By Paul Howard
Special to washingtonpost.com's Think Tank Town
Tuesday, July 17, 2007 12:00 AM
Michael Moore's "Sicko" is now in national release, chock full of anecdotes and scare stories denigrating American health care in favor of the United Kingdom, Canada and even Cuba. But Moore ignores the fact that our greater commitment to market-driven medical innovation makes miracles possible for patients with the most deadly and rare diseases, like cancer.
Here's one story you won't see in Moore's film: During the recent NBA playoffs, Derek Fisher, a point guard for the Utah Jazz, discovered that his daughter Tatum, then 10 months old, was diagnosed with a rare form of cancer called retinoblastoma. (There are only 350 annual cases of retinoblastoma in the United States.) Left untreated, the cancer grows on the retina until it causes blindness and death. Luckily for Tatum and her family, the U.S. is the global leader in cancer treatment and research.
Tatum's story is a microcosm of how the United States is revolutionizing cancer treatment. After her diagnosis, Fisher and his family flew Tatum to the world-renowned Memorial Sloan-Kettering Cancer Center in New York, where doctors are testing an experimental procedure that didn't exist even a year ago. At Sloan-Kettering, Dr. David Abramson and his colleague Dr. Pierre Gobin enrolled Tatum in a clinical trial where cancer-killing drugs are injected directly into the eye in an attempt to not only kill the tumor, but to save a child's eyesight. After treatment, Tatum's doctors were optimistic that her prognosis is good.
Think Tatum's story is one of a kind? Think again. America's commitment to the treatment of patients with rare diseases is unmatched. The Orphan Drug Act, passed by Congress in 1983, gives companies tax incentives and seven years of market exclusivity in return for developing treatments for rare diseases. (The FDA designates "orphan" drugs as those that treat diseases affecting fewer than 200,000 American patients annually.) According to the FDA, in the decade before the act passed there were fewer than 10 products approved for orphan diseases; today, there are over 300.
Patients with rare diseases aren't the only ones seeing improvements in treatment. U.S. cancer mortality rates have declined every year since 1991, an unmatched achievement in the developed world. Five year survival rates for breast cancer, if detected early, are over 95%. In January 2007, the American Cancer Society reported that total cancer deaths in the U.S. declined for the second straight year, despite an aging population that is at higher risk for cancer.
How about Europe, where health care is "guaranteed"? In their 2006 book "The Business of Health," researchers Robert Ohsfeldt and John Schnieder report five-year adjusted cancer survival rates for the United States, England, Denmark, France, Germany, Italy, Sweden and Switzerland. For breast, thyroid and cervical cancer in women, and for colon, lung and prostate cancer in men, Ohsfeldt and Schneider reported that U.S. patients have better survival rates than European cancer patients.
Why is the U.S. better? Partly because cancer patients here get faster access to new medicines. In many European countries, companies must engage in lengthy negotiations with government health bureaucrats over prices for new cancer drugs. (Even afterwards, patient access to new medicines may be restricted.)
The absence of price controls means that more cancer drugs are launched here first than anywhere else. The Karolinska Institute in Stockholm recently issued a survey of cancer treatment in 25 countries. The report found that "the [U.S.] has been the country of first launch for close to half of the oncology drugs brought to market in the last 11 years." From 1995-2005, the U.S. had 12 "first launches," compared to two in Germany, four in the U.K., three in Switzerland, and one in France.
The U.S. system isn't perfect. It takes companies, on average, about $1 billion and a decade of research to develop and bring a single FDA-approved drug to market, and new cancer treatments are expensive until their patents expire. The FDA and industry must work harder to lower drug development costs, and find better ways to detect and treat cancer in its earliest stages, when it is easier and less expensive to cure.
Moore is right that American health care is in need of reform. But any reforms must maintain market incentives for medical innovation, and we shouldn't accept policies that will inevitably result in rationing health care for the sickest and most vulnerable patients.
American health care isn't perfect, but it's always trying to do better. Tatum's story is a tribute to that commitment, one that we must sustain.