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'Star Trek' medicine comes with high price

If "Star Trek" is an accurate depiction of life in the 23d century, one problem we won't face in the future is rising healthcare costs.

On "Star Trek," all medical problems are treated the same way: Dr. McCoy reaches for a gizmo the size of a cellphone and runs it over a patient's body. In a few seconds, the patient opens his eyes, sits up and, bingo, he's cured. The technology is both fast and cheap. There are no long hospital stays, expensive drugs, or invasive surgery.

Regrettably, in our primitive era, medicine isn't so simple. We regularly make advances, but the improvements come slowly and incrementally. And the cost of each step forward can be very high. Nowhere is that more apparent than in the treatment of cancer.

After years of disappointment, cancer researchers are finally optimistic that progress is being achieved. "We've discovered compounds that offer enormous possibility and potential," said Dr. Robert Mayer, a prominent oncologist at the Dana-Farber Cancer Institute.

The new cancer drugs target cancer cells without damaging healthy cells. The drugs have slowed the growth of tumors in some patients and extended life for others.

In a small percentage of cases, the results have been dramatic. No one is talking about a cure, but researchers say cancer may become a chronic condition, like diabetes, that can be treated and managed.

For a price. One of the new drugs for colorectal cancer, Erbitux, sells for $12,000 a month. Another called Avastin, costs about $4,800 a month. In a paper he wrote for the New England Journal of Medicine, Mayer estimated that spending on Avastin could eventually exceed $1.5 billion a year.

The good news and bad news is that there are many more such drugs in the pipeline. Dr. Thomas Roberts says the net result will be a huge increase in spending on cancer treatment over the next decade.

Roberts is an oncologist with a background in economics. He works at Massachusetts General Hospital. He says spending on cancer treatment has been climbing at 15 to 20 percent a year for the past few years. Because of the new drugs he expects the rate of increase to accelerate going forward. He estimates that by 2015 the United States could be spending $750 billion on cancer care, up from about $100 billion today.

Cancer care has been spared the cost controls applied to other fields of medicine for obvious reasons. Cancer is the scourge of our time. America has been waging an expensive war against cancer since the 1970s.

Now that victories are in sight, who wants to be the one to tell a patient the new treatments may not be affordable for everyone? Not Thomas Roberts. "When I put on my white jacket and talk to Mrs. Jones about her lung cancer, I don't think about costs," he said.

Dr. Thomas Lee, network president for Partners Healthcare, compares spending on new cancer treatments to spending for college tuition. "It is one of those things we should be happy to spend money on," he said.

The hope in medicine is that improvements in science will allow doctors to identify in advance the patients most likely to benefit from a given drug. The idea isn't pie in the sky. Doctors from Mass. General and Dana-Farber recently figured out which lung-cancer patients responded best to Iressa, a new cancer drug. If the technology advances far enough, the costs would be held in check because the expensive therapies would be given to targeted groups, rather than everyone with cancer.

I hope the optimists are right. But my hunch is the day is fast approaching when some hard choices may have to be made. Everyone wants the latest treatment when cancer strikes close to home, but will they feel the same if the person with cancer is poor and on Medicaid and requires a drug that costs $12,000 a month? And what if that drug only extends life for six more months?

One day science will catch up to science fiction and, just as in "Star Trek," we will have a quick and easy cure for disease. Until then progress will be halting and the price of progress will often be steeper than we would like it to be.

Charles Stein is a Globe columnist. He can be reached at stein@globe.com.

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