Americans are rightly furious about the high and unsustainable price of cancer drugs, which now routinely cost more than $100,000 per year of therapy. Those prices are made worse by the fact that most cancer drugs offer only modest benefits — one study put the median benefit at 2.1 extra months of life — along with the fact that expert physicians frequently recommend these drugs for off-label uses, meaning using a drug for a purpose it was not initially approved for.
The House of Representatives, the Senate, presidential candidates, and even the president have floated proposals to tackle drug prices. While all contain good ideas, none address one of the elephants in the room: the experts who tell doctors how to use these medications.
Expert physicians play an oversized role in cancer medicine. They write the editorials in major medical journals that can influence physicians’ prescribing practices, they give educational sessions at national meetings, and they decide what evidence is good enough for off-label use. Spoiler alert: That evidence is often weak. All of this might be fine if experts offered neutral or unbiased information, but evidence suggests they do not.
One study found that 85% of the experts who wrote widely used cancer guidelines had received payments averaging more than $10,000 from pharmaceutical companies. These guidelines mandate that Medicare pay for off-label use of cancer drugs. Research also shows that physicians who consistently put pharmaceutical money in their bank accounts are more likely to prescribe that company’s drugs.
Financial conflict of interest in cancer medicine matters. The pharmaceutical industry is run by intelligent people who choose to pay physicians millions of dollars. It is hard to believe they have not calculated that this aids their bottom lines. Within the profession, there is little interest in reform. Our rules are suggestions. Our punishments lack teeth.
Last year, Dr. José Baselga, the physician-in-chief at Memorial Sloan Kettering Cancer Center, was found to have violated the disclosure policies of several medical journals across dozens of publications. Baselga resigned from his position, but his “punishment” lasted only 116 days before he was named executive vice president of AstraZeneca (AZN), a prominent and coveted industry position.
Want more proof that cancer doctors don’t take conflicts of interest seriously? At the American Society of Clinical Oncology meeting, a major national cancer meeting, speakers are asked to disclose their conflicts of interest at the beginning of their talks. My team found that 38% of slides were flashed faster than a human being can read. That isn’t disclosure. It’s a token gesture.