for many years, and will likely live to be a ripe old age. Are they "cured?" Well, sorta, but their health has been permanently compromised by their disease and its treatment. Things are moving toward being able to treat certain cancers more like a chronic disease than an acute one. This won't make research or treatment obsolete, it will spur new areas of inquiry.
posted by desuetude at 5:20 PM on February 17, 2010 [1 favorite]


This is a cartoon, but it helped me to understand the improbability of finding "the" cure for cancer.
posted by Mendl at 5:55 PM on February 17, 2010 [1 favorite]


Response by poster: Thanks, MeFites, I knew I could count on you. This question came up in a debate with a friend last night, who strongly suspects that research is being suppressed. She's a bit of a hippie but quite intelligent, and I had brought up many of the points you've mentioned during the discussion.

Still, I was left with doubts which you've done a lot to clear up. The hard thing about conspiracy theories like this is that of course, sometimes in this world "following the money" really -does- help explain what's going on, when there's a LOT of it involved. But the fact that no-one has come in to say "I've been doing primary / clinical research and have seen this happen" is the best answer of all.

(BTW, I'm quite aware that there can never be a single "silver bullet" for cancer because it has so many thousands of different forms and etiologies -- nor did my friend argue otherwise -- but I wanted to keep this brief, thus an "in theory" question).
posted by dacoit at 6:09 PM on February 17, 2010


Best answer: My mother's doctor was the head of Breast Oncology at MD Anderson -- a hospital well-known for cancer treatments, and a hospital that participates in lots of studies. Her doctor cried when she died. I have no doubt at all that if he'd known of any cure he would have immediately made it available to all his patients.

If there had been a cure, we would have paid any amount for that cure.

I bet everyone knows at least one family that has someone fighting, or who has fought, cancer.

I make the above points to say this: I think it helps to realize that hospitals, research centers, pharmaceutical companies, are all ultimately made up of people... people who would give any thing for a cure. With all the money that could be made from a cure, and with all the grief that a cure could end, do you think it's at all possible that a cure could be kept a secret?
posted by Houstonian at 6:12 PM on February 17, 2010 [1 favorite]


If someone doesn't die of cancer they will have to one day die of something else. Not too mention the generally high medical costs of maintaining someone into old age even they are in relatively good health. Whether its fake hips, Parkinson's, osteoporosis, back problems, heart problems, high blood pressure, these things cost a lot of money whether its for surgery, medication, or just ongoing nursing care. It's actually conceivable that medical care costs could go up on.
posted by whoaali at 6:23 PM on February 17, 2010


Agree with the above. One other point to consider is that suppressing a discovery on this scale of amazing (and again, this is hypothetical, because of what KathrynT said) would be exceedingly difficult because of the number of people typically involved in bringing such a thing about. Medical science is incredibly collaborative and even when it's not, it builds upon the findings of a vast network of researchers in the same field. Even if all the research were done internally at EvilPharm Inc., your would think at least one member of the research team would let the cat out of the bag.
posted by drpynchon at 7:34 PM on February 17, 2010


Best answer: I work in the industry and I should probably find sources here, but it's generally believed that current modalities have lead to more people surviving cancer and even more people being diagnosed with cancer earlier. Hence it seems like the industry is just growing and growing. But really it's getting better - more people today survive cancer than ever before. More people are finding out about their cancer earlier, during earlier stages of disease progression where treatment can work better.

One problem with treatment is that it can lead to other illnesses. Some survivors develop cardiac issues, GI issues, you name it really. Sometimes they develop a completely new type of cancer. You survived breast or lymphoma cancer treatment and later develop a leukemia. Some people have other chronic issues like HIV/AIDS or COPD and then develop a cancer.

No one wants this. Not the patients, not the people that treat them, not the people that made the drugs that treated the first cancers. So I would argue that advances have lead to longer life, but with that chronic illness and co-morbidity have complicated the lives of many living longer than they would have 15 years ago.

There's a culture around oncology and it's very hopeful towards the goal of a cure. I'm not a religious person but I would describe it as having faith in a cure someday. It's very emotional. It's spiritual. We want it so badly. If you look at the big cancer centers they usually have mottos expressing that. MD Anderson's motto is 'making cancer history' and they mean they want cancer to BE history. Dana Farber is 'dedicated to discovery, committed to care.' Discovery is about research toward finding treatments that work better - that improve or even eliminate the need for care.

I don't think many of us could actually work in the field if we didn't hope for the best, didn't hope for what may seem impossible. The emotional toll you witness in patients and family is too great. In some ways we see things that were previously thought to be impossible. Biotherapies that target specific markers on cancer cells and leave normal cells alone for example. That fucking blows my mind. Some researcher figured it out in a lab somewhere and it's amazing.

This culture of hope is so vast in the field. If and when my job becomes obsolete I will be part of the biggest celebration ever. Then I'll get a job doing something else with that awesome achievement on my resume. Maybe I'll be a geriatric nurse then. That would be good.
posted by dog food sugar at 7:51 PM on February 17, 2010


Best answer: Before the Salk vaccine, polio treatment was a pretty major industry (iron lungs, institutions, etc).
(I tried to google the effect of the vaccine on the polio treatment business, but the search was overwhelmed by nauseating anti-vax crap, and I stopped).
The business of polio treatment pretty much disappeared, but it was not much noticed in the country at large.

Polio before the vaccine was extremely scary--like our current terrorist fearmongering, but as if al-kaida concentrated on children. Parents were advised to keep their kids out of crowds, and lots of other semi-useless or semi-impossible things.

There probably are pharma executives who have fantasies about suppressing cancer 'cures' in favor of more remunerative 'treatments', but in fact, treating cancer just isn't that profitable anyway--victims tend to die pretty quickly or not need treatment pretty quickly. There isn't the years and decades of treatment that polio required.

All that said--I do not necessarily believe that there can not be a cancer 'magic bullet drug'.
Cancer cells are pretty bizarre--all it takes is one sneaky protein that targets runaway-growing cells and lyses them, and cancer is pretty much licked, whatever causes it. Such a drug should also be harmless (or at least pretty harmless) to healthy cells, and that seems to be a major sticking-point.

Treating the causes of cancer may be undoably complex; treating the effects of cancer is an endless round of one damn thing after another; treating the characteristics of cancer is now science-fiction. Oh, well.
posted by hexatron at 7:53 PM on February 17, 2010


IMHO, the documentary Hoxsey - How Healing Becomes A Crime presents credible evidence of shennanigans in the 50s with regard to one particular cancer treatment. A tragic story of profiteers vs. humanitarians. Of course, the official record claims the method was driven out of the US due the 'fact' it was pure, unsafe quakery. It is a worthwhile watch, regardless of what conclusion you draw, as it gets one to thinking about 1) an individuals right to choose treatment methodologies for his/her own person, and 2) whether government should be able to interfere with that right, especially when the impetus to do so comes from protecting the vested interests of pharma-business.
posted by Rube R. Nekker at 8:17 PM on February 17, 2010


Best answer: There is proof that some medical treatments are squashed, though I doubt a successful cancer cure is among them. My best friend, who is a research scientist at a major pharmaceutical company, knows of a couple of extremely successful drugs that were mothballed.

We haven't talked about it in years, but I remember him telling me about one (I think it was some sort of insulin) that was much more effective and cheaper to produce (once the changeover was done) than the older drug. A major company bought the patent and did nothing with it because they had a huge stockpile of the old drug and the cost to change over production to the new drug.

That was during the 80s. The drug hadn't seen the light of day when we talked about this a few years ago.
posted by thekiltedwonder at 8:35 PM on February 17, 2010


I came in to second the cartoon Cancer:
Researcher #1: There will never be a cure for cancer.
Researcher #2: Don't tell our sponsors.
posted by Deathalicious at 8:51 PM on February 17, 2010


Like everyone else here, I don't think there's any big conspiracy to cover up cancer cures.

Preventing cancer by regulating dangerous substances, and restricting environmental exposures to carcinogens is another matter, however. An example: the Canadian and Quebec governments have a pretty shameful record promoting the sale of asbestos, a well-known carcinogen, overseas, despite a metric tonne of criticism. Even when there is a compelling case against cancer-causing products, it can be an uphill battle against companies and industries invested in selling those products.

So when you ask about the sheer scale of financial and institutional resources invested in the status quo I believe there is an interest in keeping things the way they are - it's just more connected to some causes of cancer instead of treatment.

Sounds like an interesting discussion between you and your friend in any case - thanks for letting us take part in it.
posted by Joad at 10:10 PM on February 17, 2010 [1 favorite]


The amount invested in the status quo pales into insignificance when compared to what I'd invest in a cancer cure to save a loved one. I'd give them my house, my superannuation, let them garnish my salary for the rest of my life, live in a cardboard box - whatever it took. Few things are more terrifying than cancer, and the current cures are almost as scary.
posted by obiwanwasabi at 1:01 AM on February 18, 2010


I agree, there is no conspiracy to cover up cures for diseases of the rich: short-term reward will always dominate. This is not true for diseases of the poor - cf difluoromethylornithine and T. brucei. Even then, it's not really a conspiracy as much as a bold statement of "why bother?". (Full disclosure: I have received indirect support for my (now long-past, cancer-related) research in the form of free DFMO, and I still think the process stinks.)
posted by overyield at 1:37 AM on February 18, 2010


Sure, follow the money is a good principle. In this case, the trail leads to the NIH, which fund 4.8 billions dollar of cancer research every year.

http://www.cancer.gov/cancertopics/factsheet/NCI/research-funding

Some conspiracy theorists needs to do their homework.
posted by gmarceau at 10:52 AM on February 18, 2010


Response by poster: Not to get MetaTalk here, but I would have thought that funding for research would be orders of magnitude higher than $4.8 billion annually. Of course any of us would pay any price for a course of treatment that would save the life of a loved one. Yet $4.8 billion is actually quite a small figure at the federal government scale. For example, it is approximately the cost of two Northrop Grumman B2 aircraft.

Anyway, I've stopped marking "best answers" because there are so many interesting and valuable perspectives here ... thank you to everyone.
posted by dacoit at 12:31 PM on February 18, 2010


A more feasible conspiracy theory is that such cures are being held back by governments due to the incredible social upheaval that near-immortality (which is what "a cure for cancer" amounts to) would bring.

The cancer researcher who lives next door was over for dinner a few months ago (yes, that's my citation for this) and told us that while the discovery of antibiotics lengthened average lifespan by about 10 years, eradicating cancer would lengthen it by about 2 years.
posted by palliser at 4:42 PM on February 18, 2010


A more feasible conspiracy theory is that such cures are being held back by governments due to the incredible social upheaval that near-immortality (which is what "a cure for cancer" amounts to) would bring.

Except for the deaths from heart disease, respiratory disease, stroke, accidents, AIDS...

Leading causes of death in the US.
Top 10 causes of death worldwide by broad income group
.
posted by desuetude at 7:12 PM on February 18, 2010


The cancer researcher who lives next door was over for dinner a few months ago (yes, that's my citation for this) and told us that while the discovery of antibiotics lengthened average lifespan by about 10 years, eradicating cancer would lengthen it by about 2 years.
This, yes, 100 times. Even if we could cure all the somatic diseases, cognitive failure will still be a hard upper limit for most people. I love my 89-year-old great-aunt, and loved my 87-year-old grandmother, but both of them were pretty damn vague by the time their bodies failed around them. Until we can reach in and pull our minds out of the neuronal substrate (and there's a real chance that will never happen) we are going to be strictly mortal along current lines. Given that, the chance to strip people's financial legacy away for the minimal price of 2-4 years extra life, who could resist it?
posted by overyield at 8:23 PM on February 18, 2010


It totally slipped my mind when I posted before, but there was a cancer vaccine that was in human testing in the late 90's that was kicked back by the FDA. This was because too many of the patients died while using it, even though a significant percentage (3/5 maybe? I really can't remember) ended up in remission. From what I remember the problem wasn't with the patients dying (they had to be terminal to get into the trial) but they couldn't prove that the drug didn't kill them. I'll try to remember to ask my best friend about it next time I talk to him.
posted by thekiltedwonder at 1:23 PM on February 19, 2010


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