Chemo?

The sneaky way Big Pharma is ripping off cancer patients to the tune of $3 billion per year

Photo by Matt Roth for the New York Times

Photo by Matt Roth for the New York Times

Imagine this scenario. There is only one tire store in your city. You go to the tire store to get some new tires put on your car. The man behind the counter tells you that new tires only come in packs of five. So you have to buy five tires when you may only need four, or two. And there’s one more thing. You can’t keep the extra tires you paid for. They have to throw them away.

WASHINGTON — The U.S. federal Medicare program and private health insurers waste nearly $3 billion every year buying cancer medicines that are thrown out because many drug makers distribute the drugs only in vials that hold too much for most patients.

The expensive drugs are usually injected by nurses working in doctors’ offices and hospitals who carefully measure the amount needed for a particular patient and then, because of safety concerns, discard the rest.

If drug makers distributed vials containing smaller quantities, nurses could pick the right volume for a patient and minimize waste. (That makes way too much sense) Instead, many drug makers exclusively sell one-size-fits-all vials, ensuring that many smaller patients pay thousands of dollars for medicine they are never given. This is according to researchers at Memorial Sloan Kettering Cancer Center, who published a study on Tuesday in BMJ.

Some of these medicines are distributed in smaller vial sizes in Europe, where governments play a more active role than the United States does in drug pricing and distribution.

“Drug companies are quietly making billions forcing little old ladies to buy enough medicine to treat football players, and regulators have completely missed it,”

said Dr. Peter B. Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering and a co-author of the study. “If we’re ever going to start saving money in health care, this is an obvious place to cut.”

The researchers analyzed the waste generated by the top 20 selling cancer medicines and concluded that insurers paid drug makers $1.8 billion annually on discarded quantities and then spent about $1 billion on markups added by doctors and hospitals.

One example from the study is Velcade, a multiple myeloma and lymphoma drug that only comes in 3.5-milligram vials that sell for $1,034. This dose is enough to treat a person who is 6’6″ and weighs 250lbs. If a patient is smaller, then a quantity of the precious powder is thrown away.

Lena Haddad, 53, of Germantown, MD., who has been living with multiple myeloma for four years, now gets a weekly dose of 1.8 milligrams of Velcade. On a recent day at Ms. Haddad’s doctor’s office in Bethesda, Md., a nurse, Patricia Traylor, took a vial of Velcade from a large drug cabinet. She injected a syringeful of saline into the vial and shook it, pushed a needle into the vial and withdrew about half the contents. Then she threw out the vial with the remaining medicine.

Safety standards permit nurses to use drug leftovers in other patients only if used within six hours and only in specialized pharmacies.

Told that she was using only about half of the drug that was purchased, Ms. Haddad said she was shocked.

“No wonder my premiums keep going up,” she said.

Medicare and many private insurers charge patients drug co-payments of as much as 20%, which can add up to tens of thousands of dollars annually for the latest drugs; much is spent on cancer medicines that patients never receive.

Dr. Dixie-Lee Esseltine, vice president for oncology clinical research at Takeda, wrote in an email that the pharmaceutical firm “worked closely with the F.D.A. to establish the Velcade vial size of 3.5 mg to ensure that one vial of Velcade would provide an adequate amount of the drug for a patient of almost any size.”

Takeda is expected to earn $309 million this year on supplies of Velcade that are discarded, an amount that represents 30 percent of the drug’s overall sales in the United States, the cancer researchers estimated. If Takeda provided an additional vial size of 0.25 milligram, waste would be slashed by 84 percent, also reducing Velcade’s sales in the United States by $261 million annually, the researchers calculated.

“You have these incredibly expensive drugs, and you can only buy them in bulk,” said Dr. Leonard Saltz, who leads the pharmacy and therapeutics committee at Memorial Sloan Kettering and was a co-author of the study. “What’s really interesting is they’re selling these drugs in smaller vials in Europe, where regulators are clearly paying attention to this issue.”

Velcade is sold in Britain in both 1-milligram and 3.5-milligram vials.

Christopher Kelly, a spokesman for the FDA, said the agency objected to companies’ proposed vial sizes only if it believed that an excessively large volume of medicine “could lead to medication errors or safety issues due to inappropriate multiple dosing.”

In other words, as long as nurses are not tempted to do anything but discard additional quantities, the drug agency is fine with extra-large, one-size-fits-all packaging. Congress has not given the drug agency the authority to consider cost in its decisions. (Because the pharmaceutical industry owns congress and the FDA)

“(Drug) companies propose the vial sizes that they would like to market,” Mr. Kelly said.

Rising drug prices have been a concern for many years, and high initial prices and subsequent increases are an industrywide phenomenon.

The last 10 cancer drugs approved before July 2015 have an average annual price of $190,217, and major drug makers routinely increase the prices of big sellers by 10% or more each year, far above the rate of inflation.

The industry explains that high prices are needed to fund research, but companies such as Pfizer and Merck spend just 17% of their revenues finding new drugs, according to their financial statements. Far more goes to marketing and profits.

For decades, cancer doctors largely ignored the issue of pricing, but as their patients became impoverished, some began to speak up. In 2012, Dr. Bach and Dr. Saltz wrote an Op-Ed article in The New York Times announcing that their hospital would not purchase a new cancer drug that was twice as expensive as but no more effective than an existing medicine. The maker of the drug slashed its price.

Dr. Bach and Dr. Saltz say they have since become concerned that prices of new cancer medicines have almost no connection with their lifesaving potential. Dr. Bach recently unveiled a complex calculator of drug value.

But there was nothing complex about measuring the value of a drug that was thrown away, Dr. Saltz said, since the value to the patient was zero.

The two doctors have proposed that the government either mandate that drug makers provide medicines in enough vial sizes to minimize waste, or mandate that drug makers refund the government for wasted quantities.

Dr. Saltz first noticed the problem of waste when he was considering adding Keytruda, a new immunotherapy drug for metastatic lung cancer and melanoma, to the hospital’s list of drugs to be used on patients. Although a 150-pound patient would need 136 milligrams of the drug, Dr. Saltz noticed that Merck, its manufacturer, sold the medicine only in 50-milligram vials — ensuring waste.

“I thought that was really cynical,” Dr. Saltz said in an interview. “And then it got worse.”

In February 2015, Merck introduced 100-milligram vials and stopped selling Keytruda in 50-milligram vials, ensuring far larger amounts of waste. The company still sells 50-milligram vials of the drug in Europe.

Pamela L. Eisele, a Merck spokeswoman, said the company hoped to persuade the F.D.A. to approve a fixed dose of 200 milligrams of Keytruda for all patients, higher than the dose presently given to nearly all patients. In studies given to the drug agency, there was no evidence that the higher dose was more effective, Ms. Eisele said, but the fixed dose “will eliminate wastage.”

Since the extra medicine does nothing to help patients, Dr. Bach said that the company was advocating that waste be injected into patients rather than thrown away. (This is insane)

Under its present dosing, Merck would earn $2.4 billion over the next five years from discarded quantities of Keytruda, half of which would result from switching to 100-milligram vials, the researchers estimated.

Some cancer drugs have little waste. Treanda, which is used to treat leukemia and non-Hodgkin’s lymphoma and is manufactured by Teva Pharmaceuticals, is packaged in four separate dosages so only 1 percent of the drug is wasted, on average.

But 18 of the top 20 cancer medicines are sold in just one or two vial sizes, so on average 10% of the volume of cancer drugs purchased by doctors and hospitals is discarded, the researchers say.

BMJ Study 

Article Source New York Times

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  • SpeakinDaFacts

    This is utterly disgusting. More needs to be done about this!

  • LANI

    So true. “Let food be thy medicine…..” Hippocrates. Read the BIBLE and it talks about sorcery and pharmakon/pharmacea and idolatry….making large profits which is destroying our bodies/lives. BIBLE is TRUTH. Thank you, Chris, for pointing this out. I had breast cancer (DCIS, Stage 0)…I was told Stage 1 only to find out it was Stage 0 DCIS (discovered immediately after first mammo. FIRST MAMMO!!!! They offered me tamoxifen too but it’s a HUMAN CARCINOGEN!!!! My onc. didn’t want to hear of side effects and finally, in the end, she said side effects will outweigh the benefits for me. LOL. So, I said goodbye and found me a new one who is very supportive of my dec. It’s my body and God gave me life. I need to take care of it the way HE wants me to. AMERICAN CANCER SOC. asked me for donation and I said NO. I’m in the medical field and have done a lot of research. I know who’s behind all those companies asking for donations to find cure. We know where all the money is going! The big guys are getting greedier and greedier by the minute. I have read a recent article about Pfizer and their new breast cancer drug costing almost $10k a month. Are you kidding me? Look, only GOD knows our lives. He holds out lives in his hands. This thing with the pharmaceutical industry is just not the way to go! Do research, take control of your life and do what is right for you and trust in GOD and his power to heal. God bless.

  • chris

    It would be great if 100% of all patients would do exactly the same what LANI did. So it seems like the opened vials are landing in trash, ending up in ground waters sooner or later? Most probably ALL chemodrugs are carcinogens, so what we are ending up is a slow but steady MASSIVE POISONING of everyone of us alone through water pollution?

  • suesjoy

    Good point! I wrote an article for Gerson when I worked for them about the effect of pharmaceuticals in the ecosystem in rivers and lakes. I need to look for it. I talked about Lake Havasu, and the effect of a massive amount of birth controls that are leached into the lake from hotels in Las Vegas. It’s really frightening.

  • Ron

    Hi Chris. Someone sent me this info (attached poster) about chemotherapy. Can you (or anyone else) explain how they come up with such high survival rates? Thanks.

    • Chris Wark

      Keep in mind these are averages. Accurate 5-year survival statistics depend on what stage the patient is at diagnosis. If you average all the stage 1’s and the stage 4’s together, it paints a much rosier picture.

      Prostate cancer is very slow growing and not life threatening for most men who have it. In fact most men who have prostate cancer die of something else, like old age.

      Breast cancer survival rates are high, not because treatments have gotten better, but because early diagnosis (over diagnosis) is catching stage 0 breast cancer, which isn’t actually cancer, but those women are added to the statistical pool, making the average overall 5-year survival rate look better.

  • jkelvin

    forever grateful.I am here to testify about my life.
    i was diagnose of thyroid cancer,stage 4 and my doctor told me that my chance of living depend on no medication but only almighty God. so I gave up started praying and I was patiently waiting for my death until one day my boss visited and told me about Mr Robert, how he helped his wife fight against cancer. so I decide to give it a try with the help of the email he gave me #ricksimpson98@gmail.com I purchase 60grams of cannabis oil from the medical centre. with the help of God after 3 months now, I am back to my normal life. I am very grateful and I will continue to testify about Roberts and save more life. contact email ricksimpson98@gmail.com.

  • Angela Bello

    great testimony I must share to all cancer patients in the world. My husband was diagnosed with stage 4 primary liver cancer in March 2013. The doctor told us there was not much to be done since the tumor was 7 inches covering his lower lobe and also had spread to his lymph nodes. We decided to go home and called hospice which gave us morphine for pain. Ed hated the morphine which made him vomit and also affected his mind. After one week at home we decided to do what we have done for many years, rely on ourselves. We were only in Hospital for 3 days with severe Pain. The cancer had blocked his bile duct, after that we choose a Naturopath doctor and have not had conventional treatments. one day i came across the use of cannabis oil for treatment of cancer and i saw a post on how a cancer patient was cured with cannabis oil. I urgently needed help and i contacted the RICKSIMPSON98@GMAIL.COM to get the cannabis oil, i was given instructional guide on how to use it. After taking a gram of oil per day. Within a couple of weeks his pain and swollen stomach disappeared and with it came hope and a good quality of life. We never saw an oncologist and only have done a blood test after the first diagnose CT scan. His tumor marker went from over 6000 to normal and he is feeling well. We don’t know how this is going to play out, but enjoy every day and give thanks. As i am writing this post, my husband is free from liver cancer and the doctor confirmed that the cancer was cured permanently. For immediate assistance on every medical issue you and your family may be experiencing,

  • jkelvin

    forever grateful.I am here to testify about my life.
    i was diagnose of thyroid cancer,stage 4 and my doctor told me that my chance of living depend on no medication but only almighty God. so I gave up started praying and I was patiently waiting for my death until one day my boss visited and told me about Mr Robert, how he helped his wife fight against cancer. so I decide to give it a try with the help of the email he gave me #ricksimpson98@gmail.com I purchase 60grams of cannabis oil from the medical centre. with the help of God after 3 months now, I am back to my normal life. I am very grateful and I will continue to testify about Roberts and save more life.

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