The New Terrapin Gazette
6 July, 2012
Most of the time television is nothing more than a diversion — proof, as the old quip goes, that we would rather do anything than talk to each other. We’d also rather watch a bad sitcom than read a good book. Bad sitcoms get millions of viewers; good books get thousands.
Too many people die of cancer. Of course; even if it were a small number, it would still be too many. Yet it is worth asking whether the nation — in this discussion, the USA — might do better in researching and treating the disease. The following ruminations, though preliminary at best, are intended to provoke debate and the generation of practical proposals.
First, the metaphors should be dropped, for they are silly and misleading. There is no “war” to be waged, and “fighting” is the wrong word when it comes to research, detection and treatment of disease. Second, this discussion deals primarily with the allocation of funds, and it ignores where those monies come from.
Wikipedia claims that “…the overall death rate from cancer has not decreased appreciably since the 1970s”, and then adds that “Cancer death rates between 1990 and 2006 for all races combined decreased by 21.0% among men and by 12.3% among women”. How those statements can be reconciled is a puzzle, but let it go for the moment, and weigh this contention: cancer research has been disappointingly unhelpful. The public is not getting its money’s worth. You can dispute that, of course, but still the question remains: should policy be changed so that greater value is obtained from funds spent on research?
In Number 256 of this newsletter, childhood leukemia was mentioned, and it was implied that thirty-five years of research have produced little or no improvement in outcomes. To the extent that is true, something is wrong; either researchers are blindly groping for answers, or they have lost sight of the goal. Of course they would bitterly resent both charges. Their attitude is, however, irrelevant, as they are not funding the research.
The danger is that cancer research may become a sacred cow, an occupation that has little or even no interest in the welfare of patients. As a researcher at the City of Hope (an institution in California) remarked to an NTG staffer, “I’m not trying to cure cancer; I use it to conduct my study of life.”
Yes, basic research is useful, and may lead to new therapies for everything from dandruff to hepatitis, but that’s immaterial to a hospital that advertises itself as a sophisticated health care provider. Something is wrong.
That something is the sheer momentum of research itself. It can devolve into a directionless probing of the mysteries of the universe, a kind of philosophical contemplation of the manifold meanings of Nature’s secrets; when that happens, it should be supported by “blue sky” foundations that are not interested in specific results. That sort of research, fascinating and laudable as it is, cannot be considered a humanitarian undertaking, now can it?
Focus, then, on science in the service of health: science devoted to easing suffering and curing disease. If you have other goals, fine — but don’t misrepresent your efforts.
That suggests that some reforms might be called for. Begin with the education of biomedical researchers.
When Richard Nixon was president, he proposed a plan that would have identified college students embarking on careers in this field. He wanted to give them grants for graduate and postdoctoral study, and let them select the universities they wanted to attend. The government money would then have gone to the schools.
This plan would have put the students in control of much of the funding for biomedical research. It amounted to letting the consumer choose where to shop.
It was bitterly, angrily attacked by the research establishment. The universities and faculties denounced it as not just inimical to biomedical research, but as an assault on it that was intended to kill it.
Befuddled by the vitriolic outbursts and inflammatory rants of the academics, the legislators refused to follow Nixon’s lead. It is inconceivable that the president plotted the destruction of US research, or intended to harm it. Who, one could ask, is better qualified to direct the flow of government funds to research institutions than the students who hope to advance themselves? Could it be that a guaranteed source of funding tends to make professors and their employers complacent, hidebound, and increasingly unimaginative? What is wrong with stimulating schools to compete for the best students? In what sense does consumer choice harm product quality?
Nixon had another idea, as well. He proposed that the citizenry be encouraged to be tested for cancer. That would, he felt, identify thousands of seemingly healthy individuals who could be helped before malignancy advanced to untreatable stages.
To that simple concept, add a few elaborations: imagine the sale of inexpensive insurance policies that require their purchasers to have those examinations, and then pay for treatment of any cancers found. Next add this requirement: only some cancers would be tested for and treated; no incurable malignancies — such as pancreatic cancer — would be covered, and treatment would be covered only for cancers that have a very high cure rate when treated early with standard protocols.
That requires a bit of explanation. It is a commonplace that some cancers can often be cured, rather than just treated, when they are detected early. Curing some forms of cancer is possible with what are called “state of the art” procedures; that designation does not mean exotic, advanced and highly sophisticated techniques, but “off the shelf”, ordinary and commonly available means. Obviously those treatments tend to be less expensive than the more complex and advanced procedures.
Nixon was saying, in other words, “Look, we can cure some people who don’t know they have cancer, if we can get them tested for cancers we know how to cure when we detect them early. That won’t be expensive. Sure, it won’t cover all cancers, but that’s because we don’t have good treatments for all cancers. The shame of it is that lots of people who definitely could be saved are slipping through the system, and suffering and dying needlessly. So we’ll focus not just on prolonging life, but on curing as many people as we possibly can. We’ll test only for the cancers that offer us good chances of getting cures. That won’t most cancer sufferers, but it will will save lives that are lost under the current system. Meanwhile all other anti-cancer efforts will continue — we’ll treat everybody as usual, try to stamp out environmental causes of cancer, and carry on research.”
Nixon hoped to dragoon millions of citizens into clinics for genuinely helpful tests (why do physicians test for diseases they know are hopeless?*). He was saying simply that you go with your strength, and get all it can give you. What’s wrong with that thinking?
Well, it ran counter to the desires, purposes and aims of the health care establishment. At this point one must wonder what, exactly, that establishment had in mind. Certainly today it seems to have lacked something in the area of humanitarian motivation.
Could and should Nixon’s basic concepts be used to benefit? Would it possible to improve the old ideas a bit, and come up with a program that would save a few tens of thousands of lives every year?
Or must the public continue to spend fortunes on a research and care system that can not even provide credible, comprehensible statistics for its performance? How is it possible that there has been no “appreciable” decrease in cancer death rates since the 1970s, yet that death rate fell twelve percent for women and twenty-one percent for men in just sixteen years beginning in 1990?
It’s time to ask questions and demand straight answers that don’t provoke skepticism because they contradict each other. Perhaps some new thinking is called for, or perhaps the government should reconsider ideas that were rejected years ago. It may be time for some fundamental reforms.
The public can’t rationally demand a cure for all cancers. It can, however, demand that its money be rationally allocated.
* The NTG’s Foreign Desk Editor interrupts to recount a misadventure with an otolaryngologist: troubled by hearing loss in one ear, the editor consulted the physician, who wanted to order a hearing test. “Why?” asked the wordsmith. “I know I have trouble with that ear; you don’t have to prove it. You can even see why I have the problem, if you look in my ear.” The response was that the degree of hearing loss should be determined. The editor was having none of it: “What difference would and could that possibly make for treatment?” That triggered a mumbled circumlocution that provided no answer, but “Let’s schedule a hearing test” resurfaced. That, to quote the editor’s exact words, “…ended my visit to that money-grubbing quack. — Huh? What’s that?”
The US federal government identifies dangerous individuals and organizations by their beliefs. A tip of the hat to the Dean of NTG subscribers, JH, for his note stressing the importance of this commentary. Do heed his advice and click on the hyperlink!
Well, here’s yet more proof that morons can be heads of government: Argentina’s president says that equality is just as important as Liberty. Good grief, the female talks like Obama.
What does “green” mean? Nothing sustainable (nonsense jargon/slogan there). “…the failure of environmentalism as an ideology looks inevitable since has misconstrued the causes of many of the problems to which it claims to have a solution.” The full article deserves your attention if you want to be rational about the subject.
“This is what happens when the debate centers on programs instead of principles”, says a columnist in a barn-burner of a post. Read it, and if you know anyone who has lukewarm sentiments about the federal supreme court, the president, and the future of the USA, pass the link on.
A genuine, ethically consistent and steadfast collectivist would look at this tale of journalistic malpractice and call for governmental intervention. But…that would offend the lapdogs. Individualists, meanwhile, simply point to the facts and leave it to the market to decide whether to reward propagandists for degrading what should and could be an upstanding occupation.
Ah, the fourth of July: a money-maker for emergency rooms across the USA.
Bobby Jindal talks too fast. He’s probably interested in getting answers across within the limitations of sound bites. Perhaps the best way to find out about him is to read what he has written. The governor is brilliant — and he will be president. If Obama is re-elected, that means in 2016. There will be a huge mess to clean up, and nobody will be better qualified to do that than the man who turned cantankerous Louisiana around.
The very idea that there might be free-market alternatives that would outperform Obamacare strikes “progressives” as absurd. Let the discussion begin….
As if you did not have enough to fret about…here’s an account of how drones and piloted aircraft can be attacked and even controlled with electronic jamming. Those GPS gizmos are not trouble-free, so someone in DARPA had better get busy designing countermeasures. How about encrypted data streams? That should be easy code to write, and easy/cheap hardware to build.
A tip of the hat to reader and consultant GB for this note on a Mars mission this newsletter missed. If this gizmo works, the taxpayers should buy a few cases of Dom Perignon for the rocketeers.
The cops will love this: finally, there’s a really good reason to have and use a “mobile phone” (which is not a telephone at all, but a miniature radio transceiver that is possibly damaging the brains of users with its radiation).
The physicists have figured it all out. Again. They do this every so often…. Well, at least they don’t have any investment advice for you.
What was it this newsletter said about Romney, when the supreme court decision was announced? (See Nr. 255.) Well… it seems he has problems. (Advisory: that hyperlink may not work, but if it does not, the story is still available at the other links. Just keep clicking.) Team Obama has an opportunity, and those folks won’t be shy about exploiting it. There’s more here, as well. This could be the beginning of a turnaround in the polls. A lot of “wingnuts” and opponents of Obama have been overconfident; they assumed Romney is a solid candidate. This newsletter has never been convinced he has what it takes. Really, now: why does he want to be president? — Subsequent development: in damage control mode, Romney addresses the “tax or penalty” issue.
Related: maybe the voters that really matter are not as upset about Obamacare and the smothering embrace of collectivism as this newsletter is. Maybe Romney has little to say to those folks. And maybe that’s why he won’t win. Maybe….
This guy was the darling of The Daily Kos weblog. Then he made a documentary film about a mosque being built in the USA — and read a book — and learned a lot about Islam. That did it. What happened next shocked him, reveals a lot about the news media, and won’t surprise you. Pass this along to “progressives” you know, because they’ll never see it on The Daily Kos.
Repealing Obamacare could be a complex process. Why not just challenge it in the courts, since the tax did not originate in the House?
Genetically modified humans? Is this a hoax, or is there a Monsanto maternity suite somewhere?
It’s a sign of sheer frustration with the White House: Arizonans would like to allow their state to opt out of some federal laws. Unfortunately, it’s not that easy, and the precedent was firmly established when the Civil War was fought. Still, some of the high-handed things the feds do are irritating enough that a substantial minority of citizens would understandably like to have veto power over the president and Congress. Of course the anger would decline if the federal government were less determined to make fundamental, sweeping changes in the USA’s way of life. Reality: you either sit back and go along with what Obama has planned for you, or you resolve not to be controlled by Utopian ideologues and their greedy cronies. If you choose to resist the hijacking, you have to find something that works. The Arizona proposal is not practical.
Obama has a problem: those “Palestinians”. It’s no wonder. They cause problems for everyone, including themselves, because they are living a lie: rather than deal rationally with reality, they cherish and cultivate their phony status as victims. No minority group on the face of the earth is less deserving of internationally recognized sovereignty.
Anthropogenic Global Warming: yeah, you need more information on that, right? Well, in the extremely unlikely event that you do, you can have a look at this long, generally accurate essay that leaves out a few things you really should know before you make up your mind about the biggest science hoax in human history. — Better idea: read The Hockey Stick Illusion by Montford (ISBN 978-1-906768-35-5).
What shall we say, shall we call it by a name?
As well to count the angels dancing on a pin
Water bright as the sky from which it came
And the name is on the earth that takes it in
We will not speak but stand inside the rain
And listen to the thunder shout
I am, I am, I am, I am
The masthead includes a quote from the works of Bernard Goldberg.
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