Center Professor Dr. Leonard Fleck recently returned from Geneva, Switzerland, where he participated in a three-day event at the Brocher Foundation. Dr. Fleck was one of about 80 past Brocher Fellows who presented their current work. Dr. Fleck gave a presentation centered on precision medicine and treating cancer, titled “Precision Medicine: Can We Afford Either the Ethical or Economic Costs?”
Abstract: The language of precision medicine (targeted therapies) suggests maximal efficiency and effectiveness, especially for treating cancer. However, most cancers are extraordinarily heterogeneous in terms of their genetic drivers, which results in emerging resistance to targeted therapies. Current clinical strategy for addressing this resistance is an AIDS-like strategy, using multiple targeted therapies, either simultaneously or sequentially. The goal is to make cancer a chronic health condition extending over years. But these drugs have costs of $100,000 or more for a course of treatment. For example, ipilimumab is used to treat advanced melanoma to gain an extra life-year for $130,000. When resistance develops, pembrolizumab can be given for another life-year for $150,000. 600,000 patients die of cancer annually in the US and 1.3 million in the EU. If all 600,000 patients were provided five extra life-years at $100,000 each, that would represent $300 billion annually just for this cohort (not even other cancer patients). I will argue that no considerations of health care justice (egalitarian, utilitarian, sufficientarian, luck egalitarian) can justify such an expenditure of social health care resources, which otherwise unjustly threaten any reasonable ordering of health care priorities. If social pressure and ethical argument cannot compress the price of these targeted therapies by 80%, then an internal prioritization process among such cancer patients would be ethically necessary. I critically assess several such possibilities and suggest that none may be “just enough.”
Dr. Fleck will be presenting this work at the 17th Annual ASBH Meeting this October.