Freakonomics & Cancer

I'm reading Super Freakonomics (having read Freakonomics some time back) on Kindle loan from the library - and I'm highly recommending it to anyone out there reading this.  I'd only gotten to the second chapter and already come across several things I almost stopped to post about, but this one I simply had to.

According to the book, in only a few types of cancer is chemotherapy statistically effective. 

"The age-adjusted mortality rate for cancer is essentially unchanged over the past half-century, at about 200 deaths per 100,000 people."

I don't know how much chemotherapy has burned up cancer patients' innards in that time, but it's been a lot.

"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 non-small-cell lung cancer costs more than $40,000 but helps extend a patient's life by an average of just two months.  Thomas J. Smith, a highly regarded oncology researcher and clinician at Virginia Commonwealth University, examined 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."

Two extra months of life, and in the meantime, how many months of brutal side effects from the chemo?  But doctors are going to continue to recommend chemotherapy for those cancer patients.

"Oncologists are among the highest-paid doctors, their salaries increasing faster than any other specialists', and they typically derive more than half of their income from selling and administering chemotherapy drugs. ... It is tempting, [Smith] 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 as bad as we used to,' that's a different sell." ... 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?

Sadly, I don't think so.  Not unless they come up with another method that makes as much money for the AMA and Big Pharma.