Multiple myeloma patients usually respond well to initial treatment, and researchers are trying to figure out what new drugs to give when people relapse. Tremendous resources are applied here, late in the disease stage, and the sky is the limit. No expense is spared to cure people dying of cancer, after all.
There is a pre-malignant (MGUS) stage before patients get multiple myeloma. We used to think that the diagnosis was a lightning bolt that came out of the blue and there is no way to catch it until it happens. I have often been asked, “could my doctor have caught this earlier?” and I’ve often replied that “no, there was no way this could have been anticipated.” But, now I know that is no longer true. We could have detected it earlier. A year ago we could have detected it. A blood test that looks for abnormal antibodies – first thing that turns positive in the pre-malignant MGUS stage. It can be positive 8 years before they get myeloma.
Science is moving forward. We know that every myeloma patient gets the pre-malignant phase first and we would see this if we looked. Is there anything we could have done before the development of full-blown myeloma? The answer now is “no” because not much research has been done regarding this early disease stage. The reason there is nothing we could do is because no one is fixated on this question. They are fixated on the cure.
The healthcare exchanges will be organized into tiers of coverage, platinum, gold, silver and bronze and I bet that these strata will start to influence medical research as well. Much of what we have been doing in the lab, honestly, is research into “platinum interventions–we assume money is no object. But many (most?) people will have silver and bronze coverage, where the cost versus benefit will very much be an object. What medical innovation would I pay for if it came out of my pocket? What should the plan cover?
That’s the point. Is there something we can do earlier that is less high tech but may be just as powerful.
Prevention is a bronze intervention, not platinum. Prevention is not a high tech laser beam or nano-technology intervention. Maybe it’s two aspirin a day. But, there’s not a lot of money in aspirin and so it’s difficult to do research. Clinical research is unbelievably expensive. For the most part, clinical trials are financed by people expecting a return on investment.
The “translational research’ community focused on high technology and new drug targets has been by and large insulated from shifting economic realities. Occasionally, I will hear someone ask half-heartedly whether a new approach would be cost-effective, but let’s face it, we are largely unconcerned with the expense side of the equation. Maybe that’s how it should be–unfettered imagination for disease research. And yet…
This is my motivation for working on cheap prevention strategies for myeloma. Our colleagues found recently that nearly all myeloma patients go through the pre-malignant MGUS stage first, and yet physicians have no treatments for MGUS patients to prevent them from progressing to multiple myeloma. It’s a numbers game…most MGUS patients will be fine. I want to know if it is possible to develop strategies to prevent myeloma from happening in the first place. How effective would prevention strategies have to be for them to work? Could we use modern genomics to focus our prevention efforts? This is why we are now working on a mathematical model for myeloma development at the population level. Healthcare reform is flipping the incentive structure in medicine. We are moving into a world where keeping people healthy will be the way to make money in healthcare. Soon, the shifting incentives will start to impact translational research. Stay tuned.