1 00:00:02,720 --> 00:00:09,200 Speaker 1: Bloomberg Audio Studios, podcasts, radio news. In the summer of 2 00:00:09,280 --> 00:00:12,040 Speaker 1: twenty twenty, Stacy Deuce had seen his mom went to 3 00:00:12,080 --> 00:00:12,960 Speaker 1: the emergency room. 4 00:00:13,360 --> 00:00:17,720 Speaker 2: She had been feeling very bad and just wasn't sure 5 00:00:17,840 --> 00:00:21,079 Speaker 2: like why, and kept trying to go and see different 6 00:00:21,120 --> 00:00:23,360 Speaker 2: doctors to find out what was going on with her. 7 00:00:23,840 --> 00:00:27,080 Speaker 2: And by the time they diagnosed it, they diagnosed it 8 00:00:27,120 --> 00:00:31,480 Speaker 2: in the emergency department, which is as a health services researcher, 9 00:00:32,080 --> 00:00:35,080 Speaker 2: you're like, you know, that's the worst case scenario. 10 00:00:35,479 --> 00:00:39,120 Speaker 1: The diagnosis was advanced stage breast cancer. Stacy remembers it 11 00:00:39,200 --> 00:00:42,640 Speaker 1: was overwhelming, but also understood she'd play a big role 12 00:00:42,800 --> 00:00:43,720 Speaker 1: in what came next. 13 00:00:44,000 --> 00:00:48,000 Speaker 2: So neither of my parents had a college education, you know, 14 00:00:48,080 --> 00:00:51,159 Speaker 2: like my mom cleaned houses and my dad was a welder, 15 00:00:51,760 --> 00:00:55,040 Speaker 2: and so you know, it was like an immediate I've 16 00:00:55,080 --> 00:00:57,760 Speaker 2: got a takeover. I'm going to help figure out how 17 00:00:57,840 --> 00:01:01,680 Speaker 2: to get them through this healthcare system and navigate that 18 00:01:01,760 --> 00:01:02,840 Speaker 2: as best as we can. 19 00:01:04,040 --> 00:01:08,039 Speaker 1: Stacy is a cancer policy researcher at Vanderbilt University Medical Center. 20 00:01:08,280 --> 00:01:11,639 Speaker 1: She got her PhD in pharmaceutical sciences at UNC Chapel 21 00:01:11,680 --> 00:01:13,920 Speaker 1: Hill and still had a network there to draw on. 22 00:01:14,440 --> 00:01:17,960 Speaker 2: My friend who was a head of rest oncology, called 23 00:01:18,000 --> 00:01:20,360 Speaker 2: me and is like, hey, you know, like let me 24 00:01:20,400 --> 00:01:22,720 Speaker 2: talk to you about what this probably is going to 25 00:01:22,800 --> 00:01:27,360 Speaker 2: look like, like what's the most common cancer type, what's 26 00:01:27,400 --> 00:01:31,800 Speaker 2: the most common treatment recommendation now? And one of the 27 00:01:31,959 --> 00:01:36,320 Speaker 2: really tricky parts is like she recommended or said, you know, 28 00:01:36,400 --> 00:01:40,280 Speaker 2: like for the most common cancer, we use these combination 29 00:01:40,440 --> 00:01:43,440 Speaker 2: of this low cost hormonal therapy, and that this higher 30 00:01:43,520 --> 00:01:44,560 Speaker 2: cost treatment. 31 00:01:45,040 --> 00:01:48,480 Speaker 1: The higher cost treatment was a drug from Pfizer called Ibrants. 32 00:01:49,040 --> 00:01:51,200 Speaker 1: Stacy knew it was considered the standard of care as 33 00:01:51,280 --> 00:01:53,800 Speaker 1: first line treatment for her mom's type of breast cancer, 34 00:01:54,280 --> 00:01:56,520 Speaker 1: but she also knew there could be a problem. 35 00:01:56,880 --> 00:02:01,760 Speaker 2: My entire career leading up to that, studied the Medicare 36 00:02:01,840 --> 00:02:05,960 Speaker 2: prescription drug benefit, and I knew, like the very first 37 00:02:05,960 --> 00:02:08,840 Speaker 2: time my mom would try to fill that medicine it 38 00:02:08,880 --> 00:02:12,040 Speaker 2: would be thirty two hundred dollars out of pocket. And 39 00:02:12,160 --> 00:02:16,400 Speaker 2: we're talking about someone living on a very small amount 40 00:02:16,400 --> 00:02:21,520 Speaker 2: of retirement and like living fine, but no way, like 41 00:02:21,600 --> 00:02:24,320 Speaker 2: in no universe is that amount of money going to 42 00:02:24,360 --> 00:02:27,000 Speaker 2: be something that like she and my dad found to 43 00:02:27,040 --> 00:02:30,639 Speaker 2: be acceptable. And so like I knew, I was like, oh, 44 00:02:30,840 --> 00:02:33,840 Speaker 2: I would just figure out like, should I pay for 45 00:02:33,919 --> 00:02:35,920 Speaker 2: it for her? And I would be totally happy to 46 00:02:36,000 --> 00:02:40,040 Speaker 2: do that if it was worth doing. 47 00:02:41,080 --> 00:02:44,480 Speaker 1: In twenty twenty, Ibrins was listed for a jaw dropping 48 00:02:44,560 --> 00:02:47,880 Speaker 1: one hundred and sixty thousand dollars a year. It's since 49 00:02:47,960 --> 00:02:50,760 Speaker 1: risen to more than two hundred and fourteen thousand dollars, 50 00:02:51,320 --> 00:02:53,160 Speaker 1: and even though Medicare would have paid for most of it, 51 00:02:53,320 --> 00:02:56,080 Speaker 1: Stacy knew the cost was still going to be significant. 52 00:02:56,720 --> 00:02:59,760 Speaker 1: Worst of all, even as a cancer policy expert, she 53 00:03:00,040 --> 00:03:02,840 Speaker 1: couldn't figure out if the drug would make a difference. 54 00:03:02,840 --> 00:03:08,440 Speaker 2: Even someone as knowledgeable as myself, Like, studying this for years, 55 00:03:09,040 --> 00:03:12,880 Speaker 2: I felt like I couldn't get a clear answer. I'm like, Okay, 56 00:03:12,919 --> 00:03:15,840 Speaker 2: well this is the recommended treatment, so like that's what 57 00:03:15,880 --> 00:03:18,560 Speaker 2: you trust. You're like, okay, the young collogists are all 58 00:03:18,600 --> 00:03:21,960 Speaker 2: saying this is what we're doing now. And I couldn't 59 00:03:22,000 --> 00:03:26,040 Speaker 2: find anything that made me feel confident that if I said, 60 00:03:26,080 --> 00:03:27,959 Speaker 2: all right, like we as a family are going to 61 00:03:28,000 --> 00:03:31,640 Speaker 2: start spending fifteen to twenty thousand dollars just on this 62 00:03:31,680 --> 00:03:35,600 Speaker 2: one drug, not to mention everything else you have going on, 63 00:03:36,760 --> 00:03:39,040 Speaker 2: Like is it going to change anything? Like is it 64 00:03:39,080 --> 00:03:43,040 Speaker 2: going to change? How long you live and how good 65 00:03:43,080 --> 00:03:43,600 Speaker 2: you feel. 66 00:03:44,040 --> 00:03:47,640 Speaker 1: Stacy's mom didn't end up taking Iburns, further testing indicated 67 00:03:47,640 --> 00:03:50,960 Speaker 1: a different medication would likely be more effective. She pursued 68 00:03:51,000 --> 00:03:55,040 Speaker 1: treatment until the side effects became intolerable. She died last summer. 69 00:03:57,920 --> 00:04:01,120 Speaker 1: Bloomberg Senior healthcare reporter Robert Langreth says a big reason 70 00:04:01,120 --> 00:04:03,120 Speaker 1: why it was so difficult for Stacy to figure out 71 00:04:03,160 --> 00:04:05,360 Speaker 1: whether ibans would have been worth it is because of 72 00:04:05,360 --> 00:04:08,280 Speaker 1: how the cancer treatment industry has changed over the last 73 00:04:08,320 --> 00:04:08,960 Speaker 1: few decades. 74 00:04:09,360 --> 00:04:12,200 Speaker 3: Cancer treatments cancer drugs, and this is very interesting. That 75 00:04:12,280 --> 00:04:17,000 Speaker 3: has become the biggest selling single disease area in the 76 00:04:17,040 --> 00:04:19,839 Speaker 3: world for the pharmaceutical industry. We've found it's not over 77 00:04:20,000 --> 00:04:22,600 Speaker 3: two hundred billion dollar market now. 78 00:04:22,680 --> 00:04:26,040 Speaker 1: The market for cancer treatments keeps getting bigger and bigger, 79 00:04:26,440 --> 00:04:29,160 Speaker 1: and that two hundred billion dollars in drug sales was 80 00:04:29,360 --> 00:04:30,960 Speaker 1: just in twenty twenty four alone. 81 00:04:31,240 --> 00:04:33,240 Speaker 3: Now, to put it on context, we hear a lot 82 00:04:33,279 --> 00:04:36,000 Speaker 3: about ABC of drugs. Cancer A still way larger than 83 00:04:36,160 --> 00:04:38,520 Speaker 3: BC drugs. They may catch up someday, but they're not 84 00:04:38,520 --> 00:04:39,120 Speaker 3: close to that. 85 00:04:39,480 --> 00:04:41,880 Speaker 1: The boom in the market for cancer treatments is due 86 00:04:41,880 --> 00:04:45,039 Speaker 1: in part to legislation backed by drug makers that allowed 87 00:04:45,040 --> 00:04:48,160 Speaker 1: the US Food and Drug Administration to speed up approvals. 88 00:04:48,600 --> 00:04:50,600 Speaker 1: The agency has given the green light to more than 89 00:04:50,600 --> 00:04:54,400 Speaker 1: two hundred cancer drugs over the past three decades. For 90 00:04:54,480 --> 00:04:57,120 Speaker 1: some patients, having more treatments on the market can be 91 00:04:57,200 --> 00:04:59,760 Speaker 1: a source of hope. Some of them are game changers, 92 00:05:00,240 --> 00:05:02,720 Speaker 1: but many of the drugs are more expensive than ever 93 00:05:03,120 --> 00:05:06,120 Speaker 1: and the Bloomberg News investigation showed that fewer than half 94 00:05:06,160 --> 00:05:09,480 Speaker 1: the treatments approved since two thousand have ever been shown 95 00:05:09,640 --> 00:05:13,520 Speaker 1: to extend patients' lives. Bob says even fewer have been 96 00:05:13,520 --> 00:05:17,159 Speaker 1: shown to improve symptoms or quality of life. So how 97 00:05:17,160 --> 00:05:20,240 Speaker 1: did so many cancer drugs with unclear efficacy end up 98 00:05:20,240 --> 00:05:23,640 Speaker 1: on the market and who's benefiting and profiting from them? 99 00:05:23,800 --> 00:05:27,120 Speaker 3: What we've found is that, you know, there's another side 100 00:05:27,160 --> 00:05:29,200 Speaker 3: of the story that doesn't get told, and in the meantime, 101 00:05:29,200 --> 00:05:30,400 Speaker 3: companies make a lot of money. 102 00:05:32,680 --> 00:05:34,480 Speaker 1: I'm David Gura, and this is the big take from 103 00:05:34,480 --> 00:05:38,560 Speaker 1: Bloomberg News today on the show The Cancer Industrial Complex. 104 00:05:38,920 --> 00:05:41,760 Speaker 1: How three decades of new treatments have brought hope to 105 00:05:41,839 --> 00:05:46,080 Speaker 1: cancer patients and billions of dollars in profits to pharmaceutical companies, 106 00:05:46,480 --> 00:05:50,960 Speaker 1: even when those drugs often fail to help patients survive. 107 00:05:54,600 --> 00:05:56,680 Speaker 3: I was interested in looking at this because I've you know, 108 00:05:56,920 --> 00:06:00,960 Speaker 3: been covering cancer on and off for years, early decades. 109 00:06:01,160 --> 00:06:02,599 Speaker 1: That's Bloomberg's Robert Langreth. 110 00:06:02,800 --> 00:06:04,560 Speaker 3: There's a lot of hype and all sorts of medicine, 111 00:06:04,600 --> 00:06:06,960 Speaker 3: but because of the kind of the high stakes and 112 00:06:06,960 --> 00:06:08,640 Speaker 3: the high emotions with cancer, it seems to be a 113 00:06:08,680 --> 00:06:11,599 Speaker 3: particular lot of hype, you know, with cancer and cancer 114 00:06:11,600 --> 00:06:13,880 Speaker 3: advances and everything like a miraculous advance. 115 00:06:14,120 --> 00:06:16,359 Speaker 1: A big part of Bob's job is to separate the 116 00:06:16,400 --> 00:06:19,400 Speaker 1: signal from the noise, and over the past year, he 117 00:06:19,480 --> 00:06:22,080 Speaker 1: and a team of reporters, editors, and data journalists here 118 00:06:22,120 --> 00:06:25,240 Speaker 1: at Bloomberg have tried to answer a big question at 119 00:06:25,240 --> 00:06:26,400 Speaker 1: the heart of cancer treatment. 120 00:06:27,080 --> 00:06:30,200 Speaker 3: How many of these supposedly miraculous drugs, you know, really 121 00:06:30,200 --> 00:06:31,520 Speaker 3: do extend patient survival. 122 00:06:32,760 --> 00:06:35,240 Speaker 1: They looked at one hundred and seventy six drugs that 123 00:06:35,279 --> 00:06:38,279 Speaker 1: have entered the cancer treatment market since two thousand and 124 00:06:38,320 --> 00:06:41,720 Speaker 1: By analyzing FDA labels, they separated the drugs that had 125 00:06:41,760 --> 00:06:44,800 Speaker 1: been proven to extend cancer patients' lives from the ones 126 00:06:44,839 --> 00:06:45,440 Speaker 1: that hadn't. 127 00:06:45,600 --> 00:06:49,520 Speaker 3: We only counted it as not having proven a survival 128 00:06:49,520 --> 00:06:53,679 Speaker 3: difference if it was never proven to extend survival for any. 129 00:06:53,520 --> 00:06:54,600 Speaker 1: Of its approved uses. 130 00:06:54,920 --> 00:06:57,680 Speaker 3: If it got one out of five uses showed a 131 00:06:57,680 --> 00:07:00,479 Speaker 3: survival difference, so we gave it a yes, said that's good, 132 00:07:00,760 --> 00:07:02,120 Speaker 3: you know, So we kind of gave the companies the 133 00:07:02,160 --> 00:07:03,600 Speaker 3: benefit of the doubt for their drugs. 134 00:07:03,760 --> 00:07:05,560 Speaker 1: But Bob and the rest of the team saw some 135 00:07:05,640 --> 00:07:08,080 Speaker 1: striking trends emerge in the data they analyzed. 136 00:07:08,400 --> 00:07:11,400 Speaker 3: The prices for all the drugs increased. The starting prices 137 00:07:11,480 --> 00:07:15,000 Speaker 3: increased dramatically. I think the per median monthly cost is 138 00:07:15,080 --> 00:07:17,800 Speaker 3: up over twenty five thousand dollars a month for the 139 00:07:17,800 --> 00:07:21,040 Speaker 3: most recently approved drugs. But that is an independent of 140 00:07:21,080 --> 00:07:23,760 Speaker 3: whether they increased survival or not. In less than half 141 00:07:23,800 --> 00:07:26,320 Speaker 3: of the drugs that we've looked at have ever been 142 00:07:26,360 --> 00:07:28,160 Speaker 3: shown to increase patient survival. 143 00:07:29,600 --> 00:07:31,600 Speaker 1: So how did we get here where the market for 144 00:07:31,640 --> 00:07:34,480 Speaker 1: cancer treatments has gotten so big and there were so 145 00:07:34,520 --> 00:07:38,160 Speaker 1: many drugs available but with limited efficacy. Part of the reason, 146 00:07:38,160 --> 00:07:41,800 Speaker 1: Bob says, is that US insurers essentially have to cover 147 00:07:41,880 --> 00:07:42,720 Speaker 1: cancer treatments. 148 00:07:43,000 --> 00:07:47,960 Speaker 3: Medicare essentially covers all cancer treatment drugs because of the 149 00:07:48,000 --> 00:07:51,960 Speaker 3: protected colass under Medicare, and basically that means private insurance 150 00:07:52,040 --> 00:07:54,360 Speaker 3: essentially kind of follow along with that, and that means, 151 00:07:54,440 --> 00:07:57,520 Speaker 3: you know, ten twenty twenty five years ago, when some 152 00:07:57,560 --> 00:08:00,720 Speaker 3: of these new drugs they started coming out, companies found 153 00:08:00,800 --> 00:08:04,280 Speaker 3: essentially they could charge almost infant ount for cancer drugs. 154 00:08:04,440 --> 00:08:07,520 Speaker 1: Bob says. Another factor fueling the cancer treatment boom is 155 00:08:07,600 --> 00:08:09,160 Speaker 1: regulatory changes. 156 00:08:09,000 --> 00:08:13,840 Speaker 3: Changes at the FDA calling for various sort of fast track, 157 00:08:14,000 --> 00:08:18,200 Speaker 3: shortcut expedited approval mechanisms for cancer with very kind of 158 00:08:18,480 --> 00:08:20,240 Speaker 3: limited preliminary data. 159 00:08:20,360 --> 00:08:23,160 Speaker 1: Since the early nineteen nineties, the hurdles that companies have 160 00:08:23,200 --> 00:08:25,480 Speaker 1: had to clear to bring cancer drugs to market have 161 00:08:25,560 --> 00:08:28,360 Speaker 1: gotten lower, but Bob says one of the most critical 162 00:08:28,360 --> 00:08:31,520 Speaker 1: shifts happened in the mid two thousands when the FDA 163 00:08:31,600 --> 00:08:35,400 Speaker 1: moved away from evaluating actual survival rates and towards a 164 00:08:35,440 --> 00:08:36,199 Speaker 1: new criteria. 165 00:08:36,360 --> 00:08:39,199 Speaker 3: It's very hard to demonstrate actual survival that takes a 166 00:08:39,240 --> 00:08:41,680 Speaker 3: long time, a lot of patients and a lot of drugs, 167 00:08:41,720 --> 00:08:44,600 Speaker 3: you know, just falls short. A lot of drugs have 168 00:08:44,640 --> 00:08:47,560 Speaker 3: been approved upon with some a different metric that is 169 00:08:47,640 --> 00:08:49,920 Speaker 3: misleadingly called progression free survival. 170 00:08:50,080 --> 00:08:53,160 Speaker 1: Progression free survival is a measure of tumor growth over 171 00:08:53,200 --> 00:08:55,480 Speaker 1: a set period of time and it hinges on a 172 00:08:55,559 --> 00:08:59,280 Speaker 1: number twenty percent. If a patient's tumors grow more than 173 00:08:59,320 --> 00:09:02,800 Speaker 1: twenty percent, and doctors consider the cancer to have progressed. 174 00:09:03,400 --> 00:09:06,520 Speaker 1: If a patient's tumors grow less than twenty percent, doctors 175 00:09:06,520 --> 00:09:09,560 Speaker 1: and drug makers can classify that as what's known as 176 00:09:09,640 --> 00:09:11,160 Speaker 1: progression free survival. 177 00:09:11,640 --> 00:09:13,920 Speaker 3: It's really not survival, it's really you know, does this 178 00:09:14,040 --> 00:09:18,760 Speaker 3: delay your chair of growth by a couple months, two, three, four, 179 00:09:18,880 --> 00:09:21,000 Speaker 3: maybe five months? And what research does have found is 180 00:09:21,040 --> 00:09:24,240 Speaker 3: that metric it trens out is not actually a reliable 181 00:09:24,679 --> 00:09:28,120 Speaker 3: predictor all the time of whether the drug actually increases survival. 182 00:09:28,160 --> 00:09:30,440 Speaker 3: So you're going to have a drug that sounds great, 183 00:09:30,600 --> 00:09:33,080 Speaker 3: sounds like you're going to live longer, but you don't necessarily. 184 00:09:33,400 --> 00:09:36,280 Speaker 1: A review published in the European Journal of Cancer found 185 00:09:36,280 --> 00:09:39,480 Speaker 1: that from nineteen ninety nine to twenty fifteen, two thirds 186 00:09:39,520 --> 00:09:42,440 Speaker 1: of drug trials aiming to slow progression of solid tumors 187 00:09:42,640 --> 00:09:46,120 Speaker 1: were deemed successful, but in the long term, only thirty 188 00:09:46,160 --> 00:09:48,679 Speaker 1: eight percent of those drugs turned out to help patients 189 00:09:48,720 --> 00:09:52,559 Speaker 1: live longer. Bob says those kinds of studies take years, 190 00:09:53,000 --> 00:09:56,160 Speaker 1: and in the meantime, those information gaps can have big 191 00:09:56,240 --> 00:09:59,400 Speaker 1: impacts on the market for those drugs and the outcomes 192 00:09:59,440 --> 00:10:02,560 Speaker 1: of the patient's take them. An example of that is 193 00:10:02,640 --> 00:10:06,240 Speaker 1: a popular breast cancer medication called Ibrince, the same drug 194 00:10:06,240 --> 00:10:08,520 Speaker 1: Stacey dust Zina was looking into for her mother. 195 00:10:08,800 --> 00:10:10,920 Speaker 3: So this was a drug, it's a new class. It 196 00:10:11,000 --> 00:10:13,080 Speaker 3: was the first in new class of drugs for the 197 00:10:13,120 --> 00:10:16,920 Speaker 3: most common type of breast cancer, advanced breast cancer, hormone 198 00:10:16,960 --> 00:10:21,360 Speaker 3: sensitive breast cancer. And it was first approved in twenty fifteen, 199 00:10:21,720 --> 00:10:24,480 Speaker 3: you know, based on progression free survival. They did a 200 00:10:24,520 --> 00:10:28,240 Speaker 3: study showing it could delay slow the progression the growth 201 00:10:28,240 --> 00:10:30,760 Speaker 3: of cancer time it takes you know, your advanced cancer struck, 202 00:10:30,920 --> 00:10:33,920 Speaker 3: and it quickly became a multi billion dollar blockbust earlier. 203 00:10:33,960 --> 00:10:38,640 Speaker 3: This this early approval is a major Eventrifiser. 204 00:10:38,160 --> 00:10:41,080 Speaker 1: And critically, Robert says ibrants being able to enter the 205 00:10:41,120 --> 00:10:44,520 Speaker 1: marketplace after showing it could deliver progression free survival gave 206 00:10:44,559 --> 00:10:47,920 Speaker 1: it an advantage over competitors in the same category from 207 00:10:48,000 --> 00:10:49,040 Speaker 1: other manufacturers. 208 00:10:49,280 --> 00:10:52,360 Speaker 3: And then only like many years later, the longer term 209 00:10:52,400 --> 00:10:54,640 Speaker 3: trials coming in, and then those trials, you know, it 210 00:10:54,880 --> 00:10:59,599 Speaker 3: failed to clearly extend patient survival and strangely, some of 211 00:10:59,600 --> 00:11:03,400 Speaker 3: the compute eating drugs and their trials they did extend 212 00:11:03,440 --> 00:11:06,880 Speaker 3: patient survival and look to this day, researchers of debating 213 00:11:06,880 --> 00:11:09,440 Speaker 3: why you know and which drugs are truly better. But 214 00:11:09,559 --> 00:11:12,920 Speaker 3: because Piser got that first approval, you know, based only 215 00:11:12,920 --> 00:11:16,400 Speaker 3: on the tumor slowing metric, it got you know, billions 216 00:11:16,480 --> 00:11:18,319 Speaker 3: upon billions upon billions of sales. 217 00:11:19,320 --> 00:11:21,920 Speaker 1: Ibrints had been on the market for roughly seven years 218 00:11:21,960 --> 00:11:24,960 Speaker 1: by the time Pfizer reported the trial results showed an 219 00:11:25,000 --> 00:11:29,040 Speaker 1: initial treatment of its drugs produced no survival benefit. What 220 00:11:29,080 --> 00:11:32,880 Speaker 1: has Pfizer said about your reporting or what's come to 221 00:11:32,920 --> 00:11:34,360 Speaker 1: light here about the degree to which it has not 222 00:11:34,600 --> 00:11:35,679 Speaker 1: prolonged patient's lives. 223 00:11:35,960 --> 00:11:38,080 Speaker 3: So Pfizer basically said, it took a lot longer than 224 00:11:38,200 --> 00:11:43,360 Speaker 3: plan to show the survival trials because people just lived 225 00:11:43,360 --> 00:11:46,440 Speaker 3: longer than anticipated even in the control group, and the 226 00:11:46,480 --> 00:11:50,120 Speaker 3: trials were not optimized to detect a difference in actual survival, 227 00:11:50,160 --> 00:11:51,800 Speaker 3: And they said it was hard. That can be also 228 00:11:51,920 --> 00:11:56,319 Speaker 3: hard to measure because people do different types of treatments. 229 00:11:56,520 --> 00:11:59,600 Speaker 1: At a breast cancer conference last year, Pfizer presented a 230 00:11:59,640 --> 00:12:03,320 Speaker 1: real world analysis of nine thousand breast cancer patients that 231 00:12:03,440 --> 00:12:07,000 Speaker 1: found no statistical difference between the survival rates of cancer 232 00:12:07,040 --> 00:12:10,040 Speaker 1: patients who took Ibrance and those who took competitor drugs. 233 00:12:10,720 --> 00:12:12,960 Speaker 1: Bob says doctors are divided over what to make of 234 00:12:12,960 --> 00:12:16,520 Speaker 1: the contrasting results. Anfizer stands behind its drug. 235 00:12:16,760 --> 00:12:19,319 Speaker 3: They say it's up standard of care, first line treatment 236 00:12:19,800 --> 00:12:22,400 Speaker 3: that gives women with incurable cancer more time with out 237 00:12:22,400 --> 00:12:23,320 Speaker 3: the disease worsening. 238 00:12:25,520 --> 00:12:29,040 Speaker 1: Drug Makers have made billions as the cancer drug market grows, 239 00:12:29,280 --> 00:12:32,000 Speaker 1: but they aren't the only ones. How other parties are 240 00:12:32,000 --> 00:12:35,160 Speaker 1: profiting and what all this means for cancer patients that's 241 00:12:35,200 --> 00:12:49,800 Speaker 1: after the break. Cancer treatment has become a big business, 242 00:12:50,000 --> 00:12:53,160 Speaker 1: often with mixed results. A Bloomberg analysis has found that 243 00:12:53,240 --> 00:12:55,920 Speaker 1: in the past decade alone, drug makers have made more 244 00:12:55,960 --> 00:12:59,240 Speaker 1: than fifty billion dollars on cancer drugs that so far 245 00:12:59,480 --> 00:13:03,000 Speaker 1: have demons traded no survival benefit. But drug makers aren't 246 00:13:03,040 --> 00:13:06,120 Speaker 1: the only ones cashing in on cancer treatment. I'm very 247 00:13:06,120 --> 00:13:08,720 Speaker 1: curious for who's profited from the boom that we've been 248 00:13:08,760 --> 00:13:11,240 Speaker 1: talking about in cancer treatments and how they've profited. 249 00:13:11,520 --> 00:13:15,360 Speaker 3: Uh yeah, well, I mean, basically the short answer is everyone. 250 00:13:15,440 --> 00:13:18,280 Speaker 1: Bloomberg's Robert Langreth and a team of reporters, editors, and 251 00:13:18,360 --> 00:13:21,559 Speaker 1: data journalists have looked into many facets of the cancer 252 00:13:21,640 --> 00:13:25,760 Speaker 1: industrial complex. They've dug into issues ranging from hospital markups 253 00:13:25,800 --> 00:13:28,200 Speaker 1: on medications that have been around for a while to 254 00:13:28,240 --> 00:13:30,079 Speaker 1: the gamification of clinical trials. 255 00:13:30,240 --> 00:13:34,359 Speaker 3: Well, I mean, drug industry clinical trials are lucrative. 256 00:13:34,840 --> 00:13:37,959 Speaker 1: One study published by the American Association for Cancer Research 257 00:13:38,360 --> 00:13:41,720 Speaker 1: estimated that drug companies spend eighty billion dollars a year 258 00:13:41,760 --> 00:13:45,400 Speaker 1: on clinical trials and oncology, and Bob says that money 259 00:13:45,520 --> 00:13:48,720 Speaker 1: has given rise to a sub industry of private clinical 260 00:13:48,760 --> 00:13:49,680 Speaker 1: trial operators. 261 00:13:50,000 --> 00:13:52,520 Speaker 3: So it used to be in the past that most 262 00:13:52,520 --> 00:13:55,480 Speaker 3: cancer clinical trials responsored by the government, by the National 263 00:13:55,520 --> 00:13:58,680 Speaker 3: Cancer Institute, And what's happened is the growth of industry 264 00:13:58,679 --> 00:14:02,920 Speaker 3: sponsor trialsmen and so enormous. Now cancer clinical trials are 265 00:14:02,960 --> 00:14:05,760 Speaker 3: pretty much dominated by the drug industry and drug industry 266 00:14:05,800 --> 00:14:10,520 Speaker 3: sponsor trials. But even at major academic centers medical centers, 267 00:14:10,559 --> 00:14:13,000 Speaker 3: you know, having some of these drug industry trials there, 268 00:14:13,120 --> 00:14:15,600 Speaker 3: that has a benefit in terms of prestige. And you 269 00:14:15,640 --> 00:14:18,840 Speaker 3: give the gold lecture at the big cancer conference in 270 00:14:18,840 --> 00:14:20,880 Speaker 3: front of thousands of people if you're in on the 271 00:14:20,920 --> 00:14:24,200 Speaker 3: right trial. So there are just many ways that the 272 00:14:24,280 --> 00:14:26,720 Speaker 3: system kind of rewards all the participants. 273 00:14:28,160 --> 00:14:30,800 Speaker 1: So where does the cancer industrial complex go from here? 274 00:14:31,440 --> 00:14:34,240 Speaker 1: Earlier this year, the Trump administration announced it had reached 275 00:14:34,240 --> 00:14:36,840 Speaker 1: a deal with Pfizer to sell its drugs at lower 276 00:14:36,880 --> 00:14:40,440 Speaker 1: prices to Medicaid patients. The President has also issued an 277 00:14:40,480 --> 00:14:43,400 Speaker 1: executive order to support the use of AI in childhood 278 00:14:43,400 --> 00:14:47,160 Speaker 1: cancer research. But those moves come amid significant funding cuts 279 00:14:47,200 --> 00:14:50,880 Speaker 1: at the US's chief drug regulators and research agencies. Since 280 00:14:50,880 --> 00:14:54,240 Speaker 1: Trump took office, the National Institutes of Health has canceled 281 00:14:54,360 --> 00:14:57,640 Speaker 1: or frozen more than two billion dollars in research grants. 282 00:14:58,120 --> 00:15:01,160 Speaker 1: The administration has also proposed cutting the NIH's budget by 283 00:15:01,200 --> 00:15:04,720 Speaker 1: nearly forty percent in twenty twenty six, and Bob says 284 00:15:04,760 --> 00:15:07,600 Speaker 1: that comes alongside deep cuts at the Centers for Disease 285 00:15:07,600 --> 00:15:10,120 Speaker 1: Control and Prevention and the Food and Drug Administration. 286 00:15:10,520 --> 00:15:11,920 Speaker 3: The short way of putting it is, you know, the 287 00:15:12,000 --> 00:15:13,560 Speaker 3: fd and CDC here in turmoil. 288 00:15:13,640 --> 00:15:13,800 Speaker 2: Now. 289 00:15:13,800 --> 00:15:14,720 Speaker 3: It's that period of. 290 00:15:14,640 --> 00:15:15,800 Speaker 1: Like rapid shave. 291 00:15:16,840 --> 00:15:20,440 Speaker 3: Like obviously the FDA director typically changes with the new administration. 292 00:15:20,560 --> 00:15:23,240 Speaker 3: That standard, but it's not standards that kind of you know, 293 00:15:23,320 --> 00:15:28,200 Speaker 3: the civil servants leading the major centers, they've all been 294 00:15:28,360 --> 00:15:30,320 Speaker 3: you know, pretty much replaced or. 295 00:15:30,240 --> 00:15:34,240 Speaker 1: Forced out, even amid a changing regulatory landscape. Bob says, 296 00:15:34,280 --> 00:15:38,640 Speaker 1: there have been unquestionable successes. The American Cancer Society says 297 00:15:38,920 --> 00:15:42,360 Speaker 1: US cancer death rates have fallen thirty four percent from 298 00:15:42,360 --> 00:15:45,520 Speaker 1: their peak in nineteen ninety one thanks to early detection 299 00:15:45,720 --> 00:15:49,680 Speaker 1: and a decline in smoking. Immunotherapies have also revolutionized the 300 00:15:49,680 --> 00:15:53,400 Speaker 1: treatment of certain cancers like melanoma and improved outcomes in others. 301 00:15:53,760 --> 00:15:56,160 Speaker 3: One of the types of drugs that clearly does improve 302 00:15:56,200 --> 00:15:59,320 Speaker 3: patient survival is this type of drug called amminotherapy, and 303 00:15:59,400 --> 00:16:01,360 Speaker 3: the most proper an example of that is k true 304 00:16:01,400 --> 00:16:03,680 Speaker 3: to from Mirk. It's the biggest selling drug in the world, 305 00:16:03,840 --> 00:16:06,440 Speaker 3: and it's is showing to extend patients survival for a 306 00:16:06,520 --> 00:16:09,000 Speaker 3: number of cancers. These drugs kind of work a little 307 00:16:09,000 --> 00:16:11,920 Speaker 3: bit like an on off mechanism to stimulate the immune system, 308 00:16:11,920 --> 00:16:14,120 Speaker 3: and once the immune system is turned on against cancer, 309 00:16:14,160 --> 00:16:16,600 Speaker 3: you don't need a lot more of the drug. That's 310 00:16:16,600 --> 00:16:18,240 Speaker 3: a very simple way to think of that, and. 311 00:16:18,200 --> 00:16:20,960 Speaker 1: Bob says researchers around the world are now looking into 312 00:16:20,960 --> 00:16:23,960 Speaker 1: whether it's possible for those drugs to achieve similar results 313 00:16:24,200 --> 00:16:27,600 Speaker 1: with lower doses. The finding that, if true, could have 314 00:16:27,640 --> 00:16:30,440 Speaker 1: big ramifications for patients and drug makers. 315 00:16:30,720 --> 00:16:32,920 Speaker 3: I went to India, and there are many centers in 316 00:16:32,920 --> 00:16:35,120 Speaker 3: India that are now testing these drugs at a quarter 317 00:16:35,400 --> 00:16:38,000 Speaker 3: to one six to the approved doses, and they say 318 00:16:38,000 --> 00:16:40,920 Speaker 3: they've gotten very little help from the major drug makers 319 00:16:40,920 --> 00:16:43,480 Speaker 3: in the US, and they're finding as best they can tell, 320 00:16:43,560 --> 00:16:46,560 Speaker 3: you know, there's little obvious difference in the efficacy. Now, 321 00:16:46,600 --> 00:16:50,880 Speaker 3: this is mostly preliminary studies, often you know, very small, 322 00:16:51,240 --> 00:16:53,440 Speaker 3: but there's a few larger studies starting to roll in, 323 00:16:53,560 --> 00:16:57,560 Speaker 3: so there's evidence emerging, you know that sometimes these drugs 324 00:16:57,600 --> 00:17:01,680 Speaker 3: may be effective at much lower doses. But researchers say 325 00:17:01,760 --> 00:17:04,720 Speaker 3: that I talked to say that big drug companies have 326 00:17:04,720 --> 00:17:07,199 Speaker 3: little incentive to test these drugs at lower doses. All 327 00:17:07,200 --> 00:17:09,560 Speaker 3: they're going to do is can reduce their revenue, and 328 00:17:09,600 --> 00:17:12,680 Speaker 3: that means that many people in the world, the rest 329 00:17:12,680 --> 00:17:14,520 Speaker 3: of the world, you know, may not get these drugs. 330 00:17:14,760 --> 00:17:18,359 Speaker 1: Last year, the FDA issued new guidance recommending more randomized 331 00:17:18,400 --> 00:17:22,000 Speaker 1: testing of various doses and cancer drug studies. Still, the 332 00:17:22,080 --> 00:17:25,360 Speaker 1: agency relies on the manufacturers to submit their own supporting 333 00:17:25,440 --> 00:17:28,919 Speaker 1: data and only has the authority to force labeling changes 334 00:17:28,920 --> 00:17:32,919 Speaker 1: for marketed drugs based on new safety information. A spokesperson 335 00:17:32,960 --> 00:17:36,640 Speaker 1: told Bloomberg quote the FDA will continue to use golden 336 00:17:36,720 --> 00:17:40,479 Speaker 1: standard science in its evaluation of drugs and appropriate dosing. 337 00:17:41,840 --> 00:17:44,600 Speaker 1: We'll ask you, Leslie, what you're reporting, What these findings 338 00:17:44,600 --> 00:17:47,080 Speaker 1: would mean for somebody who might find himself or herself 339 00:17:47,560 --> 00:17:51,199 Speaker 1: facing a cancer diagnosis thinking about treatment. What can we 340 00:17:51,280 --> 00:17:54,280 Speaker 1: learn from the reporting about how better to navigate what 341 00:17:54,680 --> 00:17:57,400 Speaker 1: for everyone I think is a daunting and complex process. 342 00:17:57,840 --> 00:18:00,240 Speaker 3: First of all, i'd say, you know, search for you know, 343 00:18:00,320 --> 00:18:03,359 Speaker 3: drugs and treatments that have approven survival advantage. You know, 344 00:18:03,560 --> 00:18:06,760 Speaker 3: and you want the metric called overall survival. If it 345 00:18:06,800 --> 00:18:10,119 Speaker 3: doesn't say the words overall survival, that's not survival. You 346 00:18:10,160 --> 00:18:14,360 Speaker 3: want that. Don't automatically assume that more is better, which 347 00:18:14,400 --> 00:18:16,119 Speaker 3: is kind of an assumption that's kind of baked in. 348 00:18:16,200 --> 00:18:19,120 Speaker 3: You know, three drugs helps, maybe four drugs will help 349 00:18:19,480 --> 00:18:23,439 Speaker 3: even more. Because cancer drugs have side effects, and the 350 00:18:23,440 --> 00:18:25,439 Speaker 3: more treatment you layer on, the more side effects you're 351 00:18:25,480 --> 00:18:28,640 Speaker 3: laying on it laying on. At some point those side effects, 352 00:18:28,720 --> 00:18:31,920 Speaker 3: you know, could outweigh the benefits of the treatment. And 353 00:18:32,560 --> 00:18:37,159 Speaker 3: keep in mind the drug company clinical trials by necessity 354 00:18:37,240 --> 00:18:39,560 Speaker 3: are tested on kind of like best case scenarios. These 355 00:18:39,560 --> 00:18:42,840 Speaker 3: are patients that are kind of probably have fewer other 356 00:18:42,920 --> 00:18:46,840 Speaker 3: comorbid conditions than the average person. You know, they're tend 357 00:18:46,880 --> 00:18:48,840 Speaker 3: to be tested on people with advanced cancer and no 358 00:18:48,920 --> 00:18:51,080 Speaker 3: other diseases. Often in the real world, you have advanced 359 00:18:51,080 --> 00:18:53,320 Speaker 3: cancer and heart disease and alzheim and three other things. 360 00:18:53,320 --> 00:18:55,399 Speaker 3: So and you're more likely to get those side effects 361 00:18:55,400 --> 00:18:57,960 Speaker 3: that they say, oh rare. So, you know, so keep 362 00:18:57,960 --> 00:19:01,560 Speaker 3: in mind that the drug industry Trials TEPICO represents the 363 00:19:01,640 --> 00:19:05,320 Speaker 3: best case scenario for drag outcome and minimizing side effects. 364 00:19:13,920 --> 00:19:16,680 Speaker 1: This is the Big Take from Bloomberg News. I'm David Gurat. 365 00:19:16,680 --> 00:19:18,959 Speaker 1: To get more from The Big Take and unlimited access 366 00:19:19,000 --> 00:19:22,000 Speaker 1: to all of Bloomberg dot com, subscribe today at Bloomberg 367 00:19:22,040 --> 00:19:25,520 Speaker 1: dot com slash podcast offer. If you like this episode, 368 00:19:25,600 --> 00:19:27,639 Speaker 1: make sure to follow and review The Big Take wherever 369 00:19:27,680 --> 00:19:30,080 Speaker 1: you listen to podcasts. It helps people find the show. 370 00:19:30,480 --> 00:19:32,360 Speaker 1: Thanks for listening. We'll be back tomorrow.