On July 12, an FDA panel recommended approval of the first genetically engineered T cell for commercial sale to treat childhood leukemia, a blood cancer. The biologic could cost $300,000 per patient, leaving questions of whether some insurance companies will pay for it. Such cancer therapies can run into sizable costs for patient follow-ups. But, in the coming years, engineered T cells will be in high demand, even more so if they can be applied to solid tumors.
The Trump administration keeps threatening to repeal the Affordable Care Act, which suggests new inequalities to health care access. This will only be made worse by expensive new drugs, which test the limits of insurance reimbursement. However, even a single-payer system is unlikely to help to ensure access to such staggeringly expensive biologics. For instance, the National Health Services in Britain will be hard pressed to reimburse for six-figure biologics. If so, the only ethical action would be to use the power of the state to force down the cost of such cancer drugs.
A conservative argument against socialized medicine is based on the tragic vision of human nature, which suggests that people are guided by innate self-interests, and that society—and, by implication, biotech—requires constraint through moral and legal checks. The reality is that many of us do harbor a genetic variant that predicts a rare genetic disorder, or cancer, and we certainly can’t afford to correct every anomaly in nature. However, a counter-position is that we are already participating in socialized medicine through funding the National Institutes of Health, which subsidizes the risk and cost of investigating drug targets and tools, not to mention results in generous salaries for many scientists.
In 2004, Noam Chomsky noted that Eisenhower’s “military-industrial complex” was a misnomer, arguing that the actual purpose of taxpayer support is to boost economic prospects for investors, including those at life science companies. If you walk around MIT today, around Kendall Square, you see small biotech companies, spin-offs of government-sponsored research in what will be the cutting edge of the economy, namely, biology-based industries.
If you looked around 40 years ago (then to the newly developing Route 128 corridor), you would have seen small electronics firms, spin-offs of what was then the cutting edge of the economy, electronics, under military cover. So Eisenhower’s military-industrial complex is not quite what is generally interpreted. In part, yes, it’s military. But a main function of the military, or the National Institutes of Health, or the rest of the federal system, is to provide some device to socialize costs, get the public to pay the costs, to take the risks. Ultimately, if anything comes out, you put it into private pockets.
That cancer patients should be criticized for depending on socialized medicine on the consumer end conceals the fact that scientists depend on taxpayers to subsidize their careers, while developing many of the technologies in academic settings and then profiteering them out. The high profile patent battle over CRISPR gene editing system was one of these situations, which resulted in a mix of philanthropic and public money paying for the invention of a technology that is now enrapt in a web of financial dealings not to mention bitter rivalries. Editas Medicine, a spinout of Harvard and MIT’s Broad Institute, which claims exclusive rights to medical applications of CRISPR-Cas9, signed a highly profitable $737 million deal with cancer T-cell company Juno Therapeutics.
If we are already participating in socialized medicine, the only tragedy will be if the socialism stops on the consumer side. One suggestion I have made previously is to no longer fund academic scientists and their partners who have established a strong foothold in the economy. Novartis (the company with the cancer biologic expected to price up to $300,000, compared with the $25,000 cost to actually manufacture it) recently completed a$600 million campus in Cambridge. The Broad Institute is seeded with $1.4 billion in wealth. The state of the union of life science is strong. If cutting taxpayer subsidies to scientists is too sensitive an idea, then we can use the power of the state to contain the costs of biologics, which we effectively subsidize.
A drug price fairness initiative is on the ballot in Ohio, and would enable public payers such as Medicaid to pay 20 percent under market price; transparency laws, established in Vermont make the costs of drugs clear; indeed, we may even cap the cost of biologics by executive order.
Entrepreneurial scientists are moving ahead with some exciting work on making use of CRISPR to disable genes in our T cells, which could prevent cancer cells from shutting down an immune response, and by adding bits of code to our immune cells to enable them to attach to abnormal protein fragments on solid tumors. If we take a tragic view of nature, these drugs will be priced as high as the market will allow. We can use the power of the state to change that.