Economist Steven Levitt and writer Stephen Dubner are two awesome dudes who teamed up to write two of my favorite books in the last few years:
Freakonomics and SuperFreakonomics.
They use research and statistical analysis to solve some of the most complex riddles of modern life. Absolutely fascinating stuff.
I was thrilled when I recently discovered that they had spent some time analyzing the cancer treatment industry, further proving what the natural/alternative health community has been saying for years. The question they ask and answer is this:
“Why is chemotherapy prescribed so often if it’s so ineffective?“
More than $40 Billion is spent worldwide each year on cancer drugs. In the United States, they constitute the second-largest category of pharmaceutical sales, after heart drugs, and are growing twice as fast as the rest of the market. The bulk of this spending goes to chemotherapy, which is used in a variety of ways and has proven effective on some cancers, including leukemia, lymphoma, Hodgkin’s disease, and testicular cancer, especially if these cancers are detected early.
But in most other cases, chemotherapy is remarkably ineffective.
An exhaustive analysis of cancer treatment in the United States and Australia showed that the five-year survival rate for all patients was about 63 percent but that chemotherapy contributed barely 2 percent to this result. There is a long list of cancers for which chemotherapy had zero discernible effect, including multiple myeloma, soft-tissue sarcoma, melanoma of the skin, and cancers of the pancreas, uterus, prostate, bladder, and kidney.
Consider lung cancer, by far the most prevalent fatal cancer, killing more than 150,000 people a year in the United States. A typical chemotherapy regime for no-small-cell lung cancer costs more than $40,000 but helps extend a patient’s life by an average of just two months. Thoma J. Smith, a highly regarded oncology researcher and clinician at Virginia Commonwealth University, explained a promising new chemotherapy treatment for metastasized breast cancer and found that each additional year of healthy life gained from it costs $360,000 – if such a gain could actually be had.
Unfortunately, it couldn’t. The new treatment typically extended a patient’s life by less than two months.
Costs like these put a tremendous strain on the entire health-care system. Smith points out that cancer patients make up 20 percent of Medicare cases but consume 40 percent of the Medicare drug budget.
Some oncologists argue that the benefits of chemotherapy aren’t necessarily captured in the mortality data, and that while chemotherapy may not help nine out of ten patients, it may do wonders for the tenth. Still, considering its expense, its frequent lack of efficacy, and its toxicity – nearly 30 percent of the lung-cancer patients on one protocol stopped treatment rather than live with its brutal side effects – why is chemotherapy so widely administered?
The profit motive is certainly a factor. Doctors are, after all, human beings who respond to incentives. Oncologists are among the highest-paid doctors, their salaries increasing faster than any other specialists’ and the typically derive more than half of their income from selling and administering chemotherapy drugs. Chemotherapy can also help oncologists inflate their survival rate data. It may not seem all that valuable to give a late stage victim of lung cancer an extra two months to live, but perhaps the patient was only expected to live four months anyway. On paper, this will look like an impressive feat: the doctor extended the patient’s remaining life by 50 percent.
Tom Smith doesn’t discount either of these reasons, but he provides two more.
It is tempting, he says, for oncologists to overstate – or perhaps over believe in – the efficacy of chemotherapy. “If your slogan is ‘We’re winning the war on cancer,’ that gets you press and charitable donations and money from Congress,” he says. “If your slogan is ‘We’re still getting our butts kicked by cancer, but not a s bad as we used to,’ that’s a different sell. The reality is that for most people with solid tumors – brain, breast, prostate, lung – we aren’t getting our butts kicked as badly, but we haven ‘t made much progress.”
There’s also the fact that oncologists are, once again, human beings who have to tell other human beings that they are dying and that, sadly, there isn’t much to be done about it. “Doctors like me find it incredibly hard to tell people the very bad news,” Smith says, “and how ineffective our medicines sometimes are.”
Despite the mountain of negative evidence, chemotherapy seems to afford cancer patients their last, best hope to nurse what Smith calls “the deep and abiding desire not to be dead.” Still, it is easy to envision a point in the future, perhaps fifty years from now, when we collectively look back at the early twenty-first century’s cutting-edge cancer treatments and say: We were giving our patients what?
The age adjusted mortality rate for cancer is essentially unchanged over the past half-century, at about 200 deaths per 100,000 people.
(End Quote) (Bold parts bolded by me)
Powerful stuff right? For the skeptics out there, Levitt and Dubner reference all their research, clinical studies, interviews, etc. in the back of the book.
Both Freakonomics books are a really fun read.
Freakonomics: A Rogue Economist Explores the Hidden Side of Everything: Things you always thought you knew, but didn’t.
Which is more dangerous: a gun or a swimming pool? Why do drug dealers still live with their moms?
Did legalized abortion reduce violent crime?
SuperFreakonomics: Global Cooling, Patriotic Prostitutes, and Why Suicide Bombers Should Buy Life Insurance: Things you never knew you wanted to know, but do.
What’s more dangerous driving drunk or walking drunk? Did TV cause a rise in crime?
Who adds more value a pimp or a realtor?
These guys are great. They’ve got a blog, podcast, and a Freakonomics movie.
Check out their website at freakonomicsbook.com.