In this episode of the Cancer Letter Podcast, all three of The Cancer Letter’s reporters come together to talk about the potential impact of President Donald Trump’s tariffs on cancer care.
Claire Marie Porter, reporter with The Cancer Letter, Jacquelyn Cobb, associate editor and reporter, and Paul Goldberg, editor and publisher, discussed last week’s story, “Trump’s tariffs will likely affect cancer drugs and devices—and may deepen drug shortages.”
This episode is available on Spotify and Apple Podcasts.
The effects are wide-ranging and pretty uncertain, Claire said. But the cost of raw materials for drugs has already risen since the tariffs have been imposed, and health economists are predicting that the tariffs—if healthcare and medical goods are not exempted—will lead to shortages of generic drugs and higher costs in the branded drug space.
If shortages of generic drugs worsen, there’s no question that there would be direct harm to patients, the American Society of Clinical Oncology’s Julie Gralow said in the story.
“Direct harm to patients means pretty direct. I mean, it’s death, in a lot of cases,” Paul said. “If you didn’t get the platinum drugs or 5FU or what have you, well, you can actually show how many patients died. It affects pediatric patients even.”
Other stories mentioned in this podcast include:
- Guest editorial by Shannon McWeeney and Sorena Nadaf-Rahrov: Caught in the crossfire: The critical threats facing cancer centers, research, and patient care
- Columbia’s cancer center becomes collateral damage in Trump’s war on antisemitism
- Guest editorial by Former NCI Director Kimryn Rathmell: We need a “March Madness” for cancer research—“Cancer is a tremendously challenging tournament, but we are in it to win”
- Guest editorial by Jamillah Hoy-Rosas: Health innovation and health equity: Ensuring technologies advance resilience, justice, and compassionate care
This episode was transcribed using transcription services. It has been reviewed by our editorial staff, but the transcript may be imperfect.
The following is a transcript of this week’s In the Headlines, a weekly series on the Cancer Letter Podcast:
Jacquelyn Cobb: This week on the Cancer Letter Podcast…
Paul Goldberg: Direct harm to patients means pretty direct. I mean, it’s death in a lot of cases. If you didn’t get the platinum drugs or 5FU or what have you, you can actually show how many patients died—pediatric patients even. And these are, again, cheap drugs, easy to produce. We’ll see, as they say, as economists like to say, the future is uncertain. No kidding.
You’re listening to the Cancer Letter Podcast. The Cancer Letter is a weekly independent magazine covering oncology since 1973. I’m your host, Paul Goldberg, editor and publisher of The Cancer Letter.
Jacquelyn Cobb: And I’m your host, Jacquelyn Cobb, associate editor of The Cancer Letter. We’ll be bringing you the latest stories, groundbreaking research and critical conversations shaping oncology.
Paul Goldberg: So, let’s get going.
Jacquelyn Cobb: Hello and welcome to another episode of the Cancer Letter Podcast. This week we have both Claire and Paul joining us; a trifecta. First time, we have three, well, three of our people from The Cancer Letter on the podcast. Very exciting. We are going to dive into the lead story from last week, but I was out of office last week, so Claire is going to valiantly take over going through last week’s issue. So, I’ll hand it over to Claire.
Claire Marie Porter: No problems. I’m Claire Marie Porter, a reporter at The Cancer Letter. Our cover story this week was reported by Jacquelyn and myself. It was on Trump’s tariffs and how they will affect cancer via drug shortages and rising costs. We spoke with an economist who discussed the short and long-term effects of these tariffs on healthcare. Sorena Nadaf, the chief digital strategy and AI data innovation officer at Cancer Center Informatics Society, and Shannon McWeeney, chief data officer at OHSU Knight Cancer Institute, wrote a guest editorial on the critical threats facing NCI-designated cancer centers and academic medical institutions due to funding instability, including freezes on federal grants and setting caps to indirect cost rates.
Paul Goldberg wrote a story about Columbia University and the casualties of Trump’s attack on anti-Semitism. The Trump administration had declared a cancellation of $400 million in government funding to punish Columbia for its handling of the Israel-Gaza protests. Columbia’s Cancer Center was kind of caught in that crossfire, its CCSG was or is in peril. We published a comprehensive list of the research that would be impacted by this funding cut.
Just to note that we published this story on Friday, and on Friday Columbia turned around and announced it would acquiesce to Trump’s demands. For the most part, it agreed to overhaul its protest policies, security practices, and Middle Eastern studies programs. We have yet to see what that actually means, but other universities are a little bit worried that Columbia has set a precedent.
We had our weekly column by Kim Rathmell. This column was kind of a pep talk and a call for more March Madness-like advocacy for cancer research. And lastly, we had a guest editorial by the Ronald McDonald House on health innovation and health equity. So, another big week for journalism and cancer.
Jacquelyn Cobb: Yeah, it’s never-ending. Yeah. So, a very big week, like you said. I think we should walk through, probably, the tariff story a little bit. It’s a pretty complicated set of issues. Claire, I know that we co-reported this story, but I mean it was really your labor more than anything else. Do you want to take us through sort of the general gist of what happened and what we covered in it? I can get into details with you as well, but…
Claire Marie Porter: Sure. So, I mean, I’m not an economist by any means, and I never thought I’d be talking about tariffs on a podcast, but I mean, I think Paul and I were talking last week about how when you’re a journalist, you kind of become this like temporary expert on one small thing and then move on. And if you’re me, you forget about what it was.
But for the meantime, I can say a couple of things that I’ve learned this week. So, at the beginning of February, Trump had declared this new blanket imposition of tariffs on imported goods. So, it was 25% tariffs on Canadian and Mexican goods. China was hit with a second 10% tariff on American imports since Trump took office, and that brought that total levy to 20%. Those were delayed by a month, and then implemented on March 4. And then there’s another pending tariff on India.
So, the effects are wide-ranging and multifarious and pretty uncertain. But when it comes to healthcare goods and cancer drugs like APIs, which are the raw materials used in cancer drugs, so 80% of those come from outside the country, primarily concentrated in China, which fulfills around 40% of the global supply. And since this imposition, the cost of raw materials for drugs has already risen.
So, we spoke with Richard Frank, an economist, director of the Brookings Center on Health Policy, to try to kind of get a handle on what this means for cancer care. So, he explained, that a huge amount of these inputs are imported—the APIs, the vials, the incipients, the needles. So, even if the final product is made in the U.S., these tariffs will affect them.
Jacquelyn Cobb: Yeah, absolutely. And I mean, Paul, we’ve covered, I mean, you’ve covered drug shortages forever, and we covered the platinum shortage I guess now it was a year and a half ago, not a year ago. And we really dove into the idea that the generic drug market is really unstable, or maybe unstable isn’t in the right word, but fragile already, before all of these tariffs. And one plant in India going down was the beginning of the whole crisis last year, a year and a half ago.
What does this mean now with this extra layer of stress on the system?
Paul Goldberg: Well, the system isn’t a system. It’s a sort of haphazard mess of practices and economic behaviors, which do not work at all to produce anything. So, basically people aren’t willing to pay the price, a proper price that would make sense. And then when the price is not paid, the drug is not made. And for patients, that’s life and death.
Now, if you didn’t get platinum drugs when you needed them at the last explosion, well too bad for you. So, it’s really interesting because the system which is producing these super-duper drugs, which by the way will also be going up in price, is unable to produce drugs that are pretty straightforward and simple. I mean, some of them are of the sort you might be able to make in your bathtub if your neighbors don’t mind the smells and the smoke rising and stuff like that. But you probably shouldn’t try it at home. But really it is a catastrophe in the making if the prices do not go up. Now, if the prices go up, that’s called inflation as well.
So, that’s just for the generics. With branded drugs, that’s also a big problem because branded drugs cost a lot as it is, and it is an international market for them, and also international production. So, we’re talking about China and India, which play a huge role in producing both generics and branded drugs.
Now, my favorite part of your story was this idea of why tariffs. I mean, the tariffs are protection, right? And also an impetus for domestic industries to arise. Maybe we should talk about that. Does that work here?
Jacquelyn Cobb: Yeah, that was literally my next question. So, you took the words right out of my mouth, the idea of the benefit/goal of incentivizing domestic manufacturing. And you mentioned branded drugs, and they’re sort of the ones leading the charge in terms of committing to doing some of that domestically. Right, Claire?
Claire Marie Porter: Yes. Like that can incentivize reshoring of manufacturing. But my understanding is that the big difference between Trump’s tariffs and other historical situations is that it’s impossible to predict their economic impact. The size of the tariffs, the timing, the countries against which the tariffs will apply are unknown. And Trump has said that he could change this at any time. So, I think there’s a lot of uncertainty. There’s not these reciprocal agreements, that it feels more, I guess, punitive.
And Frank said that the transition would, if it did occur, would be very bumpy and very long. There’s a lot of pieces that would have to fall into place. I believe it is the Pharmaceutical Research and Manufacturers of America Group, they represent innovator companies, and they estimated that building a new manufacturing facility can cost up to $2 billion and take five to 10 years before it even becomes operational.
Paul Goldberg: Well, by then, Trump presumably will be out of office.
Jacquelyn Cobb: Yeah, yeah. But I mean, this is also in a space where manufacturers are exiting the market because there’s not enough profit.
Paul Goldberg: Manufacturers are exiting the market in generics. There’s no shortage of branded drugs. Now the problem is going to be the cost that’s going to probably rise, because people won’t be able to, it would cost a lot to move them back and forth, because drug moves across boundaries all the time. So, every which way, God knows what any of that means right now. But it’s not going to be good. We know that.
Jacquelyn Cobb: So, Trump has said that the U.S. will feel “a little disturbance” from the imposition and it will just basically result in tax cuts for Americans. Do you guys face, well, I haven’t talked to one person, but Claire, I guess, and Paul, if you’ve had conversations as well, do economists think that Trump is fully comprehending the complexities of these tariffs?
Claire Marie Porter: Trump said, “That tariffs are about making America rich again and making America great again, and it’s happening and it will happen rather quickly.” That’s a quote. But yeah, I mean, he has said that he believes that foreigners pay the tariffs. So, that’s where the idea of tax cuts for U.S. citizens comes from. I guess what his take is that it will lead, tariffs will kind of lead to this golden age of U.S. manufacturing supremacy. But economists seem to think that he’s not really understanding that Americans do have to pay.
Jacquelyn Cobb: Yeah.
Claire Marie Porter: Is that right? Am I understanding that, characterizing that right, Paul?
Paul Goldberg: Well, I mean, the price increases are passed on to the consumer in the United States. So, it is a tax on the consumer, a tariff. But to be fair, this is not the first time the President of the United States was being challenged on his understanding of the principles of economics.
Claire Marie Porter: Where does that idea come from? Is that accurate in any way?
Paul Goldberg: It’s old. Yeah, it’s all accurate, but the idea is old. There were tariff wars before World War II. There were tariffs, tariffs are not new. I don’t know why, he teased on them. There are not really even professors or TAs at most institutions of higher learning who could disabuse him of the notion that this is a good idea. But they’re not running the country, so.
Jacquelyn Cobb: Looking forward, lobbyists for hospital associations and drug makers are writing letters and making statements asking Trump to exempt medical, what is it? It’s healthcare specifically.
Claire Marie Porter: Healthcare and medical goods.
Jacquelyn Cobb: Yeah.
Claire Marie Porter: Which he did the first time around.
Jacquelyn Cobb: Yeah, in the first, in his first term, you mean; right?
Claire Marie Porter: First administration. Yeah.
Jacquelyn Cobb: Yeah. Excuse me. You’re right.
Is there any hope of that happening this time around?
Claire Marie Porter: So, early February was after these impositions were announced, a bunch of different organizations wrote letters that were pretty much saying the same things. American Hospital Association, Advanced Medical Technology, just petitioning Trump to provide a carve out for these sectors, given the risks to the hospital supply chain.
Trump told reporters at the Oval Office, he said, just I think a week or two ago. He said quote, “People are coming to me talking about tariffs. A lot of people are asking me if they could have exceptions.” And then he said, “And once you do that, for one, you have to do that for all.” So, it doesn’t seem likely nothing’s changed yet.
And as of the publishing of the story on Friday, there was no reprieve being teased at. So, it doesn’t seem likely.
Paul Goldberg: Well, this is one of the things that’s crashing the stock market right now, because again, this is not some obscure knowledge. This is not a notion that evades a lot of people. I mean, investors understand that it, so, we’ll see.
Jacquelyn Cobb: So, Claire, what does this mean for patients?
Claire Marie Porter: Right. So, we asked ASCO and Julie Gralow, they’ve said, “The future is uncertain, but if shortages worsen that there’s no question that there would be direct harm to patients. Oncologists could be forced to choose between which patients get their recommended therapy and who has to wait, who has to delay their care or make do with alternate treatments.” So, she said that ASCO has been advocating for comprehensive solutions to address these systemic problems, these systemic drug shortages for years. And we’ll monitor the impact supply chain disruptions may have on cancer care in patients. So, I mean, yeah, the future is uncertain, but there are historical parallels to be drawn.
Paul Goldberg: Direct harm to patients means pretty direct. I mean, it’s death in a lot of cases. If you didn’t get the platinum drugs or five of you or what have you, well, you can actually show how many patients died. It affects pediatric patients even. That’s, and these are, again, cheap drugs, easy to produce. So, yeah, we’ll see. As they say, as economists like to say, the future is uncertain. No kidding.
Claire Marie Porter: Yeah. We’ll continue to cover it, of course.
Paul Goldberg: Yes. So, it’ll be a very interesting year to watch this sink in, if it sinks in.
And then again, yeah, my personal frustration with the issue of drug shortages is that I’ve been covering it for a couple of decades and nothing seems to change. Just comes back in different ways. And it’s boring now. It’s like watching grass grow.
The way it usually works is there is this sudden worsening of the thing, and then there’s a lot of sort of activity, forensic activity and breast-beating going on, “Yes, we’ll solve it. Yes, yes, yes, yes. There’s solutions, there’s monitoring.” It just comes right back because, well, nobody ever actually solves it. And the main reason is really straightforward. The system that exists now drives down the price of drug to the point where most people can’t afford to produce it and don’t make enough money. And this is on the generic side.
And on the branded side, the price goes up, up, up, up, up. And in this case, the costs of inputs go up, up, up, up, up. And then the price will go up. A mystery, a great economic mystery. Call that TA to explain it. Maybe that’s the problem. There aren’t enough TAs in America.
Jacquelyn Cobb: That’s the problem. Yeah, that’s the root of all of it.
Paul Goldberg: Yes. We should do something about it.
Claire Marie Porter: You really got to the bottom of that very quickly.
Paul Goldberg: Oh, we did. We solved it.
Claire Marie Porter: All right. Well, I think that’s everything. Does anybody have anything they want to add before we sign off?
Paul Goldberg: This is a great time to be a journalist, isn’t it?
Jacquelyn Cobb: Once again. I’m not doing it in sync this time. I’m not going to try with three people, I refuse.
Paul Goldberg: No, you don’t want to say, “This is a great time to be a journalist”? Claire, is it a great time to be a journalist?
Claire Marie Porter: I said that before and I’ll say it again. If I have to, if I must.
Jacquelyn Cobb: Thank you for joining us. See you next week.
Claire Marie Porter: Thank you. Bye.
Jacquelyn Cobb: Thank you for joining us on the Cancer Letter Podcast, where we explore the stories shaping the future of oncology. For more in-depth reporting and analysis, visit us at cancerletter.com. With over 200 site license subscriptions, you may already have access through your workplace. If you found this episode valuable, don’t forget to subscribe, rate and share. Together, we’ll keep the conversation going.
Paul Goldberg: Until next time, stay informed, stay engaged, and thank you for listening.
