Joe Biden won’t keep quiet against cancer

Vice President Joe Biden won’t be playing a lot of golf after he leaves office. Instead, he will continue to take his whacks against cancer through a new non-profit that will carry on the mission of the Cancer Moonshot program he chaired.  

A Washington Post article reports that the new organization will continue to advance the Moonshot goals, “including the need to knock down “silos” in cancer research and share research data and medical records more widely, boosting participation in clinical trials, and finding new ways to improve treatment provided by community oncologists. He said he also wanted to work on reducing racial disparities in diagnosis and treatment.”

{mosads}He will also focus on how to reduce drug prices. Biden said he is getting strong encouragement from throughout the cancer community to grapple with the pricing issue. “The researchers, the insurers, all of the major cancer centers. . . want me to pursue it.” He added that Greg Simon, executive director of the White House Moonshot Task Force, recently met with the pharmaceutical company officials. “They all realize they have a problem,” the vice president said.

The Biden initiative could make a real contribution to the pricing discussion. Unlike many other politicians, Biden is well aware of the factors and reimbursement practices – particularly the rigged system of rebates – that influence the launch price of new medicines.   

First, Biden will not ignore the long-term savings and gains generated by the appropriate use of drugs.  Indeed, though less than 1 percent of health care spending goes to new cancer drugs, such innovation has helped save 50 million life years, worth $3 trillion to our economy.

Second, he is aware of how insurers limit access to new medicines to generate as much rebate revenue as possible.  He is aware of the discriminatory nature of drug plans that single out people with cancer and other complex, chronic diseases with high out of pocket costs, and that health insurers set the price people must pay for medications. The time to eliminate the artificial financial barriers to care is now.  There are lots of ways to finance innovations that pay off long term, and they don’t involve making medicines unaffordable.

Third, he is aware that changing the way drugs are evaluated and approved by the FDA can bring down the cost of innovation.  The price of a medicine reflects the total expected cost of developing a new drug. The launch price also reflects the firm’s opportunity cost of investment capital. More likely success, shorter development times, and faster access to patients will lower expected development costs. That will create real competition where little now exists. And just as fracking reduced the cost and risk of finding energy, technological advances in drug development can yield high returns at a lower cost.

As Biden has noted, we know what patients will benefit from specific medicines in early trials. It is time to fully apply these insights to make the Food and Drug Administration’s program of speeding breakthrough cancer drugs to approval the new normal.  

Fourth, using genomics and big data, it’s possible to collect and analyze real-world use of combinations of cancer medicines instead of waiting years to find out what cocktail of medications work. The data from the clinical use of these cocktails can then be used by researchers, the FDA and health plans to rapidly reduce trial and error cancer treatment and improve survival, well-being, and quality of life.

Finally, Biden will be in a position to improve the relationship between academic medicine and private industry. At present, the relationship is like that of North Korea and the U.S. but with more food choices.  At present, the interactions are defined by a set of ideas that demonize the private medical products industry, and that is promulgated by the principal beneficiaries of the relationship between the government and research institutions, such as university officials and medical-journal editors.  If anyone can reduce the hostility, Biden can.  

Vice President Biden has said that “I’m leaving, but I’m not going to be quiet.” That’s great news for everyone affected by cancer. We need his voice, his passion, and political acumen to not just “reimagine but transform the cancer system of the 20th Century for the 21st Century to match the breakthroughs creating an inflection point in this fight.”