Unintended consequences of expensive cancer therapeutics - The pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: The John Conley lecture Article uri icon


MeSH Major

  • Diffusion of Innovation
  • Head and Neck Neoplasms
  • Health Care Costs
  • Medical Oncology
  • Therapies, Investigational
  • Unnecessary Procedures


  • Cancer is expected to continue as a major health and economic problem worldwide. Several factors are contributing to the increasing economic burden imposed by cancer, with the cost of cancer drugs an undeniably important variable. The use of expensive therapies with marginal benefits for their approved indications and for unproven indications is contributing to the rising cost of cancer care. We believe that expensive therapies are stifling progress by (1) encouraging enormous expenditures of time, money, and resources on marginal therapeutic indications and (2) promoting a me-too mentality that is stifling innovation and creativity. The modest gains of Food and Drug Administration-approved therapies and the limited progress against major cancers is evidence of a lowering of the efficacy bar that, together with high drug prices, has inadvertently incentivized the pursuit of marginal outcomes and a me-too mentality evidenced by the duplication of effort and redundant pharmaceutical pipelines. We discuss the economic realities that are driving this process and provide suggestions for radical changes to reengineer our collective cancer ecosystem to achieve better outcomes for society.

publication date

  • January 2014



  • Article



  • eng

Digital Object Identifier (DOI)

  • 10.1001/jamaoto.2014.1570

PubMed ID

  • 25068501

Additional Document Info

start page

  • 1225

end page

  • 36


  • 140


  • 12