詹姆斯·霍华德认为，大多数人都觉得自己愿意付出任何代价来保住性命——直到有人让他们给生命标出一个具体的美元金额。
James Howard thinks most people would say they're willing to pay any price to stay alive — until they're asked to put a dollar figure on it.
他说：“从来没有人准备好去问自己的问题是，你的生命值多少钱……而你做这个决定需要花多长时间。”
"The question that nobody's ever prepared to ask themselves is how much is your life worth ... and how long does that decision take for you," he said.
对霍华德而言，这个答案是每月9万加元，用于购买一种他希望能够延长生命的新型胰腺癌药物。
For Howard, the answer is $90,000 a month for a new pancreatic cancer drug he hopes will extend his life.
温哥华的医生于2025年11月确诊霍华德患有胰腺癌。他接受了化疗，但此后癌症已经发生转移，目前已是第四期。
Doctors in Vancouver diagnosed Howard with pancreatic cancer in November 2025. He underwent chemotherapy, but the cancer has since metastasized and is now Stage 4.
今年早些时候，他了解到daraxonrasib这款药物，这是一种美国食品药品监督管理局（FDA）于8月批准、但尚未在加拿大获批的疗法。按照每天三次的剂量计算，它每月的费用约为6.3万美元——折合约9万加元。
Earlier this year, he learned about daraxonrasib, a treatment approved by the U.S. Food and Drug Administration (FDA) in August but not yet in Canada. At three doses a day, it costs him about $63,000 US — roughly $90,000 Cdn — a month.
霍华德绝不是唯一一个面对新癌症疗法价格飙升的加拿大人。全国各地的肿瘤学家表示，日益昂贵的药物——尤其是那些尚未在加拿大获批或获得公共资助的疗法——正迫使一些患者在自己支付巨额费用与放弃可能延长生命的药物之间做出选择。
Howard is far from the only Canadian confronting the soaring cost of new cancer treatments. Oncologists across the country say increasingly expensive drugs — particularly treatments not yet approved or publicly funded in Canada — are forcing some patients to choose between paying enormous sums themselves and going without potentially life-extending medication.
接受加拿大广播公司新闻（CBC News）采访的25名以上的癌症专家表示，这种趋势正给患者和公共医疗系统带来日益增长的压力。
More than two dozen cancer specialists who spoke with CBC News said the trend is putting growing pressure on patients and the public health-care system.
安大略省金斯顿的内科肿瘤学家克里斯托弗·布思博士表示，这并不是说制药公司不配从其产品中赚钱。但他表示，价格已经达到了利润可能以牺牲患者为代价的地步。他说：“企业贪婪将伤害患者和医疗系统。”一个禁止谈判的生态系统身为安大略省金斯顿女王大学卫生服务研究员的布思，治疗胰腺癌——这种最具致命性的疾病之一——患者已有20多年历史。
It's not that pharmaceutical companies don't deserve to make money from their products, says Dr. Christopher Booth, a medical oncologist in Kingston, Ont. But he says prices have reached a point where profit can come at the expense of patients. "Corporate greed is gonna harm patients and health systems," he said. An ecosystem that forbids negotiation Booth, who is also a health-services researcher at Queen's University in Kingston, Ont., has been treating patients with pancreatic cancer — one of the most lethal forms of the disease — for more than 20 years.
他说，美国的达拉索拉西等药物获批并获得资助，是在一个“本质上禁止”谈判的“生态系统”中进行的。
He says U.S. drugs like daraxonrasib are approved and funded in an "ecosystem that essentially forbids" negotiation.
在加拿大，卫生部会批准医生和医院使用某种药物，随后卫生当局会与药企协商确定价格。
In Canada, Health Canada will give regulatory approval for doctors and hospitals to use a drug and then health authorities will work with the drug companies to determine a price.
但他说，在美国，政府在大多数新药上市时与制药公司谈判属于违法——2022年《通胀削减法案》略微放宽了这一规定——这使得制造商能够自行定价。
But in the U.S., he says, it's illegal for the government to negotiate with the pharmaceutical companies when they launch most new drugs — a rule that was eased slightly in the 2022 Inflation Reduction Act — allowing the manufacturers to set their own price.
总部位于波士顿的临床与经济评价研究所（ICER）的一份新报告显示，去年美国新上市药物的中位净价超过25万美元，比三年前19万美元的中位数上涨了35%以上。
The median net price for new drugs launched in the U.S. was more than $250,000 US last year, according to a new report from the Boston-based Institute for Clinical and Economic Review (ICER), up more than 35 per cent from the $190,000 US median three years earlier.
总部位于加利福尼亚州的药企Revolution Medicines将达拉索拉西的上市价定为每年48万美元（约合67.5万加元），即每30天用量的批发成本为4万美元。
California-based drug maker Revolution Medicines set its launch price for daraxonrasib at $480,000 US ($675,000 Cdn) annually, or $40,000 for a 30-day supply at wholesale cost.
利润高于患者 Booth回忆说，当他和许多同事看到达拉索拉西这种靶向胰腺癌细胞特定突变的药丸在临床试验中显示出疗效时，都感到“非常兴奋”。
Profits over patients Booth recalls how he and many of his colleagues were "thrilled" to see a treatment like daraxonrasib, a pill targeting a specific mutation in pancreatic cancer cells, prove effective in clinical trials.
研究发现，达拉索拉西使近三分之一患者的肿瘤进展停止或逆转，而接受化疗的患者这一比例约为10%，并将生存期从不足7个月延长至约13个月。
The research found daraxonrasib halted or reversed tumour progression in nearly a third of patients, compared with about 10 per cent of those given chemotherapy, and increased survival from less than seven months to roughly 13.
Booth对CBC新闻表示：“这是一个希望的信号，表明我们终于开始在治疗这种极其棘手的疾病方面看到了一些进展。”
"It was a signal of hope that we finally started to see some progress in this very difficult disease," Booth told CBC News.
但当Revolution Medicines宣布该药物（商品名Rasonque）的价格时，这种兴奋感消退了。
But the excitement faded when Revolution Medicines announced the price of the drug, marketed as Rasonque.
Revolution Medicines在发给CBC新闻的电子邮件声明中表示，患者自付多少费用取决于治疗时长和保险覆盖范围等因素。
In a statement emailed to CBC News, Revolution Medicines said how much a patient pays out of pocket depends on factors including treatment duration and insurance coverage.
“我们的目标是确立一个能够反映有意义的治疗进步、同时支持患者获取药物并持续推动科学创新的价格，”一位发言人写道。
"Our goal is to establish a price that reflects meaningful therapeutic advancement while supporting patient access and continued scientific innovation," a spokesperson wrote.
但那些患者可能从达拉索拉西（daraxonrasib）中受益的医生们对该价格提出质疑。
But doctors whose patients may benefit from daraxonrasib question the price.
“有时他们报出的价格完全讲不通，”麦吉尔大学（McGill University）肿瘤学副教授、从事早期临床试验研究的拉米·萨利赫（Ramy Saleh）医生说。
"Sometimes the prices they quote make absolutely no sense," said Dr. Ramy Saleh, an associate professor of oncology at McGill University who researches early-stage clinical trials.
“作为一名肿瘤学家和研究人员，我不相信一种药物获批上市后，每年的费用会高达五十万美元，”他说。“我非常确定，生产它的成本只是那笔费用的一小部分。”加拿大癌症护理机构（CancerCare Manitoba）资深医学肿瘤学家拉尔夫·黄（Ralph Wong）医生指责该公司从像他这样的患者身上牟利。“我诊所里有多名患者因为买不起这款药而哭泣，”他说。
"I'm not convinced as an oncologist or a researcher that when a drug is approved that it will cost half a million a year, he said. "I'm pretty sure to produce it is, you know, a fraction of that cost." Dr. Ralph Wong, a senior medical oncologist at CancerCare Manitoba, accuses the company of profiting off the backs of patients like his. "I've had multiple patients in my practice crying because they can't access the drug," he said.
安大略省癌症患者就药物资助决定表达失望 特朗普的“最惠国”药品定价政策对加拿大人意味着什么 黄医生表示，革命药业（Revolution Medicines）根据其临床试验结果设定如此高的基准价格，而非基于他认为能够支持患者获取药物的价格，这“尤其令人愤慨”。
Ontario cancer patients speak out over disappointment with drug funding decision What Trump's 'most favoured nation' drug pricing policy might mean for Canadians Wong says it's "particularly galling" that Revolution Medicines set such a high benchmark price based on its clinical-trial results rather than what he considers a price that would support patient access.
他和其他医生表示，他们竭尽所能通过临床试验或同情用药项目为患者争取免费用药机会。
He and other doctors say they do everything they can to get patients free access through clinical trials or compassionate-access programs.
但如果一种药物未获加拿大卫生部批准，或未被公共或私人保险覆盖，患者可能只能自费购买。革命药业尚未申请达拉索拉西在加拿大的上市批准。
But if a drug isn't approved by Health Canada or covered by public or private insurance, patients can be left to pay for it themselves. Revolution Medicines has yet to apply for Canadian approval of daraxonrasib.
“毁灭性”的延长生命成本 虽然富裕患者或许能负担得起达拉索拉西这类药物的价格，但布斯表示，对许多人来说，这在经济上将是“毁灭性的”。
'Crippling' cost of longer life While wealthy patients may be able to manage the price of a drug like daraxonrasib, Booth said it would be financially "crippling" for many.
专利药品价格审查委员会（PMPRB）——这个联邦独立机构负责监管专利药品价格——的数据显示，加拿大人在药物上的支出正在增加。
Data from the Patented Medicine Prices Review Board (PMBRB), the arms-length federal agency that regulates patented drug prices, show Canadians are spending more on medications.
根据专利医药价格审查委员会（PMPRB）的最新年度报告，2024年专利药销售额达到221亿美元，同比增长近11%。专利药占药品总开支的47%。当年加拿大有1137种获批供人类使用的专利药。而这还不包括一些患者为购买加拿大买不到的药物所支付的费用。
Sales of patented drugs reached $22.1 billion in 2024, up nearly 11 percent in a year, according to the PMPRB's most recent annual report. Patented medicines accounted for 47 per cent of all spending on medicines. There were 1,137 patented medicines approved for human use in Canada that year. And that doesn't include what some patients pay for medications that aren't available in Canada.
对霍华德（Howard）来说，为购买daraxonrasib付出的费用就像是“每个月为一套公寓支付首付”，只为了换取延长生命的希望。
For Howard, paying for daraxonrasib is like making a "down payment for a condo every month" for the hope of prolonging his life.
他说：“这从长远来看是不可持续的，”尤其是获取这种药物还要面临种种障碍，包括过境到一个美国邮政地址去取处方药。
"It's not sustainable long term," he said, especially with all of the hurdles involved in getting the drug, including crossing the border to pick up the prescription at a U.S. postal address.
“[但是]如果我能获得提高生活质量的机会，让我能花更多时间陪伴家人，对我来说这就是一件重大的额外收获。”
"[But] if I can gain a quality of life which allows you to spend more time with family, that's a significant bonus for me."