Column 92 - "War" on Cancer? Are we getting our money's worth?

"War" on Cancer?  Are we getting our money's worth?

"Cancer: The Emperor of All Maladies" the documentary by Ken Burns recently played over 3 nights on KIXE.   It is inspired by the book by Siddhartha Mukherjee. It was a fascinating piece that covered the modern history of the disease and its treatment. 

Of course cancer is a broad term that essentially refers to the "girls gone wild" of cells in our bodies. Specifically there are thousands of diagnoses where these uncontrolled cells effect our biology. There is a theory that we all have opportunistic cancerous cells in our bodies, but that our immune system or certain genetic combinations allow us to fight it. 

The program showed how the idea of chemotherapy was started in childhood leukemia patients and met with enough success that it seemed to be the best approach.  Multiple variations were developed and applied, along with surgical excision and radiation. 

I recalled a program I saw in grammar school that followed research scientists and demonstrated that their idea of time is quite different than ordinary people.  The researchers would say they felt they were close to a solution.  They were asked how long they had been working on the project and how long until the ultimate solution might be found.  The responses for both were in terms of decades or years. Most of us just don't think of "soon" in terms of years!

The vignettes that were shown take us on the roller coaster journey with patients, touching our hearts and sense of hope and fear for ourselves and our loved ones.  The story takes us through decades of treatments that were periodically successful, but overall not impressive. I say that because in my business, we are acutely aware of the money that has been spent on this "war".

What struck me most, was one individual scientist who about mid-way through the program, stated emphatically that it was clear that there is no cure for cancer.  By definition the cells will continue to morph in response to treatment.  His conclusion was that had we spent as much money on prevention, we would have better served mankind. 

From my decades of experience with clients and friends going through different forms of cancer, I must say that I share his sentiments.  Of course that is not to say that we should cease research and treatments, but it may very well be time for a reality check.

Stephen Brozak, analyst for the health care industry, in his column in the Bloomberg News takes issue with 3 things that he thinks Mr. Burns got wrong.  

1)    Most advances in cancer therapy are incremental.

2)    Cancer is a mega-business that resists change.  

3)    Mergers, acquisitions, divestitures and corporate relocations are a big part of the cancer story.  Mr. Brozak states: "The Burns documentary does devote some attention to how we apportion the majority of cancer funding to late-stage treatments that have little promise of efficacy. Such a fiscally irresponsible approach would not be tolerated in any other discipline or business.  The series highlights the drama of massive interventional therapy that culminates in the rejoicing of a lucky few survivors, while offering almost boring descriptions of routine diagnostics, which identify cancer in its early or even formative stages and gives treatment options the best chance of success."

I see this as consistent with the way we finance health care in general.  We do not emphasize the cognitive skills of an accomplished diagnostician in the same way we reimburse a procedural intervention. We have just begun to recognize the benefits of funding preventive care by paying for such services at 100% per the ACA mandate.

Further, there are multiple statistics that confirm we spend the bulk of our health care dollar on the last six months of life.  It's time that as a society we addressed this unbalanced allocation of resources. This is not supporting "death panels", this is taking a serious and thoughtful approach to how we spend almost 18% of GDP.

Finally I was impressed with the featured oncologist who was the epitome of compassion and honesty in dealing with her patients.  As painful as it may be for all concerned, she was honest and forthright with her patients.  She demonstrated this in offering them the gift of a graceful and dignified exit through hospice care.  I treasure the moments I spent with my mother and mother-in-law as we did just that in our home. Both were allowed to pass in the comfort of home, absent a hospital bill in the tens of thousands of dollars.