Sunday, May 1, 2005 (SF Chronicle)
David Ewing Duncan

For 30 years, prognosticators have proclaimed that the future of health
care belongs to biotechnology -- to the promise that miraculous and
less-expensive treatments will flow from a deeper understanding of disease
at the genetic and molecular level of the human body.
This hoped-for bright future will affect California in two ways: One of
every 10 U.S. health care dollars -- a total of more than $1.6 trillion
last year -- is spent in this state, and the epicenter of the biotech
industry is the Bay Area.
Has the future arrived?
Yes and no.
Yes in the case of a few wonder drugs, and in the wealth of research that
has inched us closer to teasing out the basic mechanisms of how ailments
work.
The drugs are expensive for patients, and cost a fortune to create and
develop, but the handful of biotech home runs, such as synthetic insulin
in the 1980s and the new anti-cancer drugs Avastin and Erbitux have vastly
improved lives. They may very well reduce health care costs one day by
keeping people out of hospitals and away from costly surgeries and other
interventions.
But the bright future hasn't arrived in this sense: The price tag for
creating a promised proliferation of new drugs continues to soar, with the
secrets of how to design molecular-based drugs proving frustratingly
complex, and far more expensive than anyone imagined.
Tens of billions of dollars have been spent in the past 10 years alone in
research and development to produce a dozen or so major drugs and several
dozen treatments for rare diseases. Those treatments are a great boon for
the patients concerned, but the balance sheet for the industry remains
deeply in the red.
Successful drugs reflect this cost at the retail level, with some biotech
drugs priced in the thousands of dollars a month.
Even when new drugs contribute to reducing overall costs for the total
health care system, individuals don't always see the savings.
No one draws up personal budgets based on, for example, the savings they
realized by avoiding an operation for colon cancer because they took South
San Francisco-based Genentech's Avastin.
But people do know when they have to pay thousands of dollars a year for
drugs -- particularly when insurance does not cover all or part of the
cost, and the cash comes out of pocket. Avastin, the first drug of its
kind, works by restricting the blood vessels that supply cancerous tumors
with oxygen and nutrients. It increases average survival rates by several
months for 150,000 patients a year diagnosed with colon cancer.
For some, it saves their lives. It is far less toxic than traditional
chemotherapies. Recently, Avastin has been shown to reduce tumors in lung
cancer and breast cancer.
Its cost, however, is a whopping $4,000 a month during a typical colon
cancer patient's treatment of about 10 months -- or $40,000 total. This is
far more than traditional chemotherapies, which cost a few hundred dollars
a month.
Another unique cancer drug, ImClone's Erbitux, which stimulates the body's
antibodies to fend off cancer, costs up to $12,000 a month, though it is
taken for a shorter period of time.
The wholesale cost for all drugs to treat each colon cancer patient
(treatment is usually in the form of multiple drugs) has climbed to
$250,000 today, says cancer doctor Leonard Saltz of Memorial
Sloan-Kettering Cancer Center in New York City.
Cancer in the United States requires about $64 billion a year in direct
costs to treat, and $125 billion more in lost productivity, according to
the National Cancer Institute. Avastin, Erbitux and other expensive wonder
drugs add to this cost.
"How can we afford to pile $20,000-a-year drugs on top of $20,000-a-year
drugs?" asked Michael Friedman, CEO of City of Hope National Medical
Center in Los Angeles in an interview last week with BusinessWeek.
The pharmaceutical and biotech industries argue that in the long run, new
drugs will save money. Heart drugs, such as those that lower cholesterol,
do save money by preventing surgery.
Twenty years ago, biotech broke into prime time by coming up with
synthetic insulin and growth hormones, and with drugs, such as synthetic
erythropoietin, that stimulate bone marrow to ramp up the production of
red blood cells for patients suffering from anemia, particularly cancer
patients and patients on dialysis.
These drugs are still expensive, but they do save lives, and in some
cases, they save money in the long run by keeping people healthy who would
otherwise need expensive medical treatment.
Biotech also has enormous potential to find cures in areas such as stem
cells and nanotechnology -- although the costs likely will be high.
One day soon, society will need to weigh the benefits and costs of these
treatments and soberly assess whether we can afford the bill -- even with
so many lives at stake.
The potential of biotech as a potent weapon to fight disease is being
established, and we can hope that biotech will pay for itself -- and
provide the long-promised miracles for less -- but that remains to be
determined.

David Ewing Duncan is a science writer and author of the forthcoming book,
"The Geneticist Who Played Hoops With My DNA ... and other masterminds
from the frontiers of biotech." E-mail the author at his Web site,
www.davidewingduncan.com. ----------------------------------------------------------------------
Copyright 2005 SF Chronicle