financial statements far more goes to marketing and profitsimagecreditmatt roth for the new york timesfor decades cancer doctors largely ignored the issue of pricing but as their patients became impoverished some began to speak up in 2012 dr bach and dr saltz wrote an oped article in the new york times announcing that their hospital would not purchase a new cancer drug that was twice as expensive as but no more effective than an existing medicine the maker of the drug slashed its pricedr bach and dr saltz say they have since become concerned that prices of new cancer medicines have almost no connection with their lifesaving potential dr bach recently unveiled a complex calculator of drug valuebut there was nothing complex about measuring the value of a drug that was thrown away dr saltz said since the value to the patient was zerothe two doctors have proposed that the government either mandate that drug makers provide medicines in enough vial sizes to minimize waste or mandate that drug makers refund the government for wasted quantitiesdr saltz first noticed the problem of waste when he was considering adding keytruda a new drug for metastatic lung cancer and melanoma to the hospitals list of drugs to be used on patients although a 150pound patient would need 136 milligrams of the drug dr saltz noticed that merck its manufacturer sold the medicine only in 50milligram vials ensuring wastei thought that was really cynical dr saltz said in an interview and then it got worsein february 2015 merck introduced 100milligram vials and stopped selling keytruda in 50milligram vials ensuring far larger amounts of waste the company still sells 50milligram vials of the drug in europepamela l eisele a merck spokeswoman said the company hoped to persuade the fda to approve a fixed dose of 200 milligrams of keytruda for all patients higher than the dose presently given to nearly all patients in studies given to the drug agency there was no evidence that the higher dose was more effective ms eisele said but the fixed dose will eliminate wastagesince the extra medicine does nothing to help patients dr bach said that the company was advocating that waste be injected into patients rather than thrown awayunder its present dosing merck would earn 24 billion over the next five years from discarded quantities of keytruda half of which would result from switching to 100milligram vials the researchers estimatedsome cancer drugs have little wastetreanda which is used to treat leukemia and nonhodgkins lymphoma and is manufactured by teva pharmaceuticals is packaged in four separate dosages so only 1 percent of the drug is wasted on averagebut 18 of the top 20 cancer medicines are sold in just one or two vial sizes so on average 10 percent of the volume of cancer drugs purchased by doctors and hospitals is discarded the researchers say