Compelling tale about greed and how the system works
This is about the Cancer Game, which might be seen as a part of the Cancer Industry, a kind of bizarre and ghoulish phenomenon of modern times that exists precisely because there is no cure for cancer. Indeed, Alex Prud'homme, who is a gifted researcher and prose stylist, whose work has appeared in such prestigious journals as The New Yorker, Vanity Fair, The New York Times, etc., might very well have called his book "The Cancer Game." I wonder why he didn't. Would such a title have offended those who play the game?
It is specifically about the rise and fall of one Sam Waksal, oldest son of Jewish emigrants and Holocaust survivors, a man of irresistible charm, fabulous energy, and great intelligence, a man driven to success and the high life, a man who had bounced around academia without much success until in the 1980s he saw an opportunity to become a player in the cancer game, and, along with his younger brother Harlan, founded ImClone Systems, Inc.
It is also about an anticancer drug called Erbitux, originally known as C225 because it was the 225th drug tested by its discoverers, John Mendelsohn and Gordon Sato in 1980. It showed promise because in tests it stopped the growth of tumors in mice.
And finally it is a story about how drugs get discovered, how they are developed, and especially how they get approved (or not) by the Food and Drug Administration. And of course it is about the Byzantine and incestuous relationship that exists between that August government agency and the massive pharmaceutical industry.
The curious thing about all this is that Imclone never turned a profit, Erbitux never came to market, and most of the people associated with Waksal and ImClone either made out like bandits or got stuck holding the bag. The drug itself, which works against cancer tumors, particularly colon cancer, by cutting off the blood supply to the tumors (an "antiangiogenesis" drug), was touted as a miracle that would save the lives of innumerable patients and make possibly billions of dollars for ImClone.
At least this was the hype delivered by Sam Waksal, and bought hook, line and sinker by pharma giant Bristol-Myers Squibb, and by desperate cancer patients as well as salivating Wall Street investors who jumped on the bandwagon as ImClone's stock rocketed skyward. Because of the promise of the drug, Waksal himself was able to live his dream life as a New York socialite, throwing lavish parties for celebs (including Martha Stewart while he dated her daughter), collecting fine art, popping open $600 bottles of Chateau Lafite-Rothschild while secretly selling stock on the side, sending the proceeds overseas, buying expensive apartments and houses for himself, etc., etc.
But the cold hard facts of Erbitux, like those of almost any cancer drug one can name, are very far from the hype. As Prud'homme notes on pages 332-333, "these agents...[Erbitux and others like Avastin and Iressa] are remarkable scientific advances, [but] they still only benefit some 10 to 20 percent of patients, and they only extend patients' lives by a matter of months."
That's it. That's the bottom line. And yet these drugs are so valuable that the companies that end up selling them can make hundreds of millions if not billions of dollars.
Waksal apparently came to this understanding sometime during the early eighties. He realized first the simple fact that the way the cancer industry works is doctors have to prescribe something rather than nothing. Then he realized that living a few months longer can mean a lot to people. Therefore any FDA-approved cancer drug will automatically fill a need. What this means is that the PROMISE of a cancer drug, if cleverly promoted, will spark a rally in the shares of the company that owns the patent. If, like Sam Waksal, you own millions of those shares, you can get rich on mere promise alone.
Furthermore, should the drug have any real value at all, and be approved (or even look like it's going to be approved) by the FDA, you might be able to get some pharmaceutical giant like Bristol-Myers Squibb to front a whole lot of money on that promise since they are desperate to find a cancer drug to replace those that have gone generic.
This works because even drugs with very limited effectiveness are better than no drug at all. This is true for many patients, for many doctors, and is especially true for the big pharmaceutical companies.
Note that these drugs are valuable because the people who need them are typically people of relative means who can afford to pay large sums of money for them, either through their HMOs, their government, or their own funds. In contrast a drug that would prolong the life of poor people in third world countries would be of only marginal value to the big pharmaceutical companies.
I should also mention that Prud'homme spends some serious ink in this book on Waksal's long-time friend Martha Stewart and her troubles. Her personality, her empire, and the way she handles herself are vividly detailed. In fact, some readers might find her story the most interesting part of the book.
--Dennis Littrell, author of “The World Is Not as We Think It Is”