Since the beginning of President Nixon’s “War on Cancer” in the early 1970s, cancer research in the US has been driven by the National Cancer Institute. (NCI) This organization did an excellent job for many years and as a result, many improvements in cancer care have become standard practice, and the survival of many patients has improved. The NCI basically has funded individual physician/investigators, mostly at medical schools and other cancer research facilities, to perform both basic (lab) research and clinical trials. These trials and research projects are carefully vetted by peer-review, which rewards only the most promising proposals. However, starting about 10 years ago, the NCI reorganized and downsized their clinical research budget, which left private pharmaceutical companies as one of the few remaining sources of funds. As a result, Big Pharma has, for all intents and purposes, seized control of the research agenda, by agreeing to fund ONLY those studies which might turn a profit for the company. Big Pharma will generally not fund research in alternative therapies, or in older drugs whose patent protection has run out. The NCI’s clinical trails research program has become a shell of its’ former self.
The medical equipment industry is also a problem. They fund the development of new surgical instruments, for example, with the purpose of turning a profit, NOT for improving care overall. A major example: Robotic-assisted surgery has taken over many surgical specialties, due to clever marketing. The use of robot surgery seems very “sexy” to the public, who will often ask their physician specifically for it. The manufacturers have marketed the devices, which may cost $1-3million dollars to install. to hospitals as a money making tool, as most robot-assisted procedures pay better than traditional surgeries. However, these devices undergo little or no unbiased testing in safety of effectiveness. As a result, mistakes have been made. Radical hysterectomy is the standard surgical treatment for early cervical cancer, and has been for years. As the robot rapidly supplanted traditional surgery, a few physician/investigators decided to compare the outcomes in an unbiased fashion. The results of 2 large studies(listed below) show that robot-assisted radical hysterectomy was associated with WORSE survival than traditional radical hysterectomy. Many major cancer treatment facilities banned robot-assisted radical hysterectomy in the wake of these studies, but many community hospitals (who invested heavily in robot technology) continue to allow if not encourage their doctors to use these devices. We must get private industry out of the research/testing process of new drugs and devices if we are to avoid further harm to patients.
- Biliang Chen, Mei Ji, Pengfei Li, Ping Liu, Wei Zou, Zhao Zhao, Bo Qu, Zhiqiang Li, Xiaonong Bin, Jinghe Lang, Hailin Wang, Chunlin Chen,
Comparison between robot-assisted radical hysterectomy and abdominal radical hysterectomy for cervical cancer: A multicentre retrospective study,
Gynecologic Oncology,. Volume 157, Issue 2, 2020, Pages 429-436.
ISSN 0090-8258, - Pedro T. Ramirez, M.D., Michael Frumovitz, M.D., Rene Pareja, M.D., Aldo Lopez, M.D., Marcelo Vieira, M.D., Reitan Ribeiro, M.D., Alessandro Buda, M.D., Xiaojian Yan, M.D., Yao Shuzhong, M.D., Naven Chetty, M.D., David Isla, M.D., Mariano Tamura, M.D., Tao Zhu, M.D., Kristy P. Robledo, Ph.D., Val Gebski, M.Stat., Rebecca Asher, M.Sc., Vanessa Behan, B.S.N., James L. Nicklin, M.D., Robert L. Coleman, M.D., Andreas Obermair, M.D. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. The New England Journal of Medicine. November 15, 2018 vol. 379 no. 20