(via Brooks Elliott)

(via Brooks Elliott)

My wife, the writer and scholar Anne Friedberg, died last month.  She was 57 years old.  She died of colorectal cancer.

In the year prior to her death she had radiation therapy, chemotherapy, two major surgeries.  We are among the fortunate: because of my union membership, I have an insurance plan that actually covers the costs of real illness.  There were copays, to be sure, and many out-of-pocket expenses, to be sure.  But we could make decisions about Anne’s health care based on fact, science, medicine.

As some of the available chemotherapies proved ineffective against the progression of Anne’s disease, and others proved too toxic, we made use of two newer drugs.  These drugs were ‘targeted agents,’ which attack the ways in which cancer cells reproduce and metastasize, without the wholesale collateral damage of traditional chemotherapies.  They fall into the category of ‘biologics.’

The first was Avastin, from Genentech, an antiangiogenic monoclonal antibody.  When it works, it prevents cancer cells from obtaining the access to the blood supplies they need in order to thrive.  A year’s treatment with Avastin costs, according to The New York Times, $90,000.  According to The New England Journal of Medicine, it extends life expectancy by 4.7 months.

The second was Erbitux, from Imclone.  You may recall the name from the Martha Stewart trial – it was early word of Erbitux’s poor showing in a clinical trial that was alleged to have prompted Imclone execs to intimate to Ms. Stewart that the stock was about to start “trading downward.” But Erbitux was ultimately approved.  It, too, is a monoclonal antibody.  It works by inhibiting the epidermal growth factor that tumors need to grow.  The cost of a course of treatment, according to Bloomberg News, is approximately $80,000, and, on average, extends life expectancy by roughly 1.2 months.

Our insurance covered both drugs.  But imagine if it hadn’t:

Would you want to be in the position of making life-or-death decisions about a spouse or child based on the figures on the right-hand side of the menu?  I can only contemplate what that might be like.  Was the possibility of extending Anne’s life by a few months worth $80,000?  $90,000?

If you had to choose: four point seven months for your spouse, or four years of college for your child?  A monthly bill from the chemotherapy center, or the monthly mortgage?

As someone with recent experience, I can tell you that you would do anything – anything – that held out hope.  That the equation of $80,000 for the possibility of 1.2 months would make sense to you.

These are, of course, impossible choices.  But what makes them impossible is the cost of the biologics.

What keeps these costs so frighteningly high?  The lack of generic competition.  As these drugs are new, they are protected.  You want bevacizumab, your sole and only choice is to buy Avastin from Genentech/Roche.  You want cetuximab, your sole and only choice is to buy Erbitux from Imclone/Bristol Myers-Squibb.  As Thomas Ward’s 1688 poem about the livery stable owner Thomas Hobson put it, “Where to elect there is but one, / ‘Tis Hobson’s choice—take that, or none.”

Senator Sherrod Brown and Congressman Henry Waxman introduced legislation that would give the manufacturers of biologics a five-year window to reap the profits of exclusivity – and then open the door to generic competitors.  But they lost out to language from Senator Hagan and Rep. Eshoo, which would give the Genentech/Roches of this world twelve years of exclusivity – and then allows that exclusivity to be extended indefinitely, simply by changing to recommended dosage or administration of the drug.

You know, and I know, that the price of these drugs will never come down unless competition from generics forces them down.

And if the Hagen/Eshoo PhRMA-driven language is allowed to stand intact, ten or twenty years from now a husband, a wife, a parent, will be in that impossible position.  Are 1.2 months of life worth $80,000?

Genentech, Imclone, their fellow drug manufacturers, have no worries.  Because they already know how you will answer that impossible question.