Health reform and cancer: Mass can’t get either one right?

Fortune/CNN jumps all over Mass health reform

 …(T)he plans offer lavish subsidies that swell the demand for health care, they do nothing to increase the supply of medical services in a market suffering from shortages of everything from family doctors to nurses to hospital beds. Two years after enacting health-care reform to rein in costs, Massachusetts strengthened “certificate of need laws” that prevent hospitals and other providers from competing with high-cost, entrenched suppliers. The state now requires that ambulatory surgical centers and outpatient treatment facilities get permission from regulators before they can enter the market. Their rivals invariably lobby the regulators to block competition, and usually win.

 And, the NY Times holds up MGH research as an example of the limits of targeted cancer therapies.

 Enthusiasts for the targeted drug have been saying for years that tumors will eventually be characterized by their molecular profiles — which mutated genes they have — rather than where in the body they occur. Names like breast cancer and lung cancer will be supplanted by terms like B-RAF-positive or EGFR-positive tumors. And drugs will be chosen based on that profile, the way antibiotics are generally selected based on the pathogen that is causing the infection, not on where in the body the infection occurs.

 Massachusetts General Hospital, for instance, is running a clinical trial testing a drug from AstraZeneca on any type of cancer — providing it has a mutation in the gene B-RAF, the same gene that is the target of PLX4032.

 But the test of PLX4032 in colon cancer suggests that the location of the tumor still does matter, that it will not be just a case of looking at the target. There are other examples as well. Erbitux and Vectibix do not work in colon cancer patients with a mutation in a gene called K-RAS. But the relationship between the mutation and the effectiveness of Erbitux does not seem to hold in lung cancer.

 

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