Why Reseach Is So Important: It Changes Lives

Why Research Is So Important: It Changes Lives

By

Leonard Zwelling

https://www.nytimes.com/2024/01/31/opinion/gene-therapy-cure-diseases.html?searchResultPosition=1

In this opinion piece in The New York Times on February 2, Dr. Daniela J. Lamas describes one of her patients with spinal muscular atrophy who calls himself the “last dinosaur.” The patient is a 43-year-old who has suffered from the genetic disease since childhood and was never expected to have lived this long. There is now a gene therapy for children with this disease who are under two years of age. It can be administered once and the disease will be eradicated. This has also now occurred with sickle cell disease, something I could have barely imagined when I was an intern fifty years ago.

In the field of oncology, headlines of new successes are occurring regularly. I cannot keep up and I only read The New England Journal of Medicine. It seems that every issue contains a new treatment that delays the progression of malignant diseases of all kinds including ones like lung cancer which were virtually untreatable when I was a fellow in 1975. It is truly amazing.

And what do we attribute this progress to? Research. Millions of dollars of government and drug company money are poured into new treatments from gene therapy, to CRISPR treatments, to immunotherapy, to monoclonal antibodies, to new, targeted small molecules.

In the field of oncology, the reason the major cancer centers exist is to be at the forefront of that research by supporting laboratory-based investigation, institutionally-sponsored clinical trials, and the rigorous performance of human subjects research supported by the pharmaceutical and biotech industries.

The roles of the major academic cancer centers IS NOT to see more and more patients who could be treated in their communities to keep the coffers of the institution full. Being big is not the goal. Being smart is. Being novel is.

The financial pressures on the big academic cancer centers have become intense, but not only because research is expensive. Salaries of executives have ballooned out of control and the number of administrators and lawyers has increased exponentially compared to what it was when I was a vice president. Even then there were too many administrators. Now it has run amok.

If the academic cancer centers find themselves under increasing financial pressures, perhaps rather than constantly seeking to increase sources of revenue, especially patient clinical revenue, they should examine their current costs. Back when I was just staffing for Dr. Hohn in 1993, I constantly asked about the cost structure of MD Anderson. The financial people could never answer me. They had no idea what anything cost at MD Anderson. They only knew the charges which were basically as much as the insurance companies would pay.

Remember, a patient care facility has few direct costs—the cost related to patient care like IV poles and band aids. Most of the cost is indirect—support staff, infrastructure, and administration. Of the approximately 26,000 workers at MD Anderson, fewer than 10% generate revenue. That would be the billing doctors, and other care givers and the research faculty accumulating grant money. But the indirect costs of an NIH grant don’t really cover the true indirect costs of research. In essence, only the docs really bring in the money. But one product that cannot be accurately valued is research.

When a new treatment for cancer saves a life, what’s that worth? Invaluable.

I think the cancer centers have grown in an uncontrolled fashion—perhaps ironic for a cancer center. The smart ones will know their costs, create a reasonable and affordable budget for research, and select the best research to pursue while applying the latest discovery to novel patient care.

Is that what is happening where you work?

If we are going to make the current cancer patients the “last dinosaurs” because the next cancer patient can be cured, we need to rethink the model. That means knowing the cost of seeing the next patient before blindly thinking more patients are better. That next patient may cost more than you can generate and what you generate is paying for research that is aimed at putting you out of business.

Won’t that be a great day?