Too many drugs? Too few patients?

The article by Gina Kolata in the New York Times ( August 13, 2017) is written from  a perspective that favors drug companies over the patients.    

The current system of clinical trials  started when the average American lifespan was less than 70 years for men, before we knew anything about the molecular basis of cancer, and the slide rule was the most sophisticated, widely available, computational tool. It has always been clear that this system slowed drug availability and, consequently, led to deaths.  

From the patient's (and the caring provider's) perspective anything that improves the chance of more effective therapy is welcome. "Too many drugs" is when there are adequate treatments for all diseases.  "Too few patients " is universal wellness...at reasonable cost. 

The article quotes two Genetech executives (see same day NYT page 7 for the ad for an unrelated Genentech product)  questioning how many immunotherapeutic  agents can be tested.  Genentech's entry in this field,  TECENTRIQ®,,is having trouble proving its worth .  The company  may want to beat its competitors.  The irony of a Merck vice president saying: "How many  PD-1 antibodies does Planet earth need? " is not lost on me.  He might well think that the Merck product, Keytruda, is enough. We do not know that .

The idea of "outstrip[ping] our progress in understanding the basic underlying science"  is incredibly arrogant.  Most of our currently effective  cancer treatments  were developed in the context of models that have been long abandoned.   Our current understanding of immunology and  gene interactions remains primitive and will almost certainly be changed in the future.   Part of refining the model  will depend on the results of treatment with these medicines.  That is the history of medicine. 

In the article the "cost" of genetic testing is quoted at $5000. I find that interesting .  The cost depends on who is paying.  Currently, the materials cost is less than $100.  The amount billed to the insurance company is often about $8500.  If the patient pays directly, it is no more than $3500.

From the  cancer  victim's perspective, the problem is not too many drugs.  The  problem is  the cancer.  The drug companies, the  FDA  and insurance companies are standing between patients and their treatment.  The system needs to change.