While the world agrees that prevention is better than cures, the capitalist argues that the cure is more profitable than cancer prevention.
The financial incentives around cancer prevention are hotly debated and the world continues to be stunned by exorbitant prices being charged for life saving drugs.
As long as treatment pays more cash, the cash benefits of prevention are largely ignored. Way before this was obvious with Obamacare, it was very clear with HIV and AIDS. In the 1990’s we knew that Pre-Exposure Prophylaxis (PrEP), or treatment with the antiviral before being exposed, would reduce or eliminate the chance of developing HIV.
We knew that Post-Exposure, or a pill a day for a week or two after a random needle stick or sex act, would also reduce or eliminate infection. And we knew that treatment reduced the viral load enough to make transmission very improbable. Yet many states still withhold treatment until HIV becomes full blown AIDS. Many AIDS Activists ignore PrEP and PEP. And the number of cases in regions with ignorant policy well exceed other locations.
There is a different explanation which is more fundamental to the nature of drug development which is the real reason why companies are not developing “drugs that prevent.”
Cancer is not one thing. Lung cancer is different from ovarian, is different from pancreatic and melanoma and so on. Even within lung cancer, there are four major types that behave differently. Within those types, there are differences; there is a new class of drugs that is highly effective in 5% of Western Adenocarcinoma of the lung, and more than 25% of those in Asians. The point is, “prevention” is preventing hundreds of diseases, each one different.
Next is the rarity of cancer. For example, a woman has a 1 in 70 lifetime chance of developing ovarian cancer. So if the new cancer preventative is 100% effective, a study would have to follow 70 women for their entire adult life for every one cancer prevented. Even a study that was enriched for people with risk factors would require tens of thousands of patient-years of observation.
Safety is a factor as well. Drugs have off-target effects and can interact with other drugs, so the risk and benefit would need to be balanced in every case.
There are two much more fruitful approaches to preventing cancer. First, early detection. There are interesting early developments to diagnose cancers while they are small and curable that will be available in a few years.
Most of all, take the simple steps that work for cancer prevention: exercise, diet, don’t smoke.