(Steven Brill is a Reuters columnist but his opinions are his own.)
By Steven Brill
Feb 26 (Reuters) - Let’s begin this column with a quiz, one designed to test your story-generating talents. If the answer comes to you within 10 seconds, you, too, could be an editor or TV news producer. If you are an editor or producer and don’t see it instantly, you need better radar.
First, read the opening two sentences from a story that appeared in the Financial Times a few weeks ago:
“Europe’s most senior justice official is adamant she will fight US attempts to water down a proposed EU data protection and privacy law that would force global technology companies to obey European standards across the world. Viviane Reding, EU commissioner for justice, said that the EU was determined to respond decisively to any attempts by US lobbyists - many working for large tech groups such as Google and Facebook - to curb the EU data protection law.”
What’s the story that screams out to be written or televised based on these two sentences? Hint: It’s all about how Washington has been brought to its knees by special interests.
The answer: Let’s compare lobbying practices and regulations in the United States to those in other venues, including the European Union and its constituent countries. This story - with its reference to the EU commissioner vowing to fight “attempts by U.S. lobbyists,” which are the words that rang the idea bell in my head - presents the perfect backdrop for reporting I’ve wanted to see for years comparing how lobbying is done, if at all, in other developed democracies to the way lobbyists and big money have come to dominate the agenda in Washington.
The rest of the Financial Times story explains that American lobbyists for tech companies seem to have persuaded the U.S. government to push back against the EU’s plans to promulgate privacy protections for consumers that would impair the ability of companies such as Facebook and Google to collect data from users in ways that will continue to boost their advertising revenue. In other words, the companies’ lobbyists in Washington have recruited our government to become their lobbyists at the EU.
One implication of that is that Google and Facebook, juggernauts though they are, can’t deploy their own lobbyists in Belgium the way they can in Washington. Is that true? What are the regulations or traditions that limit the effectiveness of lobbyists in venues like the EU?
Following the battles over other big issues that cross national borders could add texture to the story. How, for example, have Goldman Sachs or JP Morgan Chase tried to influence banking regulations around the world, including the crucial Basel rules on capital and liquidity?
These questions could lead to a tour of various world capitals describing how the influence industry works, or doesn’t work, in each place. Are the results always better? I bet not everywhere. True, America’s open system of influence peddling - in which lobbyists have to register and report their fees - is the embodiment of Michael Kinsley’s famous observation that the real scandal in Washington “isn’t what’s illegal but what’s legal.” Yet a balanced approach to this story might find not only examples of governments with a far cleaner process more grounded in the public interest, but also places where simple under-the-table bribes make Washington’s K Street culture look tame.
Following a wonder drug’s bottom line:
This story in Saturday’s New York Times about the Food and Drug Administration approving a promising new breast cancer drug suggests a reporting project that could produce a dramatic tale of scientific discovery along with an important look at the economics of the pharmaceutical industry. It could also open a window on the health and public policy issues associated with how we regulate drugs and drug prices and how we allocate healthcare resources in the United States.
According to the New York Times:
”The drug, which will be called Kadcyla but was known as T-DM1 during its development, extended the median survival of women with advanced breast cancer by nearly half a year in a clinical trial.
“Genentech, which developed the drug, said it would cost about $9,800 a month, or $94,000 for a typical course of treatment. That is about twice the price of Herceptin itself, which is also made by Genentech, but it is similar to the price of some other new cancer drugs.”
Many tough questions flow from just those two paragraphs. This seems to mean that patients will get to live “nearly half a year” extra if they or their insurance company (or Medicare if the patient is 65 or older) pays $47,000 - the difference between the cost of the new drug and the one a breast cancer victim would otherwise take.
Most state laws require insurance companies to pay for any approved cancer drug at whatever the drug company sets as its average sales price, plus a 6 percent profit for the hospital or doctor that dispenses it. Federal law requires Medicare to do the same. So how much will the potential widespread adoption of this treatment add to the national medical bill?
Of course, the benefits are clear: an extended life and, apparently, more mild side effects than the alternative treatments. But a reporter unafraid to step onto this minefield would also ask experts to talk about whether anyone should be making the kind of cost-benefit analysis that would consider whether that money could be spent more effectively on other healthcare needs. But even before getting to those delicate issues about the value of life, there’s the question of how the drug company arrived at that $94,000 treatment price? Why does it have to be that much?
Which leads to the question of how much the approval of the new drug at $94,000 per treatment in the U.S. will add to the profits of Roche, the $45 billion global drug company that distributes it - and if that’s a fair result compared to the pricing regulations in effect in other countries that would limit those profits.
The New York Times story reports that Genentech, the California-based biotechnology pioneer that is now a subsidiary of Roche, “developed the drug.” However, according to the Times, “The linker and toxin used in Kadcyla were developed by ImmunoGen, based in Waltham, Mass., which will receive royalties on sales of the drug. This is the first approved product for ImmunoGen, which has been working on antibody-drug conjugates for three decades.”
That makes me want to know more not just about ImmunoGen but also about the scientists there who actually invented the treatment. Was the same person or team really working away at this for “three decades”? Let’s meet them and describe their struggle to create this treatment.
Then let’s go back to the money story. Did the ability of Genentech and Roche to manufacture, market and distribute the drug around the world make it irresistible for ImmunoGen to sell off the rights to its invention in return for royalties? How much might the royalties turn out to be? Is this an Instagram-like payday for the folks in that Waltham lab?
And what did ImmunoGen and Genetech have to invest in research and development before they hit paydirt? What were the costs and processes involved in gaining FDA approval?
In short, I’d really love to see a narrative - with all the people, as well as all the numbers - telling us the story of the new wonder drug and how it brings to life all the issues involved in modern healthcare.
Steven Brill, the author of Class Warfare: Inside the Fight To Fix America's Schools, has written for magazines including New York, The New Yorker, Time, Harpers, and The New York Times Magazine. He founded and ran Court TV, The American Lawyer Magazine, ten regional legal newspapers, and Brill's Content Magazine. He also teaches journalism at Yale, where he founded the Yale Journalism Initiative. His latest published work is "Bitter Pill," a special report in the March 4 issue of TIME on medical bills. Steven Brill