The Cancer Industry: Hype vs. Reality Cancer medicine generates enormous revenues but marginal benefits for patients By John Horgan on February 12, 2020 17
EW TREATMENTS YIELD SMALL BENEFITS, BIG COSTS Research has linked cancer to many internal and external factors, notably oncogenes, hormones, viruses, carcinogens (such as those in cigarettes) and random cellular replication errors, or “bad luck.” But with the notable exception of the smoking/cancer link, which led to effective anti-smoking measures, that knowledge has not translated into significantly improved preventive measures or treatments. Clinical cancer trials “have the highest failure rate compared with other therapeutic areas,” according to a 2012 paper. Pharmaceutical companies keep bringing new drugs to market. But one study found that 72 new anticancer drugs approved by the FDA between 2004 and 2014 prolonged survival for an average of 2.1 months. A 2017 report concluded that “most cancer drug approvals have not been shown to, or do not, improve clinically relevant end points,” including survival and quality of life. The authors worried that “the FDA may be approving many costly, toxic drugs that do not improve overall survival.” Costs of cancer treatments have vastly outpaced inflation, and new drugs are estimated to cost on average more than $100,000/year. Patients end up bearing a significant proportion of costs. More than 40 percent of people diagnosed with cancer lose their life savings within 2 years, according to one estimate. Immune therapies, which seek to stimulate immune responses to cancer, have generated enormous excitement. Two researchers won the 2018 Nobel Prize for work related to immune therapies, and a new book, The Breakthrough: Immunotherapy and the Race to Cure Cancer, claims that they represent a “revolutionary discovery in our understanding of cancer and how to beat it.” According to a 2018 report in Stat News, drugs firms aggressively market immune therapies, and patients are “pushing hard to try them, even when there is little to no evidence the drugs will work for their particular cancer.” A 2017 analysis by oncologists Nathan Gay and Vinay Prasad estimated that fewer than 10 percent of cancer patients can benefit from immune therapies, and that is a “best-case scenario.” Immune therapies trigger severe side effects, and they are also extremely expensive, costing hundreds of thousands of dollars a year, oncologist Siddhartha Mukherjee, author of The Emperor of All Maladies, a bestselling history of cancer, reported in the New Yorker last year. “Subsequent hospital stays and supportive care can drive the total costs to a million dollars or more,” he writes. “If widely prescribed, immune therapies “could bankrupt the American health-care system.” TESTS LEAD TO OVERDIAGNOSIS AND OVERTREATMENT The cancer industry, aided by celebrities who claim that tests saved their lives, has convinced the public that screening for cancer is beneficial. The earlier we can detect cancerous cells, the more likely it is that treatment will succeed. Right? Wrong. One of the most significant findings of the past decade is that many people have cancerous or pre-cancerous cells that, if left untreated, would never have compromised their health. Autopsies have revealed that many people who die of unrelated causes harbor cancerous tissue. Tests cannot reliably distinguish between harmful and harmless cancers. As a result, widespread testing has led to widespread overdiagnosis, the flagging of non-harmful cancerous cells. Overdiagnosis leads in turn to unnecessary chemotherapy, radiation and surgery. Gilbert Welch, a physician whose 2011 book Overdiagnosed: Making People Sick in Pursuit of Health helped bring overdiagnosis to light, recently called it "an unfortunate side effect of our irrational exuberance for early detection.” Overdiagnosis is more insidious than false positives, when tests erroneously indicate the presence of cancer. Biopsies can overturn false positives but not overdiagnoses. Mammograms and prostate-specific antigen (PSA) tests have led to especially high rates of overdiagnosis and overtreatment for breast and prostate cancer. A 2013 meta-analysis by the Cochrane Collaboration, an international association of experts that assesses medical procedures, estimated that if 2,000 women have mammograms over a period of 10 years, one woman’s life will be saved by a positive diagnosis. Meanwhile 10 healthy women will be treated unnecessarily, and more than 200 “will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.” Another nonprofit medical group, theNNT.com, has spelled out a disturbing implication of these data. (NNT stands for “number needed to treat,” which refers to the number of people who must receive a treatment for one person to receive any benefit. Ideally, the number is 1.) The NNT notes that some overdiagnosed women might “die due to aggressive therapies such as chemotherapy and major surgery.” Thus any benefit from screening “is balanced out by mortal harms from overdiagnosis and false-positives.” Breast-cancer specialist Michael Baum, who helped found the United Kingdom’s breast-screening program, has advocated abandoning such programs, which he believes might cut short more lives than they extend. As for PSA tests, a federal task force of medical experts estimates that 1.3 deaths may be averted for every 1,000 men between the ages of 55 and 69 tested for 13 years. But for every man whose life is extended, many more will experience “false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.” A 2017 analysis by the task force estimated the ratio of beneficial PSA tests to false positives and overdiagnosis to be as high as 1/240. A 2013 meta-analysis by Cochrane Group found “no significant reduction” in mortality resulting from PSA tests. “The strategy of routinely screening all men with PSA tests leads to interventions that are not saving lives and may be causing harm,” the NNT stated. The discoverer of the prostate-specific antigen, pathologist Richard Ablin, has called the PSA test a “profit-driven public health disaster.”
癌症行业的腐败 就一般医学，尤其是癌症医学而言，积极进取、能做的美国医疗保健方法不起作用。美国在包括癌症治疗在内的人均医疗保健支出远高于其他任何国家，但更高的支出并没有带来更长的寿命。恰恰相反。根据 2015 年的一项研究，欧洲在癌症治疗上的花费远低于美国，其癌症死亡率较低。根据我们的数据世界，墨西哥、意大利和巴西等国家也是如此。 美国的做法助长了腐败。根据肿瘤学家维奈·普拉萨德（Vinay Prasad）在 Stat News 上 2019 年的一篇文章，许多癌症专家接受他们开出药物的公司的付款。普拉萨德认为，这种做法“让我们庆祝边缘药物，就好像它们是游戏规则的改变者一样”。 “它导致专家忽视或淡化癌症临床试验中的缺陷和缺陷。它让医生对癌症药物的压价保持沉默。” 去年，《纽约时报》和 ProPublica 报道说，斯隆凯特琳癌症中心的高级官员“一再违反有关财务利益冲突的政策，营造了一种利润似乎优先于研究和患者护理的文化。”斯隆凯特琳的首席医疗官何塞·巴塞尔加（Jose Baselga）“未能在医学期刊的数十篇文章中披露来自药品和医疗保健公司的数百万美元付款。”巴塞尔加离开斯隆凯特琳，成为阿斯利康制药公司的癌症研究负责人。 肿瘤学家希望产生可货币化的研究结果也可能会损害他们的研究质量。 2012 年对 53 项“标志性”癌症研究的检查发现，只有 6 项可以复制。所谓的可重复性项目：癌症生物学已经检查了 14 项最近被高度引用的研究，并且仅确认了 5 项没有资格。 CORRUPTION IN THE CANCER INDUSTRY The aggressive, can-do American approach to health care isn’t working when it comes to medicine in general and cancer medicine in particular. The U.S. spends far more per capita on health care, including cancer care, than any other country, but higher expenditures have not led to longer lives. Quite the contrary. Europe, which spends much less on cancer care than the U.S., has lower cancer mortality rates, according to a 2015 study. So do countries such as Mexico, Italy and Brazil, according to Our World in Data. The American approach fosters corruption. According to a 2019 essay in Stat News by oncologist Vinay Prasad, many cancer specialists accept payments from firms whose drugs they prescribe. This practice "leads us to celebrate marginal drugs as if they were game-changers," Prasad argues. "It leads experts to ignore or downplay flaws and deficits in cancer clinical trials. It keeps doctors silent about the crushing price of cancer medicines.” Last year The New York Times and ProPublica reported that top officials at Sloan Kettering Cancer Center “repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care.” Sloan Kettering’s chief medical officer, Jose Baselga, “failed to disclose millions of dollars in payments from drug and health care companies in dozens of articles in medical journals.” Baselga left Sloan Kettering to become head of cancer research at the drug firm AstraZeneca. The desire of oncologists to produce monetizable findings might also compromise the quality of their research. A 2012 examination of 53 “landmark” cancer studies found that only six could be reproduced. The so-called Reproducibility Project: Cancer Biology has examined 14 more recent highly cited studies, and has confirmed only five without qualification.
国内有同事亲戚朋友都是互相认识交心说实话的，美国靠网上发帖。
国内有保险，出国全得靠自己那个口袋。
语言不通各处花钱。
出国操劳恢复根本没有条件。。
拿啥跟国内比？
美国华人真是不知道自己几斤几两啊。
没错！大家既然都投给了猪党，不能白费票啊！得享受带来的福利啊！还得抓紧，过几年翻盘了就没机会了。
其实比平均寿命很说明问题 按这个标准日本最好 为了老人不怕花钱就到日本看病。
来美国更大可能就是让老人觉得自己有用 真把老人当抹布 擦一把面子扔垃圾桶了。
你老婆把你老丈母娘弄到美国来看病你怎么不管？在网上瞎操心。
EW TREATMENTS YIELD SMALL BENEFITS, BIG COSTS Research has linked cancer to many internal and external factors, notably oncogenes, hormones, viruses, carcinogens (such as those in cigarettes) and random cellular replication errors, or “bad luck.” But with the notable exception of the smoking/cancer link, which led to effective anti-smoking measures, that knowledge has not translated into significantly improved preventive measures or treatments. Clinical cancer trials “have the highest failure rate compared with other therapeutic areas,” according to a 2012 paper. Pharmaceutical companies keep bringing new drugs to market. But one study found that 72 new anticancer drugs approved by the FDA between 2004 and 2014 prolonged survival for an average of 2.1 months. A 2017 report concluded that “most cancer drug approvals have not been shown to, or do not, improve clinically relevant end points,” including survival and quality of life. The authors worried that “the FDA may be approving many costly, toxic drugs that do not improve overall survival.” Costs of cancer treatments have vastly outpaced inflation, and new drugs are estimated to cost on average more than $100,000/year. Patients end up bearing a significant proportion of costs. More than 40 percent of people diagnosed with cancer lose their life savings within 2 years, according to one estimate. Immune therapies, which seek to stimulate immune responses to cancer, have generated enormous excitement. Two researchers won the 2018 Nobel Prize for work related to immune therapies, and a new book, The Breakthrough: Immunotherapy and the Race to Cure Cancer, claims that they represent a “revolutionary discovery in our understanding of cancer and how to beat it.” According to a 2018 report in Stat News, drugs firms aggressively market immune therapies, and patients are “pushing hard to try them, even when there is little to no evidence the drugs will work for their particular cancer.” A 2017 analysis by oncologists Nathan Gay and Vinay Prasad estimated that fewer than 10 percent of cancer patients can benefit from immune therapies, and that is a “best-case scenario.” Immune therapies trigger severe side effects, and they are also extremely expensive, costing hundreds of thousands of dollars a year, oncologist Siddhartha Mukherjee, author of The Emperor of All Maladies, a bestselling history of cancer, reported in the New Yorker last year. “Subsequent hospital stays and supportive care can drive the total costs to a million dollars or more,” he writes. “If widely prescribed, immune therapies “could bankrupt the American health-care system.” TESTS LEAD TO OVERDIAGNOSIS AND OVERTREATMENT The cancer industry, aided by celebrities who claim that tests saved their lives, has convinced the public that screening for cancer is beneficial. The earlier we can detect cancerous cells, the more likely it is that treatment will succeed. Right? Wrong. One of the most significant findings of the past decade is that many people have cancerous or pre-cancerous cells that, if left untreated, would never have compromised their health. Autopsies have revealed that many people who die of unrelated causes harbor cancerous tissue. Tests cannot reliably distinguish between harmful and harmless cancers. As a result, widespread testing has led to widespread overdiagnosis, the flagging of non-harmful cancerous cells. Overdiagnosis leads in turn to unnecessary chemotherapy, radiation and surgery. Gilbert Welch, a physician whose 2011 book Overdiagnosed: Making People Sick in Pursuit of Health helped bring overdiagnosis to light, recently called it "an unfortunate side effect of our irrational exuberance for early detection.” Overdiagnosis is more insidious than false positives, when tests erroneously indicate the presence of cancer. Biopsies can overturn false positives but not overdiagnoses. Mammograms and prostate-specific antigen (PSA) tests have led to especially high rates of overdiagnosis and overtreatment for breast and prostate cancer. A 2013 meta-analysis by the Cochrane Collaboration, an international association of experts that assesses medical procedures, estimated that if 2,000 women have mammograms over a period of 10 years, one woman’s life will be saved by a positive diagnosis. Meanwhile 10 healthy women will be treated unnecessarily, and more than 200 “will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.” Another nonprofit medical group, theNNT.com, has spelled out a disturbing implication of these data. (NNT stands for “number needed to treat,” which refers to the number of people who must receive a treatment for one person to receive any benefit. Ideally, the number is 1.) The NNT notes that some overdiagnosed women might “die due to aggressive therapies such as chemotherapy and major surgery.” Thus any benefit from screening “is balanced out by mortal harms from overdiagnosis and false-positives.” Breast-cancer specialist Michael Baum, who helped found the United Kingdom’s breast-screening program, has advocated abandoning such programs, which he believes might cut short more lives than they extend. As for PSA tests, a federal task force of medical experts estimates that 1.3 deaths may be averted for every 1,000 men between the ages of 55 and 69 tested for 13 years. But for every man whose life is extended, many more will experience “false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.” A 2017 analysis by the task force estimated the ratio of beneficial PSA tests to false positives and overdiagnosis to be as high as 1/240. A 2013 meta-analysis by Cochrane Group found “no significant reduction” in mortality resulting from PSA tests. “The strategy of routinely screening all men with PSA tests leads to interventions that are not saving lives and may be causing harm,” the NNT stated. The discoverer of the prostate-specific antigen, pathologist Richard Ablin, has called the PSA test a “profit-driven public health disaster.”
就一般医学，尤其是癌症医学而言，积极进取、能做的美国医疗保健方法不起作用。美国在包括癌症治疗在内的人均医疗保健支出远高于其他任何国家，但更高的支出并没有带来更长的寿命。恰恰相反。根据 2015 年的一项研究，欧洲在癌症治疗上的花费远低于美国，其癌症死亡率较低。根据我们的数据世界，墨西哥、意大利和巴西等国家也是如此。
美国的做法助长了腐败。根据肿瘤学家维奈·普拉萨德（Vinay Prasad）在 Stat News 上 2019 年的一篇文章，许多癌症专家接受他们开出药物的公司的付款。普拉萨德认为，这种做法“让我们庆祝边缘药物，就好像它们是游戏规则的改变者一样”。 “它导致专家忽视或淡化癌症临床试验中的缺陷和缺陷。它让医生对癌症药物的压价保持沉默。”
去年，《纽约时报》和 ProPublica 报道说，斯隆凯特琳癌症中心的高级官员“一再违反有关财务利益冲突的政策，营造了一种利润似乎优先于研究和患者护理的文化。”斯隆凯特琳的首席医疗官何塞·巴塞尔加（Jose Baselga）“未能在医学期刊的数十篇文章中披露来自药品和医疗保健公司的数百万美元付款。”巴塞尔加离开斯隆凯特琳，成为阿斯利康制药公司的癌症研究负责人。
肿瘤学家希望产生可货币化的研究结果也可能会损害他们的研究质量。 2012 年对 53 项“标志性”癌症研究的检查发现，只有 6 项可以复制。所谓的可重复性项目：癌症生物学已经检查了 14 项最近被高度引用的研究，并且仅确认了 5 项没有资格。
CORRUPTION IN THE CANCER INDUSTRY The aggressive, can-do American approach to health care isn’t working when it comes to medicine in general and cancer medicine in particular. The U.S. spends far more per capita on health care, including cancer care, than any other country, but higher expenditures have not led to longer lives. Quite the contrary. Europe, which spends much less on cancer care than the U.S., has lower cancer mortality rates, according to a 2015 study. So do countries such as Mexico, Italy and Brazil, according to Our World in Data. The American approach fosters corruption. According to a 2019 essay in Stat News by oncologist Vinay Prasad, many cancer specialists accept payments from firms whose drugs they prescribe. This practice "leads us to celebrate marginal drugs as if they were game-changers," Prasad argues. "It leads experts to ignore or downplay flaws and deficits in cancer clinical trials. It keeps doctors silent about the crushing price of cancer medicines.” Last year The New York Times and ProPublica reported that top officials at Sloan Kettering Cancer Center “repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care.” Sloan Kettering’s chief medical officer, Jose Baselga, “failed to disclose millions of dollars in payments from drug and health care companies in dozens of articles in medical journals.” Baselga left Sloan Kettering to become head of cancer research at the drug firm AstraZeneca. The desire of oncologists to produce monetizable findings might also compromise the quality of their research. A 2012 examination of 53 “landmark” cancer studies found that only six could be reproduced. The so-called Reproducibility Project: Cancer Biology has examined 14 more recent highly cited studies, and has confirmed only five without qualification.
楼主难道不知道国内也有很多为了给老人治病倾家荡产的家庭吗