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Cost is an ethical issue in three ways: price, value, and burden. In the United States, the high prices of potentially life-sustaining treatments and technologies that are set by manufacturers are frequently characterized as unsustainable for public and private insurance programs and for patients [1]. This problem, well documented in cancer care [2], is due not only to the large number of cancer cases (cancer is the second leading cause of death in the U.S., after heart disease) and the ever-growing number of drugs to treat different types of cancer, but also to highly problematic ways of describing—and marketing—drugs as “breakthroughs,” in part to justify extremely high prices. In their important article, Tito Fojo and Christine Grady make a compelling ethical case to their fellow oncology professionals: “We must stop deluding ourselves” that high-priced cancer drugs “are an aberration,” and we must change our prescribing practices so that we do not “signal” to manufacturers our tacit acceptance of ever-higher prices as the status quo [3].

Why Clinical Oncologists Should Talk about the Price of Cancer Drugs