Chapter 1: What is the main topic discussed in this episode?
Hey, this is Radiolab. I'm Latif Nasser, and today we're resurfacing a quite provocative episode we originally reported in 2014. Now, that sounds like a long time ago until you start listening and you start to realize how many parallels there are between 2014 and this moment right now.
Chapter 2: What parallels exist between 2014 and today's issues?
Outrageous healthcare costs, war in the Middle East, climate change. In every one of these cases, the specifics that they're referring to have changed, but the overall picture remains depressingly the same. Honestly, since it came out, I still think about these stories. I still remember them all the time, especially the last one.
I would say this episode is one of my all-time top 10 Radiolab episodes. I hope you feel the same way, whether you are hearing it for the first time or hearing it for the 10th time. Here it goes. Worth. wait you're listening okay all right okay all right you're listening to radio lab radio from w-n-y rewind Are you ready? Yes. Feeling full of worth? I'm feeling full of value.
Well, in that spirit, I'm Jad Abumrad. I'm Robert Krulwich. This is Radio Lab, and today... Three very different stories that try to put a dollar value... A million is okay. One million dollar. Seven dollars. Ten thousand dollars. Yeah, I would say five bucks. On things that seem... Priceless. Priceless.
Priceless.
Priceless. Isn't it really... Okay, so start at the top. Bring on the pressure. All right, we're going to start the show with a story from our producer, Molly Webster. I don't remember any of it. Who we might actually want to rename Molly Wongster because she recently got herself some serious numericizing. Actually, it didn't start as a wonky thing. It started actually with some medical journals.
So that was interesting because it was some of the most poetic writing I've seen out of doctors ever. One journal article said, like, what would one more month mean to a 37-year-old mother who has four children? Or what would one more month mean if you are a 67-year-old who's about to go traveling around the world? People were just kind of, like, drifting these questions out there.
All these questions seem to circle around a seemingly simple story of the pricing of a drug, a cancer drug. And the story, if you really want to tell it from the beginning, it begins with this guy named Leonard. Leonard Saltz. I'm a medical oncologist at Memorial Sloan Kettering Cancer Center. Which is here in New York, and it's one of the largest cancer centers in the country.
I mean, we have 17 doctors here who treat colon cancer. Just for colon cancer. We treat a very large number of patients. It's a huge hospital, and one of the things Leonard's been noticing in the last, I don't know, decade, is cancer drug prices have just gone through the roof. I mean, we have drugs out there that are many hundreds of dollars per pill. Really? Yeah. Oh, just wait. Let's see.
Where does this start? It starts, it's June in 2012. Leonard Saltz is at a conference, and at this conference is a pharmaceutical company called Sanofi, and they give a presentation about a new drug that they have. A drug called Zaltrap. And Zaltrap is a drug that, without getting into the science too much, targets the blood supply to the tumor.
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Chapter 3: How do medical professionals value additional time in life?
None of those prices are figured into it. Okay? I'm just giving you the cost of the drug. So Leonard calls up one of his colleagues. My name is Peter Bach. I'm a physician at Memorial Sloan Kettering. Peter is the number cruncher of the group. He does the statistical analysis of, I don't know, the cost of care. And Len grabbed him and ran him through all the data.
And we walked through the out-of-pocket expenses for Medicare beneficiaries. Medicare beneficiaries, if they don't have additional insurance, 20 cents of every dollar they pay out-of-pocket. And that number sort of hit him because he realized for Medicare patients, they'd be paying something like $2,000 out of pocket every month for just this drug. $2,200, if I remember the number correctly.
For a lot of Medicare patients. That's all of their money. Never mind other drugs. That's when I thought we should go public with it. Memorial Sloan Kettering, they decide to boycott this drug. Now, is that, I mean, I'm just stopping you because when you guys made that decision, was that, that feels like a big deal.
It did feel like a big deal, and it felt like a big enough deal that we decided to write the op-ed piece in the New York Times. They write an op-ed in the Times that basically says, look, this is crazy, $11,000 a month for a drug that maybe gives you 42 more days of life? Is that worth it? And a little less than a month after the op-ed piece came out, The company that makes Altrap.
They went to individual doctor's offices, sent representatives and said, we are offering a 50% discount. They cut the price in half just like that? Yep. Nationwide or like just in this area? Nationwide. It was sort of incredible. We reached out to Sanofi to talk about the price of Zaltrap and they declined to comment.
But in a statement that they released when this whole Zaltrap thing happened, they said that they incur so many costs for researching and developing and bringing a drug to market that that is what their pricing is based on. Leonard doesn't disagree. We need these companies. They're the ones developing the drugs. Which aren't easy to develop. I mean, Leonard gave us just one example.
If we talk about colon cancer. He says for years, there was only one drug on the market called 5-FU. 5-FU was patented in August of 1957. It was from 1957 until 1996 that a second drug came along. That's how long it takes to develop a good drug? In that interim, there were over 70 drugs that were tried and failed. I feel like I don't give it enough credit because that just astounded me.
It's very, very hard. And that, according to Leonard, is one of the reasons why prices are just going to keep going up. But sooner or later, this system is going to fall apart. And at what point does society say there isn't an infinite number of dollars that we can commit to our health care system?
It's funny because I had this interesting reaction to the word society because all of a sudden I thought like why is – not like a crazy death panel way, but I thought why is society involved in my conversation with my doctor about if I want to take this drug that may give me another month and a half of life? Why is society involved? Because you're not paying.
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Chapter 4: What is the significance of the drug Zaltrap in cancer treatment?
Someone else has to pay that. Obviously, he says, it's your insurance. I mean, say you're part of a policy that has 1,000 members. Let's say that the premium for that is $100. So we got $100, 1,000 people. We got ourselves $100,000. Okay. So we now have $100,000 to take care of that 1,000 people.
For that month.
Whatever amount of time. If now one person comes up with a health care cost, let's say it's for a month, that is $100,000 in that month, everybody else is in trouble. There's no money left. So they write this op-ed saying like prices are too high and the drugs are not that great.
And sort of the next like notable wave is there was this – there's this journal called Blood, which is really big to anybody that works in a community that has like – How did we not know about this when we made the blood show? Oh, I knew. Just kept it in here. Anyhow.
So, yes, there's a journal called Blood, which is basically like the journal for anybody that works in a field that has to do with blood. And what happens is, like... A hundred doctors get together and they co-sign an editorial, which basically says, we totally agree with everything you guys are saying, but we have an even bigger issue.
You know, with Zaltrap, you're talking about an expensive drug that maybe doesn't really do that much. It's kind of easy, even though it had never been done before, to say, we're not going to use this. What all of these doctors in the blood editorial are saying, what do you do when you have a really expensive drug, but it's really, really good? It's like a drug you actually want to take.
Is that like a one day in the future we will face this kind of question? No, that is like a now, today question. The most important new medicine approved this year. Everyone I talked to pointed me to this new drug. It's called Sovaldi. It's known as Sovaldi. Sovaldi. Many in the medical community are calling the new medication a blockbuster.
Sovaldi came on the market last December.
So that's December 2013.
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Chapter 5: How does the cost of cancer drugs impact patients?
And so I started looking around. I don't know. I guess I was wondering, has anyone actually thought about this? And so I started looking around, and what I realized was that the World Health Organization actually – I mean, I guess they almost have a number, but it's a number per country.
They have the recommendation that countries spend, it's going to get gobbledygookie, but just bear with me, that countries spend one to three times the GDP per capita, which is like the gross domestic product per individual. So take the entire fat ball of money that is in a country and divide it per individual?
Divide it by the individuals, and then you spend one to three times that on one more good year of life. And what would that be for us? So for the U.S., that's about 50,000 to 150,000. Interesting. And does that have any teeth? That recommendation? It legally doesn't have any teeth, but it has teeth in the sense that doctors in the U.S.
are actually going to start using this WHO number to evaluate medical treatments for cardiology. They said they were going to do this in a paper, and it was kind of very quiet, very subtle. But in other countries, this conversation is very loud, actually. It happens at the government level. They're also passing out surveys where they're asking doctors
citizens what is your limit on how much you want to spend on one more good year of life have they done that here as far as i know no why not because because the last time we tried to talk about cost in medicine it ended up in the whole death panels death panels death panels or so-called death panels thing and I don't know, I just wondered. Right, into the mess of it. Hey, Times Square.
If I actually tried to go out and ask this question in a very basic way, how would people respond? Excuse me, can I ask you a question? What is a year of life worth? Wow, what a question.
That's deep. Can I think about it?
That's a tough one, but... I was really surprised at how seriously people took the question. Man. What is a year of life worth... That was the first thing I noticed. Then the next thing was, no one could answer the question until I had answered like a million questions of theirs.
Am I going to die tomorrow?
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Chapter 6: What ethical dilemmas arise from high drug prices?
And if it's the government, that means that our grandchildren are going to end up paying for all of this money. So yes, I guess to answer your question, I think it would be healthier to know what these things cost. On the other hand, I have to say as a patient, I was so traumatized, I'm not sure I could have taken that information in.
I was thinking about your What's It Worth title, and I was thinking that the American individualistic, optimistic response would be, well, whatever it takes. Whatever it takes. Life is worth it. Whatever it takes. But whatever it takes will not cure my cancer. So I think this question changes when you have incurable cancer. It becomes a different question, which is, when is enough enough?
I remember when she said that, when is enough enough? I was just... I don't know that we are ready to say there's one magic line. Thrown back to this conversation that I had with Leonard Saltz, where he was saying that we have to look at everything in terms of value. You need to think deeply about the kind of life you want to live. It's not just about how many days, it's about what kind of days.
So if you told me that there was something that gave 72 days survival benefit, but it makes people feel nauseous for most of the time, is that worth it? When we're trying to draw this line as a society, before we figure out what we're willing to pay, we have to think about what we are paying for.
Yeah, I don't think we know what... For Susan, six years ago, she decided that she was going to get chemotherapy because, in part, it would be more time with her daughters. Yeah. And suddenly, it's worth it.
Yeah. But I think we're changed by the treatment, too.
For now, Susan's cancer is basically under control because she's on this new drug.
For two years and now a month, and I am counting, I've been alive without a recurrence, without the cancer growing, by taking these pills every day. And I take them at home. They're not infused in the hospital through my veins. They're just pills. And it's made the last few years remarkably normal-like, the new normal.
But when these drugs stop working, and I've been told they will stop working, I'm not sure I would want to go back to chemotherapy again. But I suspect I don't know until I get there.
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Chapter 7: How do we define the worth of a human life?
Like only a few houses. And then we took a small road between the...
the fields, and we actually saw that there were lots of farmers in the trees, like on the apple trees. Straddling up on these often thin and spindly branches, men and women that I've seen in photos in any case. Harold and his friend took pictures, and if you look at those pictures, you'll see the farmers holding little brooms.
This little pollen brush that they'd constructed using things like chopsticks and chicken feathers and cigarette filters. And they'd have a little bottle filled with pollen. And then what they do, they dip the brush into the bottle and they paint a flower blossom with the pollen. They dip their brush back into the pollen and they paint the next flower blossom again.
And they dip the brush back in again and they paint again and they dip again and they paint again. To make sure that all of the blossoms that they could possibly fertilize would be fertilized so that they would go on to produce fruit.
We're talking hundreds and hundreds of flowers per tree.
It was very strange to see humans doing the job of the bees. God, what a pain in the ass that sounds like. Yeah, the image of these Chinese orchardists standing up in these spindly trees traveled around the world through environmental circles. And the message that it seemed to send was that This is what happens if you lose biodiversity.
You end up standing in the trees doing the job that the bees used to do on the wing. For free. For free.
Those people are just like human bees.
But then this guy enters the story. This is Yin Sun Chen. Yeah, human bees. Four years ago, he traveled to Mao County to do a sort of economic analysis of just how much the loss of the bees was hurting the farmers of Mao County. But what he discovered, weirdly, was that the trees were producing more apples than ever.
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