Managing Editor’s Memo

It’s Better To Light a Candle...


Frank Diamond

We focus this month on health care’s hidden costs … and also on oncology. There’s a connection because there’s always something new, and usually costly, in oncology. On April 4, the FDA said that Pfizer’s Ibrance (palbociclib) can be used to treat breast cancer in men. Each year in the United States, about 237,000 cases of breast cancer are diagnosed, of which 2,100 are in men. About 450 men die from it annually; the disease claims about 41,000 women each year.

Breast cancer in men, like many niche diseases, shouldn’t be shortchanged in treatment just because it affects a relatively small population. In the best of all worlds, that is. In the real world, it often comes down to dollars and cents (Ibrance costs about $13,000 a month). However—and as our cover story by Senior Contributing Editor Timothy Kelley shows—if, in this real world, somebody knows what anything costs in health care, she or he’s not saying.

Notice how much “real world” comes up. The Ibrance story springs from the 21st Century Cures Act, which allows real-world evidence to be a factor in drug approvals. Chris Boshoff, MD, who heads global product development for Pfizer, tips his hat to the act in saying that “the FDA has allowed us to take a significant step forward in the use of real-world data to bring medicines to patients who are most in need.”

Managed Care’s been on this, and back in May 2017 we noted that real-world evidence faces real-world challenges: “The randomized clinical trial has been the gold standard in oncology research for decades and will remain so for the foreseeable future.”

Well, the foreseeable future appears more seeable. When presented with real-world evidence about drugs for an underserved population, insurers will have questions.

Like, for instance: “How much?”