(Margaret) Akpan would like to give her patients Taxol whenever they need it, but she can't. For D.C. General, a cash-strapped public hospital, the No. 1-selling cancer drug in the world is just too expensive. It doesn't even stock Taxol in its pharmacy. Taxol can cost a patient on average anywhere from $10,000 for a complete treatment of ovarian cancer to $20,000 for breast. For that amount, Akpan can treat many more patients with other, though possibly less effective, therapies.

Taxol has been a blockbuster hit for Bristol-Myers Squibb, posting sales of $2.8 billion since being approved in December 1992. Last year, Taxol accounted for nearly 40 percent of Bristol's cancer drug sales. By 2004, stock analysts predict, Taxol's slice of those sales will soar to 55 percent. The government, through its various health-benefit programs, is the largest purchaser of Taxol, with Medicare alone accounting for more than $160 million in sales in fiscal year 1997.

Further tests were run, and it was clear: Taxol attacked cancer cells in a way never seen before. Unlike other drugs, Taxol attached itself to microtubules in the tested cancer cells. Microtubules are an important structural element of the cell essential to cell division. They are like tiny rods that form the cell's skeleton. For a cell to divide, these microtubules must disintegrate so the cell can collapse into two. In cancer, cells divide uncontrollably. Other cancer drugs simply prevented these microtubules from forming or stunted their development. Taxol did the opposite, it allowed microtubules to form, but not break down. Instead, Taxol bound to them, preventing their disintegration and halting cell division. By clogging cells with microtubules, Taxol paralyzed the division process, and the cells died.