Why NBA fans shouldn't be mad about teams' strategy of fouling when leading by 3
I'm having some cognitive dissonance about the 'foul-up-three' ploy the Oklahoma City Thunder used Monday at the end of Game 4 of the Western Conference finals.
All I'm reading on social media is that the NBA needs to do something to penalize this strategy because it's too much of an advantage.
And all I'm thinking is that the league needs to stop coaches from using this strategy because they keep screwing it up and botching a hugely favorable win-probability scenario. I'm spending the last 20 seconds of every game screaming, 'What are you guys doing?!' at my TV.
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Before we go forward, let's back up. I'm a bit surprised that now is the moment we've decided this is horrible, because the foul-up-three ploy has been around almost as long as the 3-pointer itself. Notably, the Houston Rockets used it at the end of their Game 7 'kiss of death' game against the Phoenix Suns in 1995 after Mario Elie's shot put them up three with 7.1 seconds left. (I'll go more retro: My opponents in a 1989 high school game were trying to foul up three — in only the second year my state had the 3-point line!)
Generally speaking, a team with a three-point lead in the final seconds of a game is in an incredibly favorable position. Not only does the opponent have to make a 3 to extend the game, but the opponent knows it has to make a 3 to extend the game.
Thus, the 3s you end up seeing in those situations often look like this one, from when the Indiana Pacers conspicuously did not foul up three at the end of Game 2 against New York when the Knicks gained possession with 14.1 seconds left:
An opponent 3 doesn't result in a loss; it results in a worst-case scenario of the game being tied and continuing. And often, even in these situations, the opponent 3 comes before the buzzer, which means the team with the lead still has a possession to respond. In the NBA, where a team can advance the ball with a timeout, this can be particularly powerful if a team has a timeout left.
As a result, the foul-up-three isn't quite the life hack some people seem to think. However, there is one particular situation where it is valuable: the old Stan Van Gundy rule of fouling up three when the clock is inside six seconds.
Even then, it can be difficult to execute. If the opponent is inbounding from the frontcourt after a timeout and can go straight into a shot, it brings the risk of a three-shot foul. Teams are probably better off defending in that situation.
Here's a scenario where the Pacers didn't foul because of the risk of the player shooting immediately and were less fortunate: Jaylen Brown's shot from Game 1 of the 2024 Eastern Conference finals. Watch Pascal Siakam conspicuously not fouling as Brown's heave finds the net:
Indiana then couldn't score itself with 5.7 seconds left and lost in overtime, eventually being swept by the Boston Celtics.
(Indiana, I will note, also did not foul up three in overtime of Game 1 against New York, with 15.1 seconds left. New York forced up a similarly wild miss from Jalen Brunson; an offensive rebound produced a better look for Karl-Anthony Towns, but he missed too. Even if he had made it, Indiana would have had roughly five seconds to respond and retake the lead.)
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So, back to Game 4 of Thunder-Timberwolves.
Minnesota's last possession slammed into the golden Van Gundy Rule scenario where fouling up three makes the most sense: having no timeouts and needing to advance the ball the length of the court, with only six seconds left. Oklahoma City's Alex Caruso could give the foul and be relatively certain that Anthony Edwards wouldn't pull up from 60 feet and make it a three-shot scenario.
(While we're here: The other foul-up-three loophole nobody has tried exploiting, courtesy of Ken Pomeroy, is to foul up three in the waning seconds and then continuously commit lane violations on the second free throw until the other team makes it — thus eliminating the intentional miss and put-back scenario. A smart ref might eventually hit the team with a delay-of-game violation, two of which result in a technical foul.)
However, Oklahoma City's earlier strategy — fouling Naz Reid when Lu Dort had him bottled up in the corner with 7.0 seconds left — was much more questionable. The reason why is contained in the two previous playoff games where this strategy overtly failed — the early foul-up-three introduces more possessions, and thus more variance, into a game where the team up three had an overwhelming advantage.
The success of the Thunder's strategy depended on a clean inbound pass against a pressing opponent, and then matching the opponent's success at the free-throw line to maintain the three-point lead and foul once again.
This is particularly true when teams foul with more than 10 seconds left on the clock, as the Thunder did in Game 1 against the Denver Nuggets and the Knicks did in Game 1 against Indiana. The Thunder's strategy worked out so well that they lost, in regulation and by two. Great work, everyone. The Knicks would have also lost in regulation had Tyrese Haliburton's foot been half a size smaller; they ended up losing in overtime instead.
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The key problem was that Oklahoma City began fouling ridiculously early, with 12.2 seconds left on the clock. Denver ended up with three possessions in 10 seconds, where it normally would have had one, making four free throws and then an Aaron Gordon 3-pointer with 2.8 seconds left.
Ditto for the Knicks, who fouled Aaron Nesmith with 12.2 seconds left in regulation in Game 1 and defensive ace OG Anunoby draped all over him. When Anunoby missed a free throw at the other end, the Pacers were only down two and still had 7.1 seconds left, taking away the foul-up-three on the last trip and leaving just enough time for Haliburton's shot to touch the sky and fall through the net at the buzzer.
It's a point I've made over and over, but I will make again: The foul-up-three, especially with more than six seconds on the clock, is the only realistic way the leading team can lose in regulation.
With all that said, let's circle back to the main point. There's an idea out there that something needs to be 'done' about the foul-up-three because it ruins the end of games. Right now I'd argue more the opposite: That it's making the end of games more exciting, because coaches keep screwing it up and giving away games they shouldn't lose.
Also, the instances where it is truly advantageous are so specific — defending team up three, less than six seconds left, opponent not in a position to get into a shooting motion — that I wonder what a rule to address this would even look like and how often it would come into play.
That said … I wanted to see Edwards make a bull rush up the court and fling up a desperation 3 for the tie Monday just like everyone else. Also, casual fans can probably appreciate that type of play more than his near-perfect free-throw miss that yielded a mayhem rebounding situation (10 guys went all out for the board, and it hit the ground before anyone got it) and Shai Gilgeous-Alexander eventually flinging the ball from his back to an eager fan sitting courtside.
The foul-up-three also drags out the end of games, which might be good in some ways (sponsor dollars!) but is probably more of a negative in the big picture, especially since the league seems pretty concerned about fitting games into a two-and-a-half-hour window.
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So, if we really wanted the league's competition committee to legislate this, one possibility is to say that, if the offense is in the bonus, a take foul by the winning team up by three points in the last six seconds (or eight or 10, whatever the committee thinks is appropriate) is one shot and the ball out of bounds. But the league needs to be very careful about the wording of any rule, given the huge potential for unintended consequences.
Either way, the thing I can't emphasize enough is that A) we're legislating an extremely specific situation, and B) thus far this postseason, coaches inadvertently have done more to create excitement by fouling up three than they have to remove it. We only got Haliburton's and Gordon's shots because coaches screwed up the scenario.
That's why, for me, the story isn't that the foul-up-three needs to be addressed by the rules committee; it's that it needs to be addressed in coaches' meetings. Indiana is doing it right; Oklahoma City and New York, not so much, even if the Thunder ultimately hung on in Game 4.
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The Big Take Cancer Drugs Cost More Than Ever. They Often Don't Extend Lives By Robert Langreth Tanaz Meghjani Rachael Dottle May 28, 2025
The moment she heard that her mother, then 67, had advanced breast cancer, Stacie Dusetzina began hunting for potential treatments. A cancer policy researcher at Vanderbilt University, Dusetzina knew the go-to drug in many cases was Pfizer Inc.'s Ibrance. She learned it might cost her mother, who lived on a fixed income, around $10,000 out of pocket annually. Medicare, required by law to cover cancer treatment, would have paid much of the rest of the cost. At the time, in 2020, the pill listed for a jaw-dropping $160,000 a year, rising more recently to $214,000. Despite having a PhD in pharmaceutical science, Dusetzina couldn't figure out whether swallowing those costs — potentially for years — would help her mom live any longer or any better. Her research showed that while the drug might shrink tumors, no clinical trials proved it would extend her mother's life. At the time of her search, Ibrance had already been on the market for five years. 'I could not find any satisfactory data where I could say this is worth the money,' said Dusetzina, whose mother ended up not using the drug because she had a less common type of cancer. 'It was really frustrating.' Cancer Capitalism This is the first story in a series about how the hunt for profit can harm cancer patients. Ibrance is one of the biggest-selling drugs in a revolution that has made new treatments available to American cancer patients faster than ever before. Prodded by legislation backed by drugmakers that allowed the Food and Drug Administration to speed approvals, the regulator greenlit more than 200 cancer drugs over the past three decades. Cancer treatments generated at least $200 billion in worldwide sales for the pharmaceutical industry last year, turning the once-sleepy oncology business into a gold mine more than 10 times bigger than obesity drugs. The profusion of new treatments is a source of hope for many patients. Some drugs are game-changers, especially new immune therapies that teach the body itself how to destroy cancer cells. But the downside of approving so many drugs with so few hurdles is now clear: Many don't prolong life at all, or do so only modestly, with problematic side effects. Indeed, fewer than half of the cancer drugs approved since 2000 that Bloomberg News reviewed based on their FDA labels have ever been shown to extend patient survival for any of their approved uses. Even fewer have been shown to improve cancer-related symptoms or quality of life. In the past decade alone, drugmakers have made more than $50 billion on cancer drugs that so far have demonstrated no survival benefit, Bloomberg's analysis shows. Some High-Cost Cancer Drugs May Not Prolong Life Cancer drugs approved by year and initial 30-day price Not shown to prolong life Shown to prolong life One time dosing $100 $1K $10K $50K 2000 2005 2010 2015 2020 'There is a myth that these cancer drugs are saving enormous numbers of lives,' says Richard Sullivan, a professor of cancer and global health at King's College London. 'It is not true.' Trials are still underway that, according to the companies, could one day prove their drugs extend lives. Some treatments for rare cancers have kept patients in remission for years, even when they don't have formal data from controlled survival trials. The genuine successes have helped many thousands of cancer patients live longer. The American Cancer Society says US cancer death rates have plummeted 34% since peaking in 1991, thanks to early detection, advances in medicines and a decline in smoking. Immunotherapies revolutionized treatment of melanoma, while also extending survival more modestly in cancers of the lung and other organs. Drugs that block specific overactive proteins have improved the outlook for certain types of breast cancer, leukemia and myeloma. Still, an analysis in JAMA Oncology of a subset of major solid tumors estimated that four out of five cancer deaths averted from 1975 to 2020 were due to improved screening and preventive health measures, not new treatments. Survival rates remain relatively low for some types of advanced cancer, including advanced colon cancer — the second-biggest killer — and cancers of the pancreas and ovaries. Advanced cancer generally can't be cured, and the new medicines haven't changed that. They're still often used in combination with toxic chemotherapy and radiation, at a staggering cost: Bloomberg's analysis found the median initial price of a new cancer drug has quadrupled after inflation since the early 2000s to about $25,000 a month in recent years. Meanwhile, a forthcoming study from Columbia University researcher Tito Fojo measured how long the average new drug treating the disease improves survival: about three months. Sullivan says his patients assume every freshly licensed drug is 'fantastic' — and 'when you tell them that is not the case, they get super upset.' Prices of Cancer Drugs Have Skyrocketed Median 30-day cost for cancer drugs at time of launch 2000 2005 2010 2015 2020 0 10 20 $30K$24.6K The rise of what some doctors now call the 'cancer industrial complex' is in part a familiar story of a captured regulator that draws much of its funding from the industry it's supposed to monitor. In exchange for drug companies and medical device makers paying fees that now bring in almost half of the FDA's $7 billion annual budget, Congress effectively has handed them ever-more ways to shorten testing and get priority treatment from agency reviewers. This new cancer capitalism, though, is also a little-known tale of scientific gamesmanship. An empire of drugs grew out of the companies' ability to exploit one specific marker: a measure of tumor growth known as 'progression-free survival.' An obscure term used primarily by doctors until a standardized definition appeared in an academic journal in 2000, it's since become a common justification for the FDA's expedited approval of treatments. Researchers assumed that if a drug delayed the growth of tumors, it would also extend life. Recent studies have found the link is not so clearcut, and even one of the originators of the measure calls it arbitrary. Yet demonstrating a 10-month improvement on this metric turned Pfizer's Ibrance into a blockbuster. One thing it's never been proven to do: prolong women's lives. Ibrance was the top-selling drug in the Bloomberg survey that fell short on this measure, long considered the gold standard of clinical trials. Notably, a 2022 study showed no statistically meaningful improvement in survival for more than 600 women who were initially diagnosed with advanced breast cancer, the drug's main use. Women would have to read deep into the fine print on page 19 of the label to find this out. 'It's incredibly confusing for patients and their families to know what they're signing up for,' says Vanderbilt's Dusetzina. Drug companies enhanced the groundswell for new treatments by working with patient advocacy groups, led by sympathetic spokespeople: cancer sufferers. The companies help fund the groups' budgets, sponsor their conferences and sometimes pay members to consult on studies. Hospitals, for their part, share in the markups for administering the drugs and also get paid for bringing patients to trials. Improvements in Survival Have Not Kept Up With Prices For advanced cancers with distant spread, the five-year relative survival rate generally remains low 2005 2010 2015 2020 0 25 50 75% breast breast cervical cervical colorectal colorectal lung lung melanoma melanoma myeloma myeloma ovarian ovarian pancreatic pancreatic prostate prostate The growing reliance on industry in recent decades has had other long-lasting effects. Once primarily sponsored and paid for by the government, cancer drug trials are now largely conceived, organized and paid for by companies. That means basic questions sometimes go unanswered: When should treatment stop, how long should treatment last and when is it not necessary at all? Emerging studies suggest that in some cases recommended dosages may be higher than required, and given for longer than needed — a potentially lucrative outcome for drugmakers who are paid per dose. More than any part of the FDA, the cancer division has embraced the concept of allowing drugs to be approved based on preliminary data. It's led in that effort by its longtime oncology chief, Richard Pazdur, who has attributed his own conversion from 'regulator' to 'regulator-advocate' in part to his wife's death from ovarian cancer. Moving faster is popular with many patient groups. It's also led to products with uncertain benefits lingering on the market for years, saddling some patients with unnecessary treatments or, in some cases, life-threatening side effects. 'They never look at the life within those days,' says Rachel Koven, whose husband died of gastroesophageal junction cancer in 2016. She says he spent much of his last four months in the hospital being treated for side effects of various treatments that didn't work, keeping him away from home during the precious last months of his life. To this day, she's not sure all the extra treatments were worth it. The new Health and Human Services secretary, Robert F. Kennedy Jr., and Marty Makary, the newly appointed FDA commissioner, are themselves keen critics of the agencies they now lead. Kennedy has called the agency a 'sock puppet' for industry and Makary is a prominent surgeon who's written books on the absurdities of US medical economics, including The Price We Pay: What Broke American Health Care — and How to Fix It. President Trump, of course, has long cast himself as an industry scourge; an executive order he issued this month seeks to force cuts of as much as 80% in drug prices. But a similar effort in his first administration died in the courts. And pharmaceutical stocks rose the day of his new order, signaling investor skepticism of any significant impact from it. Far longer than Trump has commanded the national political stage, the FDA official guiding the cancer drug revolution has been Pazdur, a former gastrointestinal oncologist from the MD Anderson Cancer Center in Houston. He's led the FDA oncology division since 1999 and is one of the few top agency officials who has remained in his post under the new administration. In a brief interview after receiving a lifetime achievement award at a cancer conference in Chicago last month, Pazdur jokingly called himself 'the designated survivor' and said he doesn't know if the new administration will seek changes in approval standards. An FDA spokesperson says 'drug development, especially in oncology, is not static' and that the accelerated approval program 'attempts to strike a balance between the need for overall survival assessments and the need for patients to have timely access to novel drugs.' Pazdur's tenure stretches all the way back to a time when the FDA, stung by public criticism of its response to the HIV crisis, faced mounting pressure to get drugs on the market faster. A 2002 Wall Street Journal editorial painted the agency as a bureaucratic mess that held up promising treatments of all kinds, including for cancer. It was titled: 'FDA to Patients: Drop Dead.' Under Pazdur, the oncology division made more frequent use of an expedited approval program that relies on shorter-term clinical measures, such as tumor size, to assess potential treatments. The shift was welcomed by patients and especially by industry, which was increasingly responsible for, as one former FDA commissioner put it, 'trying to keep the lights on ' at the agency. Congress in 1992 had approved a 'user fee' program under which drug companies funded a share of the FDA's budget. In return, the agency agreed to speed up reviews of some drugs it deemed priority applications to as little as six months. A 1997 law had further eased approval standards, allowing the agency to fast-track certain drugs without its traditional requirement of two 'well-controlled trials.' At the time, advances in genetics were opening exciting opportunities. Researchers started identifying mutated genes that drove cancer growth. It gave the drug companies specific molecular targets for the first time. Sensing an attractive new market, the companies focused on ways to get their drugs to market faster than the years-long survival studies. They soon found one. In 2000, an international group of academics devised new standards for measuring tumors' growth. Once they grew 20% in their longest dimensions, or any new tumor appeared, the disease was considered to have 'progressed.' The threshold was chosen because it was the smallest amount likely to indicate a treatment was no longer working, says Elizabeth Eisenhauer, a professor emerita at Queen's University in Ontario who helped devise the standards. The idea was to assess whether an agent was promising or not, allowing doctors to quickly move into trials assessing survival, she says. 'It was arbitrary,' says Eisenhauer, who cautions against reading too much into the measure. A drug might shrink tumors, only to have toxic side effects that hasten death. Still, once the new standards were published in the Journal of the National Cancer Institute that year, drug companies seized on them. Progression-free survival was easier to demonstrate than actual survival; they just had to keep tumor growth below that magic 20% threshold for as little as one period of scanning, typically six to eight weeks. By the mid-2000s, the FDA increasingly started approving cancer drugs based on their ability to slow tumor growth, with the idea that the metric would reliably predict which drugs extended patients' lives. Sometimes it did. Often, it didn't. A review in the European Journal of Cancer found that two-thirds of drug trials aiming to slow progression of solid tumors were deemed successful from 1999 to 2015. This turned out to be a surprisingly poor predictor of whether patients live longer — which happened in only 38% of those cases. The manufacturers got an additional fast track with Congressional approval of another category known as 'breakthrough therapy' drugs. The concept came from Friends of Cancer Research, a group founded by Ellen Sigal, a real estate developer with a Russian literature PhD whose sister had died of cancer. She co-authored a column for The Hill with a former FDA commissioner in April 2012, calling for the 'breakthrough' designation for agents that looked promising early in testing. The effort came at a time of particularly high enthusiasm for cancer drugs, after multiple medicines had bolstered survival in advanced melanoma, previously considered one of the toughest to treat. Sigal's group hosts regular roundtables bringing together companies and regulators; Pazdur is a frequent speaker at its events. About 64% of its $6.8 million in funding last year came from drug and biotech companies including Pfizer, Sanofi and Amgen Inc., according to Friends. 'The challenges we aim to address arise and evolve due to the rapid pace of scientific progress,' a spokesperson says. 'That is the source of our agenda and the projects which we take on, not directives from industry or any one party. No matter the topic we strive toward evidence-based solutions.' The law Congress passed in 2012 required the FDA to consider requests for the new 'breakthrough' designation within 60 days and to work with the sponsor on a trial design that would be 'as efficient as practicable… such as by minimizing the number of patients.' The law also endorsed the concept of using short-term clinical data as the basis for expedited approvals. In the decade through 2020, 85% of the drugs granted accelerated approval treated cancer, many premised on preventing tumor growth. It became a shortcut to a financial, not a medical, blockbuster that rewards investors faster, says Christopher Booth, an oncologist at Queen's University in Ontario. 'The bar is lower,' he says. 'You just need to show that you can delay tumor growth by literally eight weeks without having the patient live any longer or feeling better. And that's a multi-billion-dollar drug right there.' In the program's first full year, the FDA got more than 90 applications for the new breakthrough designation. Among them was a drug from Pfizer called palbociclib. Researchers from the University of California at Los Angeles had been investigating a Pfizer compound, PD-0332991, in the lab since the mid-2000s. Now better known by its brand name, Ibrance, palbociclib appeared to target specific proteins, CDK4 and CDK6, that can become overactive and lead to the development of the most common type of advanced breast cancer. After a clinical trial at UCLA on 12 women, four had significant responses. The researchers embarked on a Phase 2 trial of the drug that eventually included 165 patients. The FDA granted breakthrough status in April 2013 after initial results showed it significantly delayed the growth of tumors in combination with a standard hormone treatment. Reviews with an agency team followed, as mandated by the new law. Some staffers pointed out that the pivotal study was small, according to meeting minutes later made public. They noted that it was hard to draw conclusions because a portion of the trial studied only women with certain genetic alterations. Pfizer hoped to get approval to use the drug more widely. That May, a team from the FDA gathered with Pfizer executives in a conference room in Silver Spring, Maryland. An agency reviewer called the initial results encouraging and said it looked forward to seeing more comprehensive Phase 3 data, recalls Mace Rothenberg, then head of development for Pfizer's oncology unit. That could add years. Then, he remembers, Pazdur's voice boomed in from a loudspeaker on the ceiling: 'I am not so sure I agree with that.' The oncology chief hadn't spoken until that point, but argued the trial challenges could be overcome. 'We knew we had some traction,' Rothenberg recalls. Pazdur's wife, Mary, who'd worked at MD Anderson as an oncology nurse, was at the time herself suffering from ovarian cancer. That, and the new law, had helped motivate him: 'I have been on a jihad to streamline the review process and get things out the door faster,' as he later told one interviewer. Pfizer formally submitted its application the next year. The company was slated to defend the drug before an external panel of advisers for a vote the FDA suggested could take place in February 2015. Rothenberg says he assigned staffers to prepare hundreds of slides for potential use during the meeting. Then, late in 2014, Pazdur called and told him the agency had decided against the panel. The drug won accelerated approval in the same month the advisory panel would've met. One condition was that Pfizer follow up with the results of its larger trial, including overall survival data by November 2020. Ibrance was an almost immediate hit for Pfizer. It beat competing medicines from Novartis AG and Eli Lilly & Co. to the market by two years. At an investment conference in New York in February 2015, Lazard's Stephen Sands congratulated its chief executive officer, Ian Read, on winning such rapid approval with preliminary results. 'That was unexpected by the marketplace, I think everybody was surprised,' he said. 'We started delivering product the day of the launch,' Albert Bourla, who was then running Pfizer's oncology and vaccines business, told investors a month later. 'Our reps were trained immediately after the approval and we had increased our salesforce the year before, so they were ready.' In October, Pfizer reported that quarterly growth in oncology revenues had reached 54%, driven by Ibrance, Analysts on earnings calls showered executives with compliments — 'great launch' — over the next year as doctors issued tens of thousands of prescriptions. Pazdur, too, won praise. In the five years following passage of the breakthrough law, the FDA approved almost 50 new cancer drugs, more than it had in the previous decade. Pazdur earned a new public profile: Fortune in 2015 put him on the magazine's list of the 'World's 50 Greatest Leaders' for his work in getting more cancer medications to market. (Pope Francis and Apple Inc. leader Tim Cook were among the others.) In November that year, Pazdur's wife died. Ibrance sales topped $2.1 billion in 2016, and the FDA granted additional approval that year for use in women who had failed other treatments. After a larger trial confirmed the initial results showing delayed tumor growth, the FDA converted its accelerated approval to a full blessing in 2017. Bourla was elevated to CEO in 2019. The next year, Ibrance sales reached $5.4 billion, making it one of the company's top three products and accounting for 13% of revenue. One Pfizer deliverable wasn't forthcoming: The overall survival data it had originally promised to submit to the FDA by November of that year. Its competitors had already raced ahead with additional studies of their own, even though they'd entered the market later. The Eli Lilly drug proved in a 2019 study to prolong survival in breast cancer patients who had failed other therapies. Two years later, the Novartis product showed it prolonged survival a full year when used as an initial treatment for advanced cancer — Ibrance's biggest use. Finally, in 2022, Pfizer reported the results of its large trial of 666 women: There was no survival benefit for initial treatment. A Pfizer spokesperson says the results took longer than planned because patients in the trial lived longer than anticipated, even those in the control group. Its trials were aimed at slowing progression and thus 'not optimized' to detect a difference in survival, which can be hard to measure due to post-trial therapies and patient dropout, the spokesperson adds. The company presented a real-world analysis of 9,000 patients at a breast cancer conference late last year that found no statistical difference in survival rates among the drugs. (A Novartis spokesperson says that study had 'design limitations' and its findings shouldn't be used to directly compare the drugs.) Ibrance 'remains a standard of care first-line treatment' that gives women with incurable cancer 'more time without their disease worsening' and can delay the need for chemotherapy, the Pfizer spokesperson said. Doctors are divided over what to make of the contrasting results. Julie Gralow, chief medical officer of the American Society of Clinical Oncology, considers Ibrance's lack of survival data an 'anomaly' that doesn't reflect real-world practice. Gralow has found that Ibrance generally has fewer side effects than its competitors. 'Getting promising drugs to patients sooner, particularly those who have run out of other options, is important,' she says. Others argue that the survival results reflect subtle but real differences that become apparent over time. Matthew Goetz, an oncologist at the Mayo Clinic in Rochester, Minnesota, says the benefits from Ibrance seem to fade more quickly than its competitors; he favors the other medicines. Pazdur is convinced the FDA's approach is correct. Borrowing a line from a Black Eyed Peas song, he says critics who focus on survival data are 'so 2000 and late.' He suggests a number of reasons why companies commonly struggle to prove their drugs prolong life. Some treatments target rare types of cancer where there are few patients to study. In other cases, patients are living so much longer that confirming survival gains can take years. Some of them drop out of studies if they end up in a control group for an extended period of time. For the patients, an effective drug means 'I might be able to make a graduation' or 'I may be able to make a wedding,' Pazdur says. 'We're working to get safe and effective therapies out to patients in the most expeditious fashion here.' He adds that in about 15% of cases, followup studies have failed to confirm the benefits of drugs approved early and the agency has pushed for their removal. 'We interpret that as a reasonable figure if you're taking the appropriate degree of risk,' he says. In the view of a growing number of cancer specialists, the trouble with this approach is that too many mediocre drugs stay on the market for years as companies drag their feet in producing the evidence that might prove whether they actually work. Booth, the Queen's University doctor, helped found a group called Common Sense Oncology in 2023 that's pushing for a return to higher standards in clinical trials. It's drawn members from Canada, the US, India, Japan, Australia, the UK, Israel, Ghana, Rwanda and Brazil. These doctors agree that new drugs give patients hope — it's just that it sometimes turns out to be false hope. In the meantime, drug companies generate billions. Takeda Pharmaceutical Co., for example, won approval for the $4,450-a-pill multiple myeloma treatment Ninlaro in 2015 after a trial showed it delayed the growth of bone marrow cancer by six months. Multiple follow-up studies failed to show Ninlaro extends patients' lives. It also can cause severe diarrhea. Since that early trial, though, Takeda has made more than $4 billion by touting the pill as the 'first and only' medication in its class that allows patients to avoid a trip to an infusion center. More Drugs Approved, Fewer Patients in Trials Median number of people in cancer drug trials used to win initial FDA approval Aaron Goodman, a hematologist at the University of California at San Diego, calls the pill 'an expensive laxative' that diverts patients from other myeloma drugs that do have proven survival advantages. 'Any time someone is getting this drug, they could be getting something else,' he says. A Takeda spokesperson called the drug an 'important treatment option' that offers patients an all-pill regimen, if not a survivability benefit. The other concern for cancer drugs is quantity. A study by Mark Ratain, a University of Chicago cancer researcher, identified dozens of cancer pills sold at unnecessarily high doses or frequencies, adding to cost and side effects. 'The thirst for profits and revenues is harming patients at this point,' Ratain says. Most mid-stage melanoma patients fare just as well with two doses of immunotherapy treatment prior to surgery, compared with the usual regimen of nearly a year of drugs such as Opdivo from Bristol Myers Squibb Co. after surgery, according to results published in the New England Journal of Medicine last year. Preliminary findings in the Netherlands suggested that lower dosing of Merck & Co.'s Keytruda was also effective at keeping lung cancer patients alive for a year. And in a 1,000-patient-study published in Nature, researchers at the Netherlands Cancer Institute showed that advanced breast cancer patients could safely postpone taking drugs such as Ibrance for more than a year without any difference in long-term progression, reducing side effects and saving millions. The conflicting evidence often leaves patients and their families questioning everything. Crystal Vaagen, a children's book writer in Fargo, North Dakota, says her mother was diagnosed with advanced breast cancer in July 2021 at age 74. Her mom was put on Ibrance three months later after a 20-minute appointment during which no other treatment choices were mentioned. Doctors didn't tell her about the Novartis drug, says Vaagen, who went to all her mother's appointments. Her mom remained on the drug until April 2024, when her tumors began spreading and she switched to chemotherapy. She died from a bloodstream infection, a possible chemotherapy complication. Ibrance 'did okay for her,' Vaagen says. But she wishes they had been told that other drugs had more proven life-extending benefits. 'If I would have known there are different medicines out there, I would have fought a little harder,' she says. 'I would have said, 'Maybe we ought to switch, is there a way of doing that?' But as a patient you are expected to know nothing.'' Costs, meanwhile, radiate across the health system. An analysis of Medicare found that annual spending on oncology drugs more than doubled in the four years ending in 2020, to $53.9 billion. By comparison, Trump's Health and Human Services Department has said it would save taxpayers $1.8 billion a year by reducing its workforce to 62,000 from 82,000. One of FDA commissioner Makary's first major hires, UC San Francisco cancer doctor Vinay Prasad, is a critic of the overuse of expedited approvals who has questioned the lack of survival evidence for some cancer drugs. As head of the FDA's Center for Biologics Evaluation and Research, he won't oversee most cancer treatments, which remain in Pazdur's division. But he may have the commissioner's ear. Ibrance has now brought in more than $40 billion for Pfizer, a decade after the drug hit the market on the strength of a trial of tumor growth in 165 patients. Sales have slipped recently, though. Ibrance was among 15 drugs selected by Medicare this year for price negotiations under a 2022 law that capped out-of-pocket prescription costs at $2,000. Bourla, the Pfizer chief executive, has recently touted a new breast cancer treatment that targets a similar protein. Derived from a Pfizer compound known as PF-07220060, this one is called atirmociclib. Early trials show an encouraging ability to shrink tumors. Related tickers: PFE:US (Pfizer Inc) MRK:US (Merck & Co Inc) 4502:JP (Takeda Pharmaceutical Co Ltd) NVS:US (Novartis AG) LLY:US (Eli Lilly & Co) With assistance from: Fiona Rutherford Damian Garde Jade Khatib Sam Hornblower Edited by: Peter Robison Cynthia Koons David Ingold Methodology Drugs listed as shown to prolong life have statistically significant survival benefit in FDA label or were under review as of April 1, 2025. Prices shown are 30-day prices at or near the time of initial approval. For single-dose drugs, total price is shown. For weight or body-surface-area based drugs, dosages for 75 kg or 1.75 m2 adults are used; pediatric drug prices are based on age. Prices are rounded up to nearest single dose vial. Prices for multiweek cycles are prorated to create an exact 30 day price.
CBS News
30 minutes ago
- CBS News
Chicago alderwoman threatens legal action against colleague amid war of words over Israeli embassy shooting
Chicago Ald. Rossana Rodriguez Sanchez (33rd) is threatening legal action against fellow Ald. Raymond Lopez (15th), amid a war of words tied to last week's deadly shooting of two Israeli Embassy workers in Washington, D.C. Lopez is standing behind comments and social media posts related to the shooting, but Rodriguez Sanchez has said they are inaccurate, dangerous, and violate the public trust. Her attorney has sent Lopez a cease and desist order, and has threatened legal action if he doesn't comply. In the hours after it was revealed the accused gunman in last week's deadly shooting outside the Capital Jewish Museum in D.C. is from Chicago, some Chicago leaders began to weigh in. Among them was Lopez, who shared a post on his aldermanic X account, writing "birds of a feather" and circling faces in a group shot of United Working Families, a group that helps promote Black and Brown political candidates. Those faces included Rodriguez Sanchez, Ald. Byron Sigcho-Lopez, Mayor Brandon Johnson, and U.S. Rep. Delia Ramirez. The photo had lines drawn on it pointing to an individual in the middle, who was later proven not to be the D.C. shooting suspect. Instead it was a former aide to Rodriguez Sanchez, Chris Poulos. "It was really nerve-wracking to see Chris in that picture, his face circled, and the sort of insinuation that this person was a murderer," Rodriguez Sanchez said. United Working Families asked Lopez to take that post down, but he has refused. Instead, the next day he posed, "Happy Friday Chicago - let's make it a great one, unless you stand with radicalized terrorists and the politicians that enable, uplift & defend them." On Tuesday, in a cease and desist letter, lawyers for Rodriguez Sanchez said his comments and decision to not remove them have "caused direct harm, including endangering her and her staff's safety. It also constitutes defamation in violation of Illinois law." And about the gunman, her attorney said: "He has no known connection to the Alderwoman and has never been a member or volunteer of 33d Ward Working Families." Rodriguez Sanchez's attorney has demanded Lopez immediately take down any social media posts falsely linking the alderwoman to the accused gunman, "and immediately cease making similar false statements." "You have shamefully and carelessly continued to put a private citizen in harms way by misidentifying him as an alleged murderer. You have recklessly exploited the tragic murders of Ms. Millgram and Mr. Lischinsky by using them as a platform to repeat falsehoods about Ald. Rodriguez Sanchez, endangering her and her staff," attorney Caryn Lederer wrote. "As a public servant, your deliberate spread of misinformation is a violation of public trust and the responsibilities of your office. It also constitutes defamation under Illinois law." But Lopez insists he has nothing to apologize for. He said, while others made the leap that the photo connected politicians to the shooter, he insisted he never did. "I simply said that those individuals were birds of a feather. If you and I are part of a same group and we take a picture, we are birds of a feather. It is not my fault people don't understand what the meaning of that is," Lopez said. In the hours after the shooting, Lopez also went on AM 560 and said, "There's some back and forth as to whether or not the individual was actually the terrorist, or if that was just Rossana's former campaign chairman/chief of staff taking one for the team to say that it's not him and that they're not sitting with the terrorist." Lopez said he has consulted with his lawyers, and he feels he has no reason to take down any of his social media posts. To be clear, the person in the photo Lopez shared on X is not the accused D.C. shooter, and there is no evidence that suspect has any ties to Rodriguez Sanchez.
CBS News
31 minutes ago
- CBS News
Arlington City Council passes resolution opposing Tarrant County redistricting process
Arlington City Council passed a resolution Tuesday night opposing the Tarrant County redistricting plans, joining a growing list of elected leaders who are calling for commissioners to halt the process. "I don't want to become adversarial, but I'll stand up for the residents of my community any day of the week, and I'll continue to fight that battle," said Arlington Mayor Jim Ross. The push to redraw the precinct boundary lines is being led by Republican County Judge Tim O'Hare, who brought in a conservative law firm in early April to draft five proposed maps. Redistricting typically follows the decennial U.S. Census, which last occurred in 2020. Republican commissioners have been open in public comments that their goal is to increase GOP representation on the court. Arlington's resolution urges the court to slow down the process to allow for more community input and legal analysis. "This is not an anti-redistricting," Ross said. "It's not anti-political parties. I certainly understand that the Supreme Court has said you can redistrict along party lines if that's what you choose to do, but in doing so, you're still obligated to adhere to the laws of the State of Texas and the federal Voting Rights Act." Ross said outside legal experts also have concerns about using the 2020 census numbers to redraw the precinct boundaries. "The problem is, you say Tarrant County has grown considerably, yet you use old data that was already evaluated by the previous commissioners court, who found there wasn't enough changes to warrant any redistricting five years ago," Ross said. "If Tarrant County has grown, and I believe it has, you need to redistrict according to what that new data is showing you." Ross and nine other Tarrant County mayors, including Fort Worth Mayor Mattie Parker, signed a joint letter to commissioners laying out the potential issues they see with the plan. The court is set to vote on the proposal on June 3, nine weeks after voting to hire the law firm to come up with the new maps. "I've never seen a redistricting process move at this speed," said Ross. "You know, typically you're taking, minimum, 6 to 12 months to get things done. It's just not feasible to be able to do it and adhere to the guidelines." Ross plans to be at next week's meeting to voice his opposition to the process. CBS News Texas reached out to County Judge Tim O'Hare multiple times for comment on the criticism surrounding the redistricting process and has yet to receive a response. In an op-ed to the Fort Worth Star-Telegram, Commissioner Manny Ramirez said, "Now is the time to act, while we can still ensure that Tarrant County's future is shaped by the conservative principles that have made it the greatest place in America."
