It's widely known that the top 1% of US households own more than half the nation’s equities and control more wealth than the bottom 90%. Five years ago a group of analysts at Citibank prepared a report for their wealthiest clients that sought to base an investment strategy on the premise that this disparity of income and wealth will persist and even become more extreme.
The Citibank analysts coined the term “Plutonomy” to describe countries such as the US that are characterized by this sort of massive economic inequality. They recommend that the most effective way for companies and wealthy individuals to prosper in Plutonomies is to disregard the “mass” consumer and focus on the rich. Over the course of 68 pages, the Citibank analysts take pains to show why more money can be made from fewer customers. Barring major disruptions such as wars, financial crises and the dreaded "populist political pressures," the Citibank analysts project that “the rich are likely to keep getting even richer, and enjoy an even greater share of the wealth pie over the coming years.”
Some observers claim that pharma's concentration on cancer as a therapeutic category is tantamount to a plutonomy strategy because prices there range from $50,000 to $200,000 per patient per year, while the number of patients who can benefit from any one drug in a personalized medicine approach remains relatively small.
This week a report in the medical journal Lancet Oncology concluded that the cost of treating cancer this way in the high-income countries "is becoming unsustainable." Factors such as "an aging global population and an endless conveyor belt of expensive new drugs and technologies" increase the at-risk population and the costs of treatment. Meanwhile both the public and many specialists lack adequate evidence of therapeutic effectiveness amid a highly emotional insistence on pursuing treatments regardless of cost.
The Lancet authors believe that a solution requires the cancer centers to manage the disease and the stakeholders more effectively. "The cancer community needs to take responsibility and not accept a sub-standard evidence base and an ethos of very small benefit at whatever cost." That means provider institutions in some cases might strongly advise patients and their insurers against spending $90,000 for three months of added survival under dubiously tolerable conditions.
The problem is that rational case management remains questionable in the presence of a raucous political segment that yells in favor of letting uninsured patients die, while cheering for executions. Their perverse form of acquisitive individualism that led them to demagogue the prospect of health care reform with cries of "death panels," and their sway over scores of Congressmen, dim the prospect of cost-effective cancer management.
It will be interesting to monitor the role that pharma decides to play on this issue of evidence-based, affordable cancer treatment. The industry has an opportunity to either become part of an equitable solution or an opportunistic exploiter of public emotion and ignorance.
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