I have read several articles and posts about the how the use of Provenge - the first vaccine to delay prostate cancer -- is well below expectations. Most of the discussion surrounds whether the slow adoption of Provenge is a function of the company not being ready to roll and work with doctors to get reimbursement for the vaccine or whether doctors are finding the effort to get approval for the use of Provenge and getting paid for it, worth the hassle and expense.
If you compare Provenge to a Benlysta, the first new treatment for lupus in 50 years, you can't help but conclude that the beating Provenge took and the uncertainty that swirls around it's reimbursement still -- some might call it fear -- is so significant among community doctors that even the best sales force couldn't ovecome it. Benlysta was approved in March of 2011 and HHS issued a reimbursement code for the drug July 1. Provenge not only took a year, it was the subject of a Medicare technology review committee hearing. A big part of the difference is the beating Provenge took at the hands of Medicare and anti-innovation types.
Is Provenge a harbinger of how innovation will be handled? I don't have the answer to that. But there is a dramatic disconnect between what scientists are discovering and the ethos of most of the rent-seeking companies, regulators, health plans administrators, Commonwealth Fund/Soros funded researchers, etc. That ethos is organized what Aaron Wildavsky called "radical eqalitarianiasm:" the belief in the moral virtue of equalizing differences. Medical innovation is regarded as a source of inequality: the less we spend on new cancer drugs, the more we can spend on healthcare entitlements.
The contributions of medical technology are denigrated and the harms of innovations -- cancer, heart attacks, autism -- as part of a narrative depicting commercialization of science as a corrupt and corrupting enterprise the place profits above people. The healthcare stakeholders by and large are consumed with finding fault, imposing the precautionary principle, holding up each and every innovation to the benchmark of comparative effectiveness or tort action. They view innovation as a source or vector for inequality or injustice and treat marketing of any form as a potential criminal activity. And hence they regard all new technologies as expensive, potentially dangerous, while adding a teardrop of benefit to society at an enormous cost.
The prevailing cultural view of "the stakeholders" towards innovation is one of deep hostility. Opposing views of the relationship between humanity and medical innovation are hardly heard and barely represented. When they are, those who regard commercialization as inherently corrupt and regard themselves as the annointed visionaries who know what is best for the rest of us, invoke the canard of conflict of interest.
The radicals claim innovation won't wither because of requlation, it will only make companies more 'competitive.' In one sense they are right. Venture capital and IPO financing for medical technology and life science companies are at all time highs -- in China. That may be part of the effort to respond to the growing demand for healthcare services in emerging markets. But in China, new biotech and medical device companies are welcomed instead being treated as criminals or obstacles to human progress.
The gauntlet Provenge had to run through is a product of that hostility. And there's more to come.
If you compare Provenge to a Benlysta, the first new treatment for lupus in 50 years, you can't help but conclude that the beating Provenge took and the uncertainty that swirls around it's reimbursement still -- some might call it fear -- is so significant among community doctors that even the best sales force couldn't ovecome it. Benlysta was approved in March of 2011 and HHS issued a reimbursement code for the drug July 1. Provenge not only took a year, it was the subject of a Medicare technology review committee hearing. A big part of the difference is the beating Provenge took at the hands of Medicare and anti-innovation types.
Is Provenge a harbinger of how innovation will be handled? I don't have the answer to that. But there is a dramatic disconnect between what scientists are discovering and the ethos of most of the rent-seeking companies, regulators, health plans administrators, Commonwealth Fund/Soros funded researchers, etc. That ethos is organized what Aaron Wildavsky called "radical eqalitarianiasm:" the belief in the moral virtue of equalizing differences. Medical innovation is regarded as a source of inequality: the less we spend on new cancer drugs, the more we can spend on healthcare entitlements.
The contributions of medical technology are denigrated and the harms of innovations -- cancer, heart attacks, autism -- as part of a narrative depicting commercialization of science as a corrupt and corrupting enterprise the place profits above people. The healthcare stakeholders by and large are consumed with finding fault, imposing the precautionary principle, holding up each and every innovation to the benchmark of comparative effectiveness or tort action. They view innovation as a source or vector for inequality or injustice and treat marketing of any form as a potential criminal activity. And hence they regard all new technologies as expensive, potentially dangerous, while adding a teardrop of benefit to society at an enormous cost.
The prevailing cultural view of "the stakeholders" towards innovation is one of deep hostility. Opposing views of the relationship between humanity and medical innovation are hardly heard and barely represented. When they are, those who regard commercialization as inherently corrupt and regard themselves as the annointed visionaries who know what is best for the rest of us, invoke the canard of conflict of interest.
The radicals claim innovation won't wither because of requlation, it will only make companies more 'competitive.' In one sense they are right. Venture capital and IPO financing for medical technology and life science companies are at all time highs -- in China. That may be part of the effort to respond to the growing demand for healthcare services in emerging markets. But in China, new biotech and medical device companies are welcomed instead being treated as criminals or obstacles to human progress.
The gauntlet Provenge had to run through is a product of that hostility. And there's more to come.
