Oncology Unscripted With John Marshall: Episode 2: Why is Cancer so Expensive? With Special Guest Dr. Laura Esserman

John Marshall, MD: Hey everybody, John Marshall for Oncology Update. Believe it or not, second episode. They let me do a second one. There's bad judgment on their part.

ASCO Buzz

[00:00:13]

We're just back from ASCO, so you know how everybody's doing. You're still trying to pile out of your emails and figure out if you're actually going to get reimbursed for that dinner or not try for it. You never know. It might work out. 

Let's start and kind of reflect a bit on this meeting, that is ASCO. You know, is it really a medical meeting, or is it really a celebration? Let's think about this. You walk into that place, there's signs everywhere. You get out at O'Hare Airport, there's signs everywhere. They're welcoming you to ASCO. You get a bunch of cancer centers marketing their cancer centers that aren't in Chicago, in the Chicago airport. And then you get to the meeting itself, it's like a celebration. You go in to where the booths are now. This makes it look like we have won, that we have cured cancer! The lights are going off, everything is all shiny and sparkly, the carpets are extra cushiony when you get onto one of the drug company booths.

I asked people while we were there which booth was by far the over-the-top booth and there is a clear winner here. We're going to give it to AstraZeneca. Amazing booth. Also, the most likely to cause a seizure was this booth, the lights and everything going on; most likely to cause a seizure for sure.

But there was also a really fun booth. I'm not going to name the company where it came from, but they had the most funky lights. There were these huge tubes that were bigger than a human. And all the lights were hanging from the ceiling from these huge tubes. All I could think about as I was walking by is that, somehow, those things must be really for erectile dysfunction, right? I mean, that's kind of what it looked like—it solved that problem. I went to the booth, turned out, no, they were just decorative. Not any erectile dysfunction problem at all. But, you know, go figure. It's what it seemed like to me.

It was clearly a super spreader event. We pretty much figured out that the best COVID comes from Western Europe, the sort of romance language part of Europe. The Germanic language part not so good, their COVID is more serious, the romance language COVID is the best. 

There weren't many community oncologists there because they had to make a decision to go there, lose RVUs to gain CME. And that trade off just wasn't there for them. If you remember from the first episode, when we really drilled down on the RVU and its value, it's going to be a disincentive for somebody to go to a medical meeting like this to try and learn the state of the art of cancer care. So, clearly that's not who was at this meeting. 

Probably the wildest thing I heard somebody say was that when I was asking about the booth, and a typical booth, even a small, modest booth might cost half a million dollars, is that they came back and said, ‘you know what, this is a good use of our money.’ Wait a second, half a million dollars, that could fund a phase 2, small phase 2, clinical trial for goodness sake. So, you know, is that the best use of your money is to have this big booth, and then the other part is who's paying for those booths? That's our health care dollar at work, whether it's the National Cancer Institute's booth, which is our tax dollars at work, or the pharmaceutical industry and all the money that they have because of the health care industry. So, that's our money they're spending in there on these celebratory booths that we need to kind of come back and think about why is that the right way to go.

Our theme today is going to be all about costs and expense, and why is it so expensive? Why is cancer care so expensive? And we're going to really drill down on a few main areas around that, the cost of drugs and the cost of clinical research.

ASCO Wins

[00:04:17] Let's start with looking at the success, amazing success, of the clinical research that was presented at ASCO. There were three standing ovations among the five plenary abstracts that were presented, and the one that probably deserved it was a drug called osimertinib. You know, this is for EGFR-targeted non-small cell lung cancer. And the benefit was dramatic. A huge delta between the curves. And all of a sudden, everybody said, this is the way to go. I think probably yeah, there's a terrible disease. It's a therapy that works very, very well. Huge improvement in outcome for patients in the curative setting. All in, right? We're all in in that group. Worth standing up and clapping for. 

But, did you know that the rumor is, a little gossip, that, uh, that the other two standing ovations also, drug therapy studies were actually s