The Public Policy

Pink Ribbon Reality

Candidates can't fight breast cancer while blocking life-saving treatments.

By 10.30.08

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You've probably seen a lot of pink ribbons around lately. Maybe you're even wearing one. October is Breast Cancer Awareness Month, after all.

But which presidential candidate deserves to wear that pink ribbon?

In other words, which of the two supports healthcare policies that are most likely to help in the fight against breast cancer? It's not enough to give lip service to the cause. Committing resources to funding research will help. But a variety of health policy issues affect women struggling with the disease now and all those who will struggle with it in the future.

Breast cancer used to be a death sentence. You might have watched the gruesome scene in last year's HBO miniseries "John Adams," in which the second president's daughter Abigail endures an anesthetic-free mastectomy. Her ordeal didn't even save her life.

But incredible breakthroughs, many made in just the last decade, are now improving and even saving the lives of cancer sufferers. We might ask which candidate supports a program that will get women suffering from breast cancer the best care as early as possible.

Perhaps the most important new drugs given to cancer patients are biologics. These medicines are not the relatively simple chemicals that make up conventional drugs. These complex medicines, often given through injection, are created through the genetic engineering of living material. These are treatments researchers refer to when they discuss "gene therapies."

These revolutionary medicines are extending and saving lives around the globe. Herceptin, approved by the FDA a decade ago, actually stops a certain type of breast cancer cell from growing. Avastin is another biologic, approved by the FDA just this year. It can extend the lives of late-stage breast cancer patients by several months by stopping the formation of blood vessels that tumors use to grow.

Right now, these life-extending drugs are available here in the U.S. and elsewhere. But that could change if our nation moves towards a government-run healthcare system, as some candidates have urged.

Look at the United Kingdom. The government decides exactly which health treatments it will provide through the National Institute for Health and Clinical Excellence (NICE). That body does cost-benefit analyses to determine whether a treatment is worth providing.

You can't put a price on the life of a loved one. But that's just what NICE does.

Pricier treatments are often the first thing to fall prey to penny pinching in strained government budgets. Biologics are in this category. The complex medicines take years to research and develop, and then more years to test and get approved.

That's why NICE originally wouldn't let breast cancer patients in the early stages of their disease receive Herceptin. The bureaucracy changed its guidelines only after a public outcry.

It hasn't changed its mind on Avastin yet. The U.K. will not fund treatment with this drug, even though it's been shown to extend lives. In fact, the government-run service is so adamant that patients not use this drug that you'll be penalized even if you buy it yourself.

The NHS informed mother-of-two Colette Mills that if she insisted on taking Avastin, though paying for it herself, she'd have to foot the entire bill for her treatment -- even for care the government typically provides.

Such a nightmare could happen here. Sens. Max Baucus (D-MT) and Kent Conrad (D-ND) have already introduced a bill to create a similar agency here to cut healthcare costs.

That's not the only way lawmakers want to cut costs to the detriment of care. We must also ask which candidate understands what makes the best climate for research and development of life-saving drugs.

Some think we can lower costs for biologics the same way we have for conventional drugs, through generics. They want to pass laws making it easier for companies to manufacture what are called "follow-on biologics."

This might sound like a good idea, but comparing biologics to conventional drugs is like comparing apples and oranges. Biologics aren't made using chemicals -- they're made using living tissue. There's no way to make an exact replica of gene therapies.

So if these drugs are legalized, lawmakers must make sure they're safe. And lawmakers must protect the financial incentives needed to create these drugs. Otherwise, we'll never know what life-saving treatments we've lost.

So don't just look at each candidate's lapel this month to see if they're participating in the fight against breast cancer -- look at their broader healthcare plans. The fight against breast cancer will take place on many different fronts.

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About the Author

Peter Pitts is partner/director of global health at Porter Novelli, a senior fellow at the Center for Medicine in the Public Interest, and a former FDA associate commissioner.