Cancer, Incorporated with Dr. Ralph Moss: Rational Wellness Podcast 160
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Dr. Ralph Moss talks about Cancer, Incorporated, his latest book, with Dr. Ben Weitz.
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3:45 Dr. Moss shares some thoughts about the current coronavirus pandemic, including that if every particle of coronavirus were visible with a light, we’d be amazed how widespread it is. He likes the medicinal mushrooms, including shitake, maitake, and reishi, for immune system support. Dr. Moss is intrigued by the concept of Superinfection Therapy, which has been used in the treatment of hepatitis B and C and for the seasonal flu and the concept is that one infection stimulates the immune system that knocks out another infection, such as with a poultry virus that does not cause any disease in humans.
12:29 Dr. Moss discussed the use of the BCG vaccine, which is used for TB, and this shows some effectiveness both as a treatment and for prevention for the SARS-COV-2 virus.
13:56 The areas where there are the highest amounts of fatalities from COVID-19 are occurring in areas with high rates of air pollution.
17:07 Dr. Moss’s latest book is Cancer, Incorporated, which talks about the war on cancer and the drugs and the financial ties between the researchers and the drug companies and the regulators. One shocking fact is that when we look at some of the new targeted drugs, like the immune therapy ones like Yervoy, which are used for solid tumor cancers during stage four, on average these drugs only extend survival by 3 to 6 months. On the other hand, some people are completely cured by targeted drugs, such as former President Jimmy Carter, who had melanoma that had spread to his brain.
21:59 These newer, targeted cancer medications tend to have much fewer side effects than traditional chemotherapeutic drugs. But there are a number of questionable ways that they were able to get some of these drugs approved, such as that some of them are approved not because of curing any cancer patients but because they improve some surrogate marker, such as a score on a test. For a drug to get approved for cancer it should either cure you or extend life in a meaningful way or improve the quality of your life. For example, some drugs are approved because they extend disease-free survival or progression-free survival, which may mean that there is actually no increase in the rate of survival from the cancer. And these drugs can have a number of uncomfortable side effects.
29:40 Immunotherapy for cancer includes drugs like Yervoy, Opdivo, Keytruda, and Tecentriq, which are heavily advertised to the public. Cancer tends to confuse and turn down the immune system, so these drugs activate the immune system and they can be very effective in certain cancers like melanoma. They are also often referred to as immune checkpoint inhibitors. But these drugs are very expensive, costing approximately $150,000 and it may be most effective to take two of these drugs at a time. There’s new drug, Kymriah, a CAR T therapy drug, also an immunotherapy, that costs $475,000 per injection, while the actual cost of production is $20,000. One of the justifications from the pharmaceutical companies is that they spend lots of money doing research and development for these drugs. But Dr. Moss points out that most of the basic research is actually done by the National Institutes of Health, by the government, paid for by taxpayers. After the taxpayers pay for much of this research, it is then handed over to big pharma, who reap most of the rewards.
35:15 These pharmaceutical companies can no longer be taken to court for price gouging since congress passed the Medicare Modernization Act of 2003. It included in the law that the government, which means Medicare, Medicaid, and the VA could not contest the prices, could not negotiate over the price of the drug. The sole reason why the same drugs are cheaper in Canada than the United States is simply because they have a universal healthcare system that goes through the government, and the government negotiates those prices down. This same provision that we not negotiate to lower the price of the drugs was also written into the Obamacare legislation in order to keep the big pharma lobbyists from opposing the legislation and keeping it from passing. When they were passing Obamacare, there were three times as many lobbyists from big pharma and the insurance companies for every member of congress.
40:25 Dr. Moss’s book Cancer, Incorporated highlights how money flows from big pharma to the oncology profession. A lot of money especially flows to the key opinion leaders, the most influential doctors, the ones whose names show up on the key clinical trial papers. In fact, if you go to a website called Open Payment Data, you can track all the money paid to doctors by drug companies. This database was part of the Obamacare bill and it requires that drug companies have to reveal all the money they give to doctors, universities, and hospitals.
Dr. Ralph Moss is the former science writer and assistant director of public affairs at Memorial Sloan-Kettering Cancer Center. He is known for his Moss Reports which are detailed reports on the most common cancer diagnoses for lay persons and he also provides informational and personalized consultations for cancer patients. Dr. Moss was a founding member of the National Institutes of Health’s Alternative Medicine Program Advisory Council, and of the Complementary and Alternative Medicine panel. Dr. Moss has written a number of books, including his latest Cancer, Incorporated.
Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.
Dr. Weitz: Hey. This is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters. For those of you who enjoy listening to the podcast, please give us a ratings and review on Apple podcast. If you’d like to see a video version, please go to my YouTube page, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.
Today, I will be talking to the medical writer, Ralph Moss, PhD, who has written or edited 14 books and collaborated on four film documentaries related to cancer research and treatment. We will be talking about modern cancer treatment, especially chemotherapy and some of the newer targeted medications. Dr. Moss is a former science writer and assistant director of public affairs at Memorial Sloan Kettering Cancer Center in New York back in the ’70s. Since leaving Sloan Kettering, Dr. Moss has independently evaluated the claims of conventional and nonconventional cancer treatments all over the world, and he currently writes the Moss Reports, which are very detailed reports on the most common cancer diagnoses for laypersons, and he also provides informational and personalized consultations for cancer patients and their families. Dr. Moss was also a founding member of the National Institutes of Health’s Alternative Medicine Program Advisory Council, and he has served as a peer juror for a dozen medical journals. Dr. Moss, thank you so much for joining me today.
Dr. Moss: My pleasure.
Dr. Weitz: So, I definitely want to focus our talk on your latest book, The Cancer Industry, but before we do-
Dr. Moss: Cancer Incorporated.
Dr. Weitz: Cancer Incorporated, okay. Sorry about that. Cancer Incorporated. Before we do, I wanted to ask you a few questions about the current coronavirus pandemic situation that we’re in. At the time of this filming, that’s what’s going on right now in the country, and you can tell from this mark on my nose from wearing a face mask almost the entire day, which is not something I’m used to since I don’t work in an emergency room. I’m in private practice. So, I know that you’re an expert at cancer, but you’re also an expert at integrative approaches to cancer, and as I think about this pandemic, I think that the way I like to look at a viral epidemic like this is the key, I think, from my integrative functional medicine perspective is that we want to make the host, which is us, very inhospitable to the virus stinking root and growing. I think of integrative cancer care the same way. We want to make the terrain of our body hostile for cancer to be able to take root and grow. So, from your perspective, what are some of the most important things that we can do to protect our bodies against this coronavirus that’s spreading around the world right now?
Dr. Moss: Well, as you say, I’m not an expert on this topic with the other 320 million Americans trying to figure out how to survive in all of this, and given my age, and some of other health conditions, I feel personally that my wife and I are at increased risk. So, we’re very vigorously following the standard recommendation, and treating like it is already in our area, although I live in Maine, and we have not been hard hit in the rural parts of Maine, but, of course, if every particle of coronavirus were visible with a little light on it, we’d probably be amazed at how widespread this thing is. Actually, that’s how we conceptualize it. So, we do take very seriously the need to wear a mask and gloves and all the rest of it. In our community, which is a very small community, the neighbors have gotten together and made a group plan where we’re all in touch via instant messaging, which initially was for helping each other do shopping, and we’ve utilized that, but it also is a way to keep in touch and know if anybody’s gotten sick and where are things then. The first notice we got of the lockdown of the state was through that little informal messaging system. I think this is going on all over the country. It’s very, very good. Oddly, the social distancing has led to greater closeness among neighbors in some parts, at least, and this has been very good.
Dr. Weitz: That would be a great positive that could come out of this situation is it actually brings the country together to fight this common condition.
Dr. Moss: No doubt. No doubt. I think history will be rewritten to be pre-COVID-19 and post-COVID-19. I see it as that. Let me just get rid of this call. So, as far as what one could do about it, I think of this in two different ways. One is what can you do personally and then the other one is what can you do society-wise. Personally, I’ve written a blog about mushrooms, medicinal mushrooms. Why? Because the strengthening of the immune system and the healing healthfulness of the immune system I think is very important. So, the things you would normally do to keep your immune system healthy and keep the numbers in a high normal range would be beneficial, and the most neglected supplement in that regard, I think, are the medicinal mushrooms, which have a tremendous amount of research behind them in Asia, not so much in the US. People go to my website, which is mossreports.com, they’ll find my blog about this and how you could prepare a soup out of medicinal mushrooms, especially shiitake, maitake, and reishi or oyster mushrooms. Amazingly, almost all of the exotic Asian mushrooms also double as immune modulators. So, I think that’s important.
A woman that I knew when I worked as a consultant to the National Institute of Health, Jennifer Jacobs, MD, has put out a blog about homeopathy and COVID-19, which I thought was very interesting. She’s a medical doctor. She’s had 40 years experience with homeopathy. So, I think her word should be taken seriously.
Then I think also from a societal point of view, the ideas that have intrigued me the most about potential treatments have been the ones that work on the immune system, and two in particular. I’ve written a blog about one of them. The other one is very much in the news, if people search for it. The first one is called Superinfection Therapy. It seems like a contradiction of terms to give an infection on top of an already existing infection. This has been used in the treatment of hepatitis B, hepatitis C, and seasonal influenza, flu in Russia from the ’60s to the ’80s. Hundreds of thousands of people who got basically non-disease-causing superinfections were deliberately given this. Some of them were given, for instance, the Sabin oral polio vaccine. So, what would that do? Well, there’s a funny thing called superinfection where if you have an infection, you give another infection on top of it, sometimes that second infection knocks out the first infection. It’s like they’re competing for the same ground. You could think of it that way. The other idea is that the superinfection, the second infection stimulates the immune system in a nonspecific way that then enhances your ability to deal with the first one. Whatever the reason is, there’s a lot of potential to this, and it’s been shown in other situations. This may be applicable to SARS type of infections, coronaviruses, and so forth. There’s a petition at the White House. The White House has the petition process and we have started the petition basically to bring this to the attention of Anthony Fauci, who is a big top scientist on the president’s COVID-19 taskforce. So, we’re hoping. It’s a long shot, but if you get 100,000 signatures on a petition to the White House, somebody in the White House has to respond to it. So, we’re trying. What else can we do, right? There isn’t much more. We’re trying to-
Dr. Weitz: Just let President Trump know how he could personally make an investment in a company that provides this therapy and you’ll be golden. It will be on every press conference.
Dr. Moss: My problem in life is I’m always trying to find the least expensive, least profitable treatments. To me, the most effective treatment would be water or something, something that was free.
Dr. Weitz: Sleep, exercise, right, meditation.
Dr. Moss: Walk in the pine forest in Maine might be the best treatment. You know what I’m saying is that … So, that’s a treatment that would be incredibly inexpensive because the one that they use in Europe experimentally is a poultry virus. These poultry viruses are very good because they are highly contagious and active, but they don’t cause any human diseases. There’s a couple of them. So, one of them is currently being proposed as a treatment. We’re not asking for anymore than a fair test initially, like a pilot study, and maybe 10 patients to start, and then, of course, we’ll work through clinical trials, although the clinical trial system seems to be tremendously under stress now for the obvious reasons.
Dr. Weitz: Oh, sure, but there are actually a huge number of clinical trials that the FDA is allowing without the normal controls because of the situation we’re in. So, actually, the scientific community is very excited about the ability to launch somebody’s treatments.
Dr. Moss: The other treatment that interests me very much is BCG, bacille Calmette-Guerin, which is the standard TB vaccine.
Dr. Weitz: They use that for bladder cancer sometimes, right?
Dr. Moss: Correct. Correct. That was your first use medical, well, repurposed use in cancer, and it’s used at very high level, instilled into the bladder mainly to prevent recurrences of bladder cancer, which are relatively easy to treat, but very difficult to keep from coming back. So, they use the BCG, instill it, but BCG has many uses. It’s been in literally over a billion people. It’s given to babies. It’s considered, of course, a very safe thing, and it seems to correlate with lower rates of viral infections, but more importantly, BCG is being tried in Europe as a way of actually treating people. Again, I think the philosophy is almost identical to superinfection theory, therapy in that it makes a nonspecific stimulation of the immune system. That can be enough to help the person in the initial stages to keep that virus from taking over the lungs. So, I think that this is very important.
Another one more thing I’ll mention, which is, and it came out, I mean, there was an article about it today in the New York Times, but there have been hints of this all along, which is that the greatest number of fatalities from COVID-19 are occurring in areas with high rates of air pollution. I thought about this because I, luckily enough, and not by accident, I live in an area with very little air pollution. I mean, we get what blows up the coast from Boston, and maybe Portland, but that’s about it. I mean, so if you-
Dr. Weitz: So, it’s probably a great idea that the president right now is trying to reduce the fuel emission standards on cars.
Dr. Moss: Well, nature is carrying out an experiment, which is to reduce air pollution. So, we got the green new deal, but we got in a way we never expected. All the industries shut down. Car manufacturing is all shut down and so forth. So, in a way, I mean, it’s ironic that it took that in order to get us to reduce our pollution of the planet, but I’m not saying … This is more like a longterm thing, but it also points to the fact that the health of the lungs proves critical in a surprise, surprise, in a respiratory disease. So, whatever you can do to improve the health of your lungs, whether it’s through exercise or through supplements, through walking in the woods, whatever you need to do, that would be a beneficial thing.
Dr. Weitz: I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.
Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.
Now, back to our discussion.
Dr. Weitz: Let’s talk about your book, Cancer Incorporated, which talks about the laws and the war on cancer and the drugs that ties between the researchers and the drug companies and the regulators.
Dr. Moss: Yes. So, I wrote the book. It took me about a year to do this, and it just came out in January. Of course, then overwhelmed by our more oppressing problems, but the cancer problem is not going away, and it will-
Dr. Weitz: In fact, patients who are currently undergoing some of these treatments for cancer actually at increased risk of COVID-19 infection and having a worse response as well.
Dr. Moss: Absolutely. Absolutely. It’s a disaster especially for cancer patients, especially people with lung cancer. It’s a terrible situation. What I focused on in Cancer Incorporated, though, is the manner in which these drugs, these new drugs in particular have been presented to the public, and what I see as the corruption of the oncology profession, the leading cancer researchers in terms of approving drugs and getting the FDA to approve drugs that are not really effective. I was led to this by the speech that James P. Allison of the MD Anderson Cancer Center gave upon accepting the Nobel Prize in December of 2018. He was contrasting a treatment that he invented called Yervoy, which is a immune therapy with all previous drugs I targeted, so-called targeted drugs, and he made a comment that I can’t quote exactly, but, basically, on average that these drugs extend survival by a few months. You push the envelop by a few months. When I looked into this, I was startled. I hadn’t realized, as critical as I’ve been of the cancer industry, I hadn’t realized that it was that limited. When I looked into this, I found that it was in fact the actual increase in overall survival from these new drugs in stage four cancers. We have to specify. We’re not talking about pediatric cancers or relatively rare kinds of cancer, but on average, for the solid tumors of adults in the final stage, in the stage four, metastatic disease, is I think-
Dr. Weitz: For those who are not aware, stage four means that the cancer has now spread from the initial organ where it was throughout the other parts of the body.
Dr. Moss: Correct. So, it’s about 3.8 months. That’s what this clinical trial show. These are the actual benefit on average of all of these targeted drugs that are now the bulk of the drugs that are being approved or what we would call targeted drugs. Even with the immunotherapy, which I do believe in in general terms, it’s really only about five or six months on average. Now, you hear about people being cured by immunotherapy. This is true. This is-
Dr. Weitz: For example, former Vice President Jimmy Carter who was diagnosed-
Dr. Moss: President, yeah.
Dr. Weitz: Yeah, former President Jimmy Carter who was diagnosed with, I think it was metastatic. What was it?
Dr. Moss: Melanomas spread to the brain.
Dr. Weitz: Spread to the brain, and it’s been years now, and he seems to be doing phenomenal.
Dr. Moss: Phenomenally well. He did have a pinpoint radiation to the brain, but especially in an older person like himself, and he’s I think in his 90s, you wouldn’t expect that to result in a-
Dr. Weitz: He takes one of these targeted meds or took one of these targeted meds, right?
Dr. Moss: He took one of the very first immunotherapy drugs. So, the targeted drugs could be divided into precision medicine, let’s say, and then a subset of that would be immunotherapy.
Dr. Weitz: By the way, these are somewhat of an improvement over the traditional chemotherapy, which were basically drugs that just kill everything and are designed to kill the cancer cells and hopefully they don’t kill you. Whereas these targeted drugs don’t have as many of the side effects.
Dr. Moss: No. That was the main selling point of that, but I go in great detail in Cancer Incorporated into what these drugs actually do, and the manner in which they’ve been approved. I was shocked by what I found because there’s couple of things. One is that, now, we’re not talking about fraud here, which sometimes occurs, but I’m no saying that there’s actual making up of data. It isn’t that, okay? So, people can disabuse themselves of that notion. It does happen, but that’s not what I’m talking about. That’s not the general course of thing. What I’m talking about is that most of the time, the drugs are approved by FDA based upon a surrogate marker. A surrogate marker means I can’t prove to you that the drug actually conveys true patient benefit, but I’ll choose something else like a score on a test or another. I’ll redefine what I mean by benefit, so that I can then get approval. The main scam going on here, and it is a scam, is a drug to be effective, for a cancer drug to be effective in stage four cancer, it basically has to do one of three things. First of all, it could cure you. That would be great. You take the drug, you have a complete response to the drug, meaning that the cancer disappears, and you live out your normal lifespan. That would be a cure. Second thing, it could extend your survival in a meaningful way. So, what would that be? Meaning that in the group as a whole, we’re not going to just consider anecdotes, individual cases, we’re going to consider the entire group being tested. They live months or years longer than they would have if they took a different treatment or if they took no treatment or they just have best supportive care. That would be increased overall survival, okay? That’s another palpable benefit of treatment. The third one would be increased quality of life, but the vast majority of drugs do not cure. They almost never tested for quality of life, very rare or they don’t really extend the overall survival. So, how could it be then? How could the FDA, the Food and Drug Administration or the equivalent agencies abroad, how could they approve a drug without it showing any benefit?
The answer is that there are a dozen definitions of survival at the National Cancer Institute dictionary, cancer terms, and they usually substitute something like disease-free survival or progression-free survival. What does that mean? So, it means that between the time that they administer the treatment and the time that they first noticed that the cancer is in fact getting bigger, progressing, spreading to other organs, whatever, that period of time, the progression-free time is longer in the patients who get the treatment than in those who don’t. So, now, when you read a headline that says, “Such and such drug increases survival in cancer patients,” most often, if you drill down and you’ll read, bother to read the article not just the headline, much less read the actual study that it’s based upon, not just the abstract but the actual study, you find that what they’ve done is they changed the shape of the curve. They moved it over so that some more time elapse between the time the person was first treated and the time that they first noticed the disease is progressing, but they didn’t increase the actual time the patient live.
So, I give an illustration on how that could be you. You have two people, patient A and patient B. So, patient A and B, they have the same disease, same stage, same type of cancer. They’re both treated on, let’s say, January 1st. One of them gets the experimental drug, and one of them gets no further treatment, okay? So, at three months, there’s no sign of further progression in patient A, but patient B is going downhill. The cancer is still growing, it’s still causing a problem. At the six-month point, patient B, of course, is still going downhill. Patient A may detect that patient A actually now has an increase in progression of the cancer, and they both continued downhill from there, and they both died exactly one year after starting the treatment. So, from a common sense or a patient or a laypersons’ point of view, what exactly was the difference between those cases? They both lived exactly to the day, one year from the time that they started the treatment. It didn’t make any difference. If you take the word survival, I mean, increased lifespan, which I think 99% of people would, it didn’t make any difference. Did patient A have a better quality of life? That’s debatable? Patient A had a period of false hope, let’s say, a period of six months where she thought that she was maybe going to be cured, but during that time, she was getting this toxic drug. So, she may have spent that time in very, very difficult, uncomfortable or dangerous circumstances. So, which is better? I don’t know. No one has ever figured that out because I think it depends on the person. Do you want that period of that false hope of six months and you can enjoy that and have a normal … or do you want to just accept your fate, not do anything, and slowly go down? I don’t know.
Dr. Weitz: You know who benefits from that.
Dr. Moss: Right.
Dr. Weitz: The executives and the shareholders of the big pharma company that are making more profits supplying this drug that costs hundreds of thousands of dollars when you’re treating that.
Dr. Moss: Right, and can have a horrendous side effect. Yes, it’s true that with chemotherapy, one of the most brutal treatments ever invented, chemotherapy, or probably the most poisonous that’s deliberately given to human beings since the bloodletting era or the mercury era, whatever you want to call it. Yes, you don’t get that kind of … but you get other toxicities, some weird things. Even with the immunotherapy, which as I say, for the highly mutated cancers like melanomas and lung cancers, can be very effective, but the guidebook on the side effects of those new immunotherapy runs to, I think it’s 65 pages of fine print for what can occur following this kind of immunotherapy.
Dr. Weitz: By the way, which are some of the examples of some of the immunotherapies and how do those drugs work?
Dr. Moss: Right. So, it’s Yervoy, and Opdivo, and Keytruda, which are heavily advertised to the public, by the way, only two countries in the world.
Dr. Weitz: Is it Yervoy, the drug that Carter was given?
Dr. Moss: I believe it was.
Dr. Weitz: Yeah.
Dr. Moss: It was either that or, yeah, I think it was or it was Opdivo, but, yes, I think it was Yervoy because that was the first one to be developed, and then there’s Tecentriq, and there’s a few others, okay? The idea is a very good one. It’s based on a very, very important fact that Dr. Jim Allison and others discovered, which is that cancers have the ability to confuse and turn down the immune system. So, the immune response can be inhibited by the cancer itself. So, it’s like a fifth column within the body that’s preventing your armed forces from being able to act, okay? So, the brilliance of what Jim Allison did, who discovered Yervoy, was to figure out a way chemically to block the interaction of the cancer cell with the immune cell, the crosstalk that goes on between the cancer and the immune system, and to block that, and then the immune system is able to be activated. This can be very, very effective in melanoma. It’s something like 50% or 60% of the patients, melanoma stage four patients are now having these major responses and durable remissions from this drug. So, I understand the excitement and enthusiasm for it, but through not any fault of Jim Allison, the company, Bristol-Myers Squibb, which owns both Yervoy and Opdivo, set the price of the drug at around $150,000, and if they’re given in combination, which is the most effective way, the price can go up to a million dollars per person.
Some oncologists in Latin America analyzed the situation and they said … They were in Chile, country of Chile, and they said only 10% of the population would even be covered through insurance for this type of treatment. Forget about the people who don’t have insurance, but just of the insured population. In Peru, a less affluent country, only 5% of the population would be covered for that treatment. So, you could be sure that 95% of humanity will be left out of that kind of treatment, that kind of pricing. It’s just out of this world. The height of absurdity came with a different type of immunotherapy called Kymriah. It’s what’s also called the CAR T cell therapy. That drug sells for $475,000 per injection, per injection. We know from the inventor of that treatment who let the cat out of the bag because he said that the actual cost of production, it’s a living drug, it’s a very interesting drug, but it’s a living drug, he says that the actual cost of production is $20,000. So, 455,000 or about whatever that is 96% is profit.
Dr. Weitz: Now, is there any justification for that based on the fact that I’m assuming to take a devil’s advocate position a drug company would say, “Look, we had to spend years researching this, and we spent years researching other drugs that didn’t work that we never got paid for.” The cost of running these trials is very expensive, right?
Dr. Moss: Right. Right, but what most people don’t realize, if we want to talk about fairness, is that the vast majority, I think some people have said 100% of all new cancer drugs are basically researched by the federal government at taxpayer expense.
Dr. Weitz: You mean, initially, the NIH is doing the basic research.
Dr. Moss: Exactly. All the basic research of almost all the drugs, the taxpayer pays for to an amazing degree, sometimes up to actually the finished product, which is then handed over to a drug company on the very disadvantageous terms to the government. The taxol famous case of the derivative, the only herbal treatment, well, one of the few herbal, the derived treatments for cancer, Bristol Meyers was given a monopoly on the sale and distribution of that drug for an incredibly small amount of money compared to the billions that they made on it. It was a scandal that actually wound them up in court, eventually, in the old days when drug companies could be taken to court, but the basic-
Dr. Weitz: Can they not be taken to court anymore?
Dr. Moss: Not for what we’re talking about because they pay … I mean, for price gouging, and monopoly practices, no, it doesn’t happen, but basically, the drug companies through the corruption of the congress and the FDA, they’d pass the law in 2003 that we live with the consequences are called the Medicare Modernization Act of 2003. One of the things that this did where they slipped in was that the government, meaning Medicare, Medicaid, and VA could not contest the prices, could not negotiate over the price of the drug. So, it’s like if you go to a plumber and you say, “You can charge me anything you want. Go ahead. Just whatever it is, I’m going to pay it and I have no recourse,” and the public is demanding that you give them that drug because of good public relations and complicity of the media. So, they got that law passed. They got it passed at 3:00 in the morning by one vote in the senate, and emergency, they called a surprise vote, the proponents of the bill, 3:00 in the morning. A lot of the opponents were not there, and they pushed it through. We’ve lived with the consequences of this-
Dr. Weitz: By the way, the sole reason why the same drugs are cheaper in Canada than the United States is simply because they have a universal healthcare system that goes through the government, and the government negotiates those prices down. That’s the main reason why-
Dr. Moss: That’s right. I mean, I’m in favor of a Medicare for all system, but we wouldn’t have even needed a Medicare for all system. All we needed was for Medicare to have the right and the requirement to economize on behalf of the American public by negotiating over the price. It wouldn’t have been perfect, but we wouldn’t see 150, 175,000, much less $475,000 drugs. It would be impossible. You know why? Because if you look at Great Britain, which has a special committee, they have national health service, so they have a special committee that judges the value of the drug. They have formulas that they work out and everything, but the basic bottom line is that set they will say, “No. We don’t want it.” It’s not enough of an innovation over the previous drug, and it’s not cost-effective. Invariably, what happens is that the company then comes back and says, “All right. Well, how about half? Would you do half?” Then they’ll look at it again, they run their numbers and they say, “No. Still no good.” The company will come back, “All right. We’ll take a quarter,” because 95% of the price is markup. That’s business.
Dr. Weitz: By the way, these companies just by partially by talking about how much they spend on research and development, and the fact is is these companies spend more money on marketing than they do on research and development.
Dr. Moss: Overwhelmingly so. Overwhelmingly so.
Dr. Weitz: That same provision was written into the Obama Care, Affordable Care Act that was written into the Medicare bill.
Dr. Moss: Yeah, because if you look at opensecrets.org and you can see to the penny how much the drug companies are giving to the different campaigns, so-called of the congress people.
Dr. Weitz: There are three times as many lobbyists for the pharmaceutical industry and the insurance industry than there are for every member of congress.
Dr. Moss: Correct. There’s between … because this came out at the time of that bill, the Medicare Modernization Act, but also more recently, the precision medicine initiative, which was Obama’s pride and joy, 1,350 drug company lobbyists were creeping and crawling all over the congress, which is exactly what you said, three times, three lobbyists for each and every member of congress. The money just flows like water, and-
Dr. Weitz: In defense of the congress people, that’s the system we have. They can’t get reelected unless they can raise millions of dollars.
Dr. Moss: Well, Bernie Sanders did it. I mean, he didn’t win, but it wasn’t for lack of money. That’s a different issue.
Dr. Weitz: Right, but that’s an exception. That’s not that easy to do what he did.
Dr. Moss: There are other countries that have public funding of election that don’t allow that.
Dr. Weitz: Absolutely. Absolutely.
Dr. Moss: So, it’s a solveable problem, but the fact is that corruption is always good with people who are going to find an excuse for corruption, but the corruption is there. A big part of my book, of Cancer Incorporated, is concerned with how this money flows to the oncology profession, and I don’t just mean the profession individually, but individual payment to leading what I call key opinion leaders, KOLs, the key opinion leaders within oncology, the most influential doctors, the ones who show up first author, second author, and final author on the key clinical trial papers. Most of those people are in the pay personally of the drug companies. This is public knowledge. There’s a website called Open Payment Data. It’s run by the Medicare facility. This is one good thing that came out of the Obama era, Obama Care era, and it basically stipulates that the drug companies have to reveal to the penny how much they’re giving to individual doctors, which is amazing because it isn’t just like, “Oh, we gave 10 billion to the oncologist.” No. You can enter in the name of the doctor, the medical doctor, American medical doctor and see who they took how much from. It’s very interesting because most of the situations that I looked at and I looked at a lot of different clinical trials as you can imagine, it’s a pattern that the key researchers, the key opinion leaders, and many of the other people included in that paper as well, the top people, the top academics, a person taking personal payments. I want to emphasize they were personal, they call these general payments. What that means is I think that’s euphemism, but what it means when not talking about the money they take for their lab or their clinic to do the research on these drugs, which is questionable in and of itself and undoubtedly you bring $12 million into your institution. You’re going to rise, you’re going to climb up that totem pole. I’m not talking about that. I’m talking about how much money you took to put your kid through a fancy school or a fancy college or you took for the yacht or you took for the second or third-
Dr. Weitz: Now, to play devil’s advocate again, I thought it was illegal for doctors to get direct payments from pharmaceutical companies.
Dr. Moss: No. It’s not illegal, and it never was illegal in oncology. Oncology wrote its own rules, which is called the chemotherapy concession by which they could buy drugs wholesale and sell them to the patients and get reimbursed at retail rates. At one time, that constituted, according to one source, that constituted two-thirds of the income of oncologists in private practice. The oncologist in private practice makes about, I think the average figure is $367,000, but that means that these people, these individuals were making the equivalent of a million dollars, two-third of which came from the sales of chemotherapy, the chemotherapy concession. Now, that all changed also with changes to the Medicare reimbursement rules, and so I’m not saying that that’s going on to the same degree as it was because oncology changed from a private practice-centered profession to a group, I mean, to it working for hospitals, basically.
This is something else. What I’m talking about is something else. This is, I don’t even know how to describe it. It’s payments for what they describe as honoraria or speakers bureau fees or consulting, different names are given, but it’s money that flows for vaguely defined services right into the pocket or to the account of the doctor who’s involved oftentimes in evaluating the product of that company. I don’t know how much more clear cut it could be, how much more grazen it could be. You’re evaluating a drug that people are going to make life and death decisions based upon your statements and your evaluations. You’re going to take up to $3 million from the company who produces that drug and then you’re going to make, you’re telling me that you’re going to make an objective evaluation of the efficacy of that drug.
I’m saying, again, they stay on the very side of the law by not lying about the results. I’m not accusing them of lying. It’s the interpretation of the results. In other words, it increased survival. Well, it did if you look up survival in the NCI, National Cancer Institute dictionary, and you want to define progression-free survival or disease-free survival as survival, they’re not lying, but the way you spin the results, the way you write it up for New England Journal of Medicine of JAMA Oncology or any of the other big journals, that’s critical because the average person is only going to read the headline of the story. Some will read down into the story itself. Some may go look at the title or the abstract of the paper. Believe me, very few people actually read the entire paper through with a critical eye, but when you do that, you see there’s no, “There, there.” There’s nothing there. It doesn’t do anything. If they’re going to charge you $150,000, we have nothing. What are they sowing? Oh, the greatest commodity in the history of the world.
Dr. Weitz: So, Dr. Moss, what are some of the solutions to the situation that we’re in?
Dr. Moss: How about reforming the congress so that they don’t take any more money for coverage?
Dr. Weitz: Well, I think there’s a lot of people who’d like to do that. The problem is is since the Supreme Court ruled on Citizens United, there’s no way that we could pass a law, even if we wanted to, because it would be overruled by the Supreme Court. So, the only two choices we have are A, to have a significant change in the Supreme Court, which is very difficult, and seems to be going the wrong direction right now or B, we would have to have a constitutional amendment that would go over the Supreme Court, and we never even passed the women’s rights amendment.
Dr. Moss: I’m totally aware of that. So, I mean, I can only put forward Utopian solutions.
Dr. Weitz: No, absolutely.
Dr. Moss: At this moment, we’re just spinning our wheels. I understand that. I’m not saying that I have a solution that’s a practical thing that could be implemented right now because the problem is so pervasive. It’s so systemic.
Dr. Weitz: No. I think it’s totally corrupted, all are on politics, and having public financing of campaigns and getting rid of lobbyists, absolutely has to be a goal how do we end up eventually accomplishing it.
Dr. Moss: Yeah. A couple of chapters were written in conjunction with other individuals who I think I was very lucky to get their input. One of them was the final conclusions of the book, of Cancer Incorporated. I co-wrote or bounced back and forth with Wayne Jonas, who was my colleague at the Office of Alternative Medicine back in the ’90s, and was the director of the OAM office, now National Center for Complementary and Integrative Health. I was an adviser to that committee.
So, Wayne and I have kept in touch for decades now. He’s a brilliant thinker and has thought of many of these. Lives in Washington area, has participated in endless discussions at the governmental level. He and I came to the conclusion quite through our own surprise that we felt that the main recommendation we could make would be to nationalize the cancer drug industry.
We don’t go as far as to say nationalize the whole drug industry. That wasn’t our focus, and I don’t really know enough about other areas where drug industry maybe is better than it is on oncology, but we feel that it’s actually an impediment to the overall drug development in the United States that the NIH and the NCI already does the heavy lifting in terms of drug development and could do a better job, and by better job, what I mean is that they wouldn’t have the same pressures that the drug industry has to show increased profits every quarter because that’s the imperative of Wall Street, of capitalism.
So, we felt that scientists would still do their work. You don’t even need the patent system. You could reward people. You could give them amazing rewards for discovering new drugs and new treatments based upon actual benefit to people. I’m talking about large rewards. You could give 50 million or $100 million to people who discover and effective new treatment. Why? Because you’re ready. Every year, the world is spending about $120 billion on cancer drugs, most of which as we see probably 90%-95% of which is pure profit to the industry, and they’re spinning their wheels.
Dr. Weitz: So, essentially, what you’re saying, doc, is right now, for those people who don’t realize it, National Institutes of Health does a lot of the basic research, they’re finding out maybe some of the mechanisms, some molecular processes, et cetera, and then that’s all done paid for by the taxpayers done by the National Institutes of Health, and then pharmaceutical companies cherry pick what they see as the more promising research and then do the last steps, and get all the money for the drugs. You’re saying just have the National Institutes of Health just finish the process and take those promising processes and develop the drug and market it, and not have those huge profits to the benefit of the taxpayers.
Dr. Moss: Correct. I fully and freely admit, I didn’t come up with this idea. What happened was is that in the course of writing the book last summer, an article appeared in JAMA Oncology. JAMA is, for those who don’t know, is Journal of the American Medical Association, advocating exactly this for cancer drugs. I mean, it blew my mind, and Wayne Jonas’ as well because he’s the one who actually brought it to my attention. He said, “Look at this.” We haven’t even gone that far in our thinking.
Dr. Weitz: Now, one of the immediate objections is going to be, “Well, we know that government can’t do anything well. They’re totally inefficient. The private sector always does things better.”
Dr. Moss: So, we talk about immune checkpoint inhibitors, okay? Immune checkpoint are the most important advance in cancer treatment in at least 25 years came about by, entirely, by government funding, NIH, National Institutes of Health and National Cancer Institute grant to a salary employee of a public institution. James Allison was a professor of virology and immunology at University of California Berkeley, a public institution, which used to be free, by the way.
So, the entire development of the immune checkpoint drugs up until the point where he had to find a private firm to take it over, which eventually wound up to be Bristol Meyers Squibb. So, government-funded, government-run, government laboratory, government-paid, and the drugs were all invented there. I could tell you many other drugs. Adriamycin got developed by the government, had to be handed over to a private company that invent the private company because none of the drug companies wanted to touch it. It wasn’t profitable enough.
Taxol, entirely developed within NIH and then NIH funded lab in New York at a public hospital in New York City, which isn’t the case. The government functions very well in the realm of biomedicine, but nothing’s ever going to be public. I’m no saying that some Utopian era is going to dawn if the government … Of course, you always, in life, it’s you go from one set of problems to another one at a “higher level” but there’s still problems. You solve one problem and then you get another problem. I mean, that’s just the nature of reality.
So, yes, we will have issues if the government takes over the drug, but you know what? I felt this way when I was consulting for almost nine years for the government. As bad as it was, you still could drag somebody up before a committee and drill them and find out and investigate, and find out where the … There’s that potential for public exposure and disclosure, right?
I said about the government runs the website that lets us see the degree of corruption of the oncology profession. It doesn’t happen automatically, but I saw it happen with my own eyes. It can happen.
So, it’s always going to be a problem to administer a country of 320 million is never going to be easy, and much less a world with whatever, seven or eight billion people, but at least there’s some disclosure. What goes on inside the boardroom at Bristol Meyers Squibb? We don’t know. I don’t know, and we’ll never know or the boardroom at Memorial Sloan Kettering private institution. You’ll never know.
This is kept close to the vest, but one thing you can be sure of with the imperatives of a private corporation, especially a corporation that’s traded on the stock exchange and is competitive with other companies and so forth that their imperatives are profit and growth, and it usually is on the quarterly basis. They’re all racing to show how well they did because Wall Street will react even to one quarter downturn.
So, they’re kind of a cancer because they have to keep on growing and spreading and metastasizing, and that’s their imperative. You don’t have the same imperative-
Dr. Weitz: It’s really the system, not the companies because as public corporations, they’re required to maximize profits, to maximize shareholder value.
Dr. Moss: Right. Even if they weren’t, they’d still have to do it because who would invest in the company that was lagging? Sometimes you get the best results at privately owned companies, and I own a company, so I’m not saying that companies are necessarily bad, but my son and I, we’re in business together, we could decide, “Oh, well, this quarter, we’re going to focus on doing something that’s not immediately profitable, that maybe it’s an investment in the future or something.” Nobody, except for our wives, nobody is going to criticize or have any word to say about this, but when you’re a publicly owned corporation, you’ve got the lash of profitability at your back and nothing can stop that. The really interesting thing was they held a meeting that this immune checkpoint inhibitor thing is just phenomenally big. I mean, it’s billions and billions. One drug alone makes, that’s Keytruda, makes over eight or nine billion dollars a year.
Everybody wants in on this, and the FDA last year held a meeting, and they brought together whoever wanted to come to discuss the development of new cancer drugs, and it was new immune therapy drugs. This was chaired by Richard Pastor, who’s considered the cancer Tsar in the United States. He’s the most powerful person probably at the FDA. In the course of the meeting, he listened to the presentations from this company, that company, this company. At the end of the presentation, he said, “So, now, what you’re telling me is …” I’m paraphrasing, “You’re all basically creating the same drug.” They all were creating Keytruda, and Keytruda is another version of Opdivo. What does that mean? It means that everybody wants in on the $8.8 billion Keytruda market. So, if I could splinter one little thing, I’ll take a cancer, a very, very small portion of that, maybe I’ll just take an angiosarcoma and I’ll run my drug against that drug, and I find that there’s some positive thing. Now, that’s not covered by your patent. I just cut away a little sliver. What can I do with that? The drug could be then extended into other kinds of cancer, become competitive with your big drug or I could sell it out to the highest bidder because even a sliver of the cancer market is worth billions of dollars. It’s so big. Huge market. So, the head, basically, I call him the head of the FDA, I mean, the top most influential person in cancer in the FDA basically said, “It’s all the same, isn’t it? It’s all the same drug.” So, you got hundreds of companies competing to create a drug that already exists. In fact, it already exists in two forms. There’s no innovation going on there. They don’t want it. Innovation is too risky. It’s much safer to create a me-too drug and then cash in your chips three, five years down the road. That’s what’s going on.
Dr. Weitz: Thank you, Dr. Moss. I’m going to have to bring the discussion to a close because I am still seeing patients at this time, and I do have a patient coming up. So, maybe you can tell everybody how they can get a hold of your reports, and find out more information about you.
Dr. Moss: Right. So, our website is mossreports.com, and I’ll hold up a copy of my book, Cancer Incorporated. This book just 250 pages in length, including all the references is available for free as an ebook at our website. So, you just go to mossreports.com/cancerinc or Cancer Incorporated, and you download a copy of the book. We wanted to get this out to as many people as possible or you can get a paperback of it if you choose. That’s not free, but not expensive either. In our Moss Reports, we have 38 diagnoses of disease, specific reports on different forms of cancer, and we have phone consultations as well. So, we’re busy. We’re active. I’ve been doing this for 45 years. Hopefully, we’ll do it another 45 years.
Dr. Weitz: Thank you so much, Dr. Moss. Fascinating discussion and a great contribution.
Dr. Moss: Thank you.
Dr. Weitz: Thank you.
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