Why do breakthrough oncology drugs cost so much?

Isn’t that a remarkably dumb and irresponsible question? Doesn’t it reveal a complete lack of understanding of how scientific discovery and commercial development work? Doesn’t it unfairly suggest — without any evidence — that our industry is predatory and our products irresponsibly priced? Yet these opinions appear just about every day in periodicals such as The Wall Street Journal and The New York Times.

Want another doozy? It’s an actual headline for an essay by Ezekiel Emanuel, M.D., in The Wall Street Journal, published in September.

“We can’t afford the drugs that could cure cancer.”

Really? Tell that to the approximately 90% of children who now survive a diagnosis of acute lymphoblastic leukemia and other childhood cancers. Tell that to the thousands of men and women who are living after a diagnosis that would have been a death sentence a generation ago.

Today, more than 200 oncology drugs are available. Some are branded, but many more are generics. Older readers may recall a few brand names: Oncovin, Adriamycin, Xeloda, Taxotere, Gemzar, and so on. As generics they’re cheap today, but I can recall when they were first marketed, our critics bellyached about their “exorbitant” prices. Just like they once complained about statins and ARBs and continue to carp about the prices of every new drug that comes along.

I wish Emanuel and his contemporaries could understand the process of discovery and innovation isn’t cheap. It never has been. And unfortunately, the costs of progress get higher as the science gets tougher.

I also wish they understood that when a drug doesn’t pan out, no one from the FDA or Congress comes running to help the developer. On the contrary, the company’s investors stampede and its employees may lose their jobs. Without the incentive of a significant financial reward for success, I doubt if we’d have much of a pharma industry at all.

Emanuel’s complaint is about the cost of CAR-T therapy, which isn’t even a drug. It’s a process of removing an individual cancer patient’s T-cells and re-engineering them to fight the disease. The cost just to remove, process, and reinfuse these cells is $60,000. And that’s for every patient. One at a time. The total cost of the treatment may add up to $400,000 or more. Is it worth it?

If it works and someone you love or care for is the patient, you bet it’s worth every dollar.

Emanuel’s claim is if every eligible patient gets CAR-T, our healthcare system will go broke. But what he doesn’t get is this technology is still new. As more companies enter the field, it’s a no-brainer that costs will plunge. Remember the sky-high price tags on the first generation of widescreen TVs, personal computers, and other advanced tech? I’m confident CAR-T therapy and other treatments still in the lab will be eventually be dramatically more affordable.

There’s just one caveat. We must be allowed to explore, develop, and profit from our biomedical technologies.

The 90% cure rates we have are good, but we can’t forget the other 10%. We can’t rest until we can offer every cancer patient a realistic shot at a cure. My worry is not that we won’t be able to afford these drugs, but that a misplaced focus on their cost will prevent them from being discovered at all.

Sander Flaum is principal at Flaum Navigators.