I spent $93,000 and all I got was this lousy legacy

Hey you, does the high cost of health care in America piss you off?

Do you wonder why it's so bloody expensive?

Well here's one reason, it's called Provenge®. Provenge is the first therapeutic cancer vaccine to be approved by the FDA. Its maker, Dendreon, calls it a 'treatment' but it's not much of the sort.

What it does is this: if you're a man and you've been given 6 months to live on account of advanced prostate cancer with metastatic tumors refractory to standard hormonal treatment (i.e. chemical castration), Provenge will on average extend your life by a little over 4 months.

You'll still die, but Provenge allows you to be in denial about it for a little bit longer.

Cost? Oh not much. Only about $93,000

So many things about Provenge piss me off I can't put together a coherent essay, so I'm resorting to bullet points.

J WELLINGTON WIMPY SYNDROME

Says Wimpy of Popeye fame, "I will gladly pay you Tuesday for a hamburger today."

Easy for Wimpy to say, he won't be making it to Tuesday.

PROVENGE IN PUBLICATION

New research published in the New England Journal of Medicine—research wholly funded by Dendreon—showed that prostate patients as described above given Provenge lived on average 4.1 months longer than those given a placebo (in other words, average survival was 25.8 months vs 21.7 months).

On the plus side, the vaccine, an aspect of personalized medicine, had a low toxicity profile and side effects were minimal. This is a modest improvement over most new cancer drugs, which cost tens of thousands of dollars as well and generally extend life a few months, but their side effects make those extra months extra-extra miserable.

PUTTING A PRICE TAG ON LIFE

It's a bitch to put a price on life. But our economy depends on money and prices. And all life ends. And although no one wants to talk about it, end-of-life care is costly. According to James Ridgeway, the Senior Washington Correspondent for Mother Jones magazine, one in ten Medicare dollars gets spent on patients with less than a month to live, a figure that amounts to $50 billion annually.

Pharmaceutical companies that routinely produce these dubious cancer drugs know a couple lucrative things better than most:

• that $50 billion is a big pot of cash just waiting to be spent somewhere, anywhere, so long as it allows people to get that hamburger of life today and put off confronting the inevitability of death on Tuesday;
• that Medicare can't deny treatment based purely on cost;
• that the Social Security Act requires the Centers for Medicare & Medicaid Services to pay for cancer drugs that receive FDA approval;.

Medicare's fronting right now, acting like they might not pay when we all know they will. Some private insurers already are.

A READY-MADE MARKET

According to Ron Winslow at the Wall Street Journal, doctors have already written 500 scripts for Provenge. At the moment, 50 centers nationwide are authorized to dispense it, and many of them have waiting lists 60 people deep because the company lacks the supply to keep up. Assuming those 500 scripts have been filled, Dendreon's revenues since April alone amount to $46.5 million. That's nothing in the pharmie-world. Pocket change. In order to reach blockbuster status, Provenge will need to top $1 billion in annual sales.

According to SEER data on prostate cancer, in 2010 217,730 men will receive the diagnosis, and over 32,000 will die. About 60% of these diagnoses are to men aged 65 or older—Medicare age, in other words.

Dendreon is salivating over all those future customers. Blockbuster status, here comes Provenge!

CAN I GET A "HEY-HO!" FOR HOSPICE?

Something these pharmaceutical companies also know, but would never admit to knowing, is that study upon study, survey after survey, all show that terminally ill people do better—psychologically and physiologically—in hospice care than they do exhausting worthless treatment options in the confines of a hospital bed. In fact, hospice care often extends life beyond what medicine can offer.

But where's the money in those proud patients? Where's the money in a patient who rejects it all? May not be any money, but here's some news: beyond the obvious, like smoking, either you're gonna get cancer or you're not. It's 50-50 if you're fortunate enough to reach Medicare age.

TESTIMONIALS, YOU KNEW THEY WERE COMING

Behold two 'testimonials' from the Dendreon website. Aware of the limitations they face, copywriters are all about economy of expression. What, then, in the following two 'quotes' is repeated and stressed the most?

Of course, it's the simple grammatical construction, 'keep verbing'.

Four extra months of life. Oh, we all love life, we all embrace it, right? We cherish it. We live our lives to the fullest! If that were true, we wouldn't we scraping the barrel for an extra few months.

DOUBLE-DUTY-DUTY

This is just a guess, but since it's true for so many prescription drugs, let's suppose it's true for Provenge: you don't just pay once for Provenge. When you 'spend' the $93k, it's actually your second time paying for this drug. Reason? Because pharmaceutical companies don't really do any of the essential research that discovers the drugs they sell. Instead, that's done at Universities and major US non-profit medical centers funded by the taxpayer. Then, when the molecule is ready to go, this or that research institute has contracts in place with Dendreon, Schering-Plough, etc. to market it.

It's well established that big pharma is a poor pill maker but a dynamo in marketing. Mad Men ain't got nothin on these guys.

PARTY FOULERS

I hope that Provenge, with this outlandishly ludicrous estimated cost, will be the straw that breaks our backs. For long enough now, we've had to put up with so many cancer treatments that do nothing but extend life a few months. This is no different. I want Provenge to be the asshole who spoiled the party for Big Pharma, so Novartis and Pfizer are like, "That's just great, you just had to push it didn't you, Dendreon!"

Because seriously, is this to be the measure of a man, willing to leave a crushing financial legacy about the neck of his family, his community, his country, in exchange for a couple spare months?

Really?

Citation and sources

• Kantoff PW et al. "Sipuleucel-T Immunotherapy for Castration-Resistant Prostate Cancer." N Engl J Med 2010; 363:411-422
• Ridgeway, James. "Meet The Real Death Panels", Mother Jones, August 2010. Print.
• Gawanda, Atul. "Letting Go: What should medicine do when it can't save your life?" The New Yorker, August 2010. Online.
• Angell, Marcia. The Truth About the Drug Companies. Random House. New York. 2005.