Health care reform shorts: The "war on cancer"

Perhaps it's because two people in my orbit -- my partner's father and a dear friend's son -- have died of cancer recently, but I found Dr. John Marshall's oped, "Fighting a smarter war on cancer," in the Washington Post yesterday one of the more challenging pieces I've read during the reform brouhaha. Here's a taste:

Cancer medicine is often regarded as an area of significant progress and clinical research, so we should be able to tell without much difficulty what kinds of treatment are valuable and what kinds aren't. But given that 80 percent of my patients will die of their cancer, it's clear that we have not found an "optimum" therapy.

... Most poor countries do not support any cancer care; most developed countries highly restrict it because of its cost and limited effectiveness. The United States is the only place on Earth with relatively unfettered access to cancer care, including the latest medicines, sophisticated scans and high-tech radiation, all of which are very expensive. But despite their more limited access, cancer patients in other high-income nations may live longer and with a higher quality of life than patients in this country.

... How did we end up here? The answer is simple: Cancer patients are scared for their lives and will accept what is offered, and we oncologists want to offer improved outcomes and recommend the best treatments we can. Insurance will pay for these treatments. A portion of fees collected by cancer doctors and hospitals is based on how much chemotherapy we administer. So the more drugs we give, the more radiation we give, the more we collect from health insurance. The incentive system makes it less lucrative to talk to patients -- to counsel them, to help with their decision-making -- than to treat them, regardless of the value of the treatment.

Dr. Marshall believes that medicine can move beyond shoving poisons that mostly don't work (though they may briefly extend life) into cancer patients. Health care reform for him involves collecting national data, including genetic data, on cancer outcomes into databases and encouraging more patients to participate into clinical trials, a choice that current insurance practices usually discourage. The current bills go some distance in these directions.

These aren't the stuff that has dominated the political arguments, but whether and how reform implements these seemingly-peripheral details will have a lot to do with whether all the sound and fury proves worth it.