Reporter’s notebook: Cleveland Clinic’s 2009 Medical Innovation Summit

CLEVELAND, Ohio — Cancer. It’s still a devastating diagnosis, thoughdoctors are getting better at treating it, and researchers and companies are getting better at developingand marketing therapies.

Many of the diagnostics, drugs, devices andbiologics don’t cure cancer.Rather, these treatments enable cancer patients to manage their illnesses, sometimes for days or months, and other times, for years or even decades.

The elephant in the room at the Cleveland Clinic’s seventh annual medical innovation summit: Does giving a cancer patient a few more days or monthsjustify the billions of dollars spent each year to find new treatments?

Economically, sometimes the answer is,no. But ask a cancer patient or doctor whether a helpful drugor therapy was worth developing, and many will say, yes. One answer may be to do more to prevent cancer.

In the opening day of the innovation summit,personalized medicine came up again and again as the the ultimateapproach tocancer diagnosis and treatment. Many researchers are looking for the right way to treateach person’s cancer.Partnerships among researchers and developersare paramount — no one institution or company has the financial or intellectual assets togo this route alone.

Dr. Toby Cosgrove, president and chief executive of the Cleveland Clinic, started the summit on a familiar note: We in the United States are debating health insurance reform instead of health carereform. Rather than demandhigher reimbursements for care, doctors and hospitalsshoulddemand greater efficiency in deliveringcare, Dr. Cosgrove said. To that end, “Some people see devices and drugs as a problem. We see them as part of the solution,” he said.

David Brennan, chief executive of AstraZeneca, talked about how his company is using biologics –treatments that come from living things, like cells or viruses — to treat lung and breast cancers. One of his company’s conclusions: Cancer isn’t just one disease; it’s many diseases. The days of the one-size-fits-all cancer treatment are gone.”Future progress depends in large part on targeting therapies,” Brennan said.

Like most drug companies, AstraZeneca is increasingly partnering with academics, other companies and institutions to find cancer solutions. Forty percent of the drugs or biologics in development at AstraZeneca come from partnerships, Brennansaid.

Dr. Daniel Vasella, chief executive of Novartis, acknowledged that the majority of cancer drugs in development will be economic failures. “They don’t bring incremental benefit to the patient,”he said.

However, that is not a reason for drug companies to stop trying.”If it is medically useful, it will be economically viable,” Vasella said. “We have a lot of new insights into biology. Iknow that this will lead to great discoveries and great advances.”

Vasella sees the financial limitations, though. “The fact is, my heart beats for innovation,” he said. “But on the innovative side, we have to be more cost-conscientious than we have been.”

Vasella also wondered why cancer outcomes in the United Kingdom are so much better than those in the United States, which spends multiples more moneyon treating cancer. His answer: the United Kingdom is better at managing conditions like obesity and diabetes, which can contribute to cancer. “They prevent obesity better than we do,” he said.

During the summit’s second roundtable, Tom Miller, CEO of workflow solutions at Siemens, Sir Bruce Ponder, a medical doctor who directs the Cancer Research UK Cambridge Research Institute, and Dr. William Hait, senior vice president and worldwide leader of hematology and oncology at Johnson& Johnson, debated the “grand challenges in contemporary cancer treatment and biology.”

One of their conclusions? Developing cancer treatments istime-consuming and costly.Information technologies can be used to target the right patients with the right treatments, and partnering with others can help speed the development process, Miller said. Butaccounting is the greatest impediment to progress. “We don’t know the return on the investment we do,” he said.

Siemens, a pioneer in cancer imaging, also is learning when to cut its losses. It has been developing a carbon ion therapy for cancer — precisely targeting tumors with ionic particles. “We started to figure that out and decided we would not do it. It’stoo expensive,” Miller said.

Another of the panel’s conclusions: Cancer is still not well understood, though in some cases, genetics research is helping doctors find the right treatment for each patient (there’s that personalized medicine theme again). But what ethics should govern genetic testing, asked Dr. Ponder. “How can the public be expected to use information about risk? How do we deal with the economics of that?” he asked.

Dr. Hait seesthechallenge as “our inability to consistently delivery highly effective drugs to patients with cancer.” The solutions to this challenge likely involvefindingbetter ways to understand cancer, discover new treatments, translate research, navigate regulatory schemes and pay for development while focusing on personalized. The challenge is daunting. “It’svery humbling ,” Hait said.

Today, we’ll hear more about the roles genes play in cancer, and about how innovation and information technology may help researchers and companies finally reap the promised return on investmentof their development efforts. We’ll also hear more about partnerships among drug companies that spread the risk and cost of developing new ways to treat cancer patients, and how to invest in and pay for cancer innovations.

See you there.