As one whose wife died of cancer, I might at first blush appear surprisingly to be the grinch who stole Christmas. But it would be intellectually remiss not to reveal the shortcomings -- and alternatives -- to Proposition 15, on the ballot November 6.
Texans will be asked to authorize the state (that is, taxpayers) to issue $300 million a year for 10 years ($3 billion) for research on the causes and cures for cancer. Actually, the cost would be $4.6 billion, with $1.6 billion added for interest on the bonds.
It is a humane cause, but voters need more information. Here are five points you probably won’t hear from Proposition 15’s well-intentioned supporters.
One. The average cost of getting a cancer drug through the FDA’s clearance process is now $1.4 billion, roughly $700 million for Research and Development and $700 million for clinical trials. And it takes an average of eight years for a drug to gain approval through the FDA’s Phases 1, 2, and 3 of clinical trials Were the full $3 billion given tomorrow to Proposition 15’s newly proposed Cancer Prevention and Research Institute, the bond issue could fund only two drugs that would take nearly a decade for market approval. And they’d better both work, without a flaw or hitch.
Meanwhile, pharmaceutical companies are spending multiple billions of dollars each year on researching, testing, and providing cancer drugs.
Two. Just what would the Cancer Prevention and Research Institute spend money on? What types of cancer, what types of treatment? What types of researchers? Are taxpayers expected to provide an irrevocable, blank check for $3 billion in good faith only?
Three. As Richard Epstein, Professor of Law at the University of Chicago and author of the recent book Overdose: How Excessive Government Regulation Stifles Pharmaceutical Innovation, urges, the FDA needs “to relax the rules on [drug] entry, not subsidize research, under the current system.” There are many investigational drugs in clinical trials that the FDA has found both safe and effective enough to continue testing on human beings. Earlier access to these drugs would extend the lives of tens of thousands of terminal cancer victims yearly.
My own wife received such an investigational drug, which extended her life by seven months and, more important, ridded her entirely of torturous, morphine-treated pain. Then, rather than relax the rules for such a safe and effective drug for many, the FDA took the drug off the market.
Four. Since Texas’s Cancer Prevention and Research Institute would share its research advances ubiquitously with the other 49 states, the local Texas subsidies, notes Epstein, “would provide the greatest net benefit to cancer patients outside Texas, not those within it.” It would therefore make greater sense to establish a national movement at the National Institutes of Health. All states share in the benefits, so let all states in some way help pay for them. “The liberalization of [FDA] approval rules,” notes Epstein, “has the real advantage of stimulating research everywhere.”
Five. Texans would gain more research advantages and faster not by giving local subsidies to a cancer institute, but by proactively working to encourage passage of the ACCESS Act in Congress.
This Act (Senate Bill 1956 and House Resolution 6303) would permit earlier access to promising investigational drugs that the FDA has found both safe and effective enough to continue testing on patients. The decision to use these drugs would remain between the oncologist and patient informed about possible risks. In an age of Vioxx fear and demand for drug safety, the FDA would still retain significant control and record-keeping under this Act.
Texans are a generous, compassionate people. But our compassion cannot be measured by government debt and new tax burdens, it must be examined in the light of impact. Sadly, Proposition 15’s most notable impact will be the expenditure of $4.6 billion that could have been used more effectively and efficiently in private hands.
Ronald Trowbridge, Ph.D., is a visiting fellow at Texans for Fiscal Responsibility and Empower Texans. In his distinguished career, Dr. Trowbridge was chief-of-staff to U.S. Supreme Court Chief Justice Warren Burger and the Commission on the Bicentennial of the U.S. Constitution, and served as director of the Fulbright program. Most recently, he was vice president of Hillsdale College in Michigan. He resides in Houston.