The Business Conundrums of Trying to Prevent Cancer

(MoneyWatch)  An article in last week's New York Times pointed out that drug companies are not particularly interested in preventing cancer.

A similar statement was made earlier this year at the American Society of Gene Therapy's annual meeting, where scientists proclaimed that the pharmaceutical industry doesn't want to cure diseases and would rather see patients on a lifetime of pricey meds.

But this time around, the issue wasn't that prevention would cut into treatment revenues, but rather that patients won't buy preventative cancer drugs.

NYT's Gina Kolata reports that cheap generic drugs finasteride and dutasteride have been proven to halve the risk of prostate cancer, while tamoxifen and raloxifene do the same for breast cancer. Yet she says the drugs are rarely used for cancer prevention, and many patients prefer vitamins and other unproven methods (some of which may even be harmful: she cites a study that hinted selenium and vitamin E, often touted for "prostate health" might even contribute to cancer.)

The article ponders what message this sends to drug developers:

Companies have taken note, saying that it makes little economic sense to spend decades developing drugs to prevent cancer.

But maybe patient reluctance could be fixed with safer drugs that offer a better risk-benefit ratio. Cutting your risk of breast cancer in half sounds great until you realize you're going from 9.8 percent to 4.9 percent, and that 4.9 percent advantage is coming along with side effects like depression, bone thinning, sexual issues and many others.

And pharma's reluctance would be hard-pressed not to melt away in the face of that market potential. Even at about $2 per day (finasteride's cost), a drug taken by 30 million to 40 million men is looking at a $25 billion market.

The bigger issue is likely to be managed care. If finasteride prevented 50,000 cases of cancer a year, that's a cost of more than $500,000 per avoided cancer. But even this hurdle might be surmountable if you use biomarkers to define the high risk patients.

And heck, we're already over the biggest hurdle ?€" proving a drug can prevent cancer. That in itself is pretty amazing.

Cancer cells photo by Flickr user euthman, CC.