Is Cancer Treatment Worth it?

Much political hay was made last year when Sarah Palin and others suggested the Democrat-written health care legislation would lead to “death panels.” The President scoffed, Pelosi told us pass it and find out, Reid kept his head down and made disingenuous promises.  What about death panels is so scary?

The Stats

In North America approximately 1.5 million people are diagnosed with cancer each year.  Nearly 25% or 1 out of every 4 Americans will get some form of cancer.  According to NanomedicineCenter.com, 1,500 Americans die of cancer every single day, that’s nearly 600,000 per year.  Only heart disease kills more Americans.

To make matters worse, the cost of cancer is not cheap.  Cancer treatment cost Americans $93.2 billion in 2008 alone.  Now the U.S. government will be absorbing much of this cost and if all goes according to plan, they will bear the sole burden of these costs before the decade ends. (Yes, I am assuming private insurers will eventually succumb to a single payer system.)

Can the system sustain the sheer weight of paying the health care costs of every American when there is no hope of budgeting for it?  Plainly put, the government has not balanced a budget for more than 2 of the last 35 years, how long can that pattern continue?  Probably not too much longer.

The Rationale

Shouldn’t “death panels” be welcomed?  Shouldn’t we view them as redemptive entities that will ease the suffering of hundreds of thousands?  The dying suffer less, families are spared months, perhaps years, of agonizing pain watching a withering loved one slowly die, and finally there is the financial benefit.  Both the individual’s family and society is spared the shared cost of futile medical treatments.  Costs can be efficiently narrowed down to comfort care, counseling, and funerary arrangements.

Logical, efficient, and rational, but entirely ridiculous.  Human life, especially that of someone you love, cannot be boiled down to a monetary ration.  Such musings are easy for intellectual discussions but are cold, cruel, and inhuman.  Undeniably there are people ready to die, in fact all of us will reach that point should we live long enough, but cancer doesn’t wait for children to grow up and leave home, it does not choose to afflict only the aged, the lonely, and the unattached.  No cancer randomly strikes athletes, slackers, successful business leaders, poor welfare recipients, honest hard-working Americans, and politicians.

Real Death Panels Aren’t Panels

The term, Death Panel, invokes an image of a high wooden bench fringed with robe-clad government bureaucrats peering down upon a family tearfully awaiting a decision on the fate of a sick loved one.  In reality that will never happen.  We don’t live in a Hollywood nightmare.  (Or do we?)

Real death panels will come in much prettier packages.  They will be packaged as life choices, end of life decisions, and facing death with dignity. Cost controls could eventually get as blatant as those we’ve seen in Oregon, where cancer patients are tersely referred to suicide assistance, but it would be pure melodrama to expect it in the near future.

Rather expect cost controls to come from less obvious sources.  We’ll see respected public and private medical organizations issue guidelines that will delay cancer detection, education programs that encourage the terminally ill to face death enthusiastically and actively, and regulatory agencies discrediting or banning expensive life-extending drugs.

So It Begins

If you have your eyes open you noticed it began even before so-called Obamacare was passed by a suicidal Congress.  Last November, the U.S. Preventive Services Task Force, recommended women not exam themselves for lumps and that women between 40 and 50 should not get yearly mammograms. In April of this year the same Task Force recommended men over 75 not get prostate screening, furthermore they see no benefit to prostate screening for men of any age.  Then this week an FDA advisory panel discredited a major cancer drug, Avastin.*

The screening recommendations came in spite of the fact that many studies have shown early detection saves lives, more than 40,000 women under 50 years old are diagnosed with breast cancer each year, and more than 200,000 men are diagnosed with and nearly 30,000 men die from prostate cancer each year.  Adding to the fishy smell, New York Times reported, only 1 in 5 women under 40 have a family history of breast cancer. As for prostate screening, as recently as last month, Lancet Oncology, published a report that there are significant benefits to prostate screening.

My wife was one of those with no family history of breast cancer.  Diagnosed following her first mammogram at age 40, her breast cancer escaped both a self exam and a doctor’s exam, even though she was stage 3.  The doctor told her without that mammogram she would have never lived to age 50.

Why Oppose Screening?

Could it be these compassionate medical panels really yearn to spare men and women the stress of false-positives?  That seems highly unlikely.  It seems far more likely they are laying the groundwork for significant future cost savings.

Saving from deferred cancer screenings could be the goal but the cynic in me says that’s only the tip of the iceberg.  I suspected this last November but the Avastin story seems to support my theory.

Failure to detect common but deadly cancers until they have achieved an advance stage could potentially result in far more cost saving than any other form of cost-cutting.  Let me explain.  If screening is delayed, cancers that might have been caught and treated at great expense will be given time to grow and those who escape detection long enough will be terminal patients who don’t require surgeries, chemotherapy, or radiation treatments.

How could this save money, you might ask.  My wife’s successful treatments cost our insurance company more than a quarter of a million dollars.  Had her cancer achieved stage 4 or worse, her treatment options could have been limited to hospice or some end-of-life solution.

By discrediting and thus eliminating life-extending drugs some very expensive treatments can be avoided.  Early detection results in expensive treatment, often including surgeries, chemotherapy, Radiation Oncology, and hormone therapies.  If life-extending treatment options are limited or not covered, terminal cancers could be much more economical for insurers, whether public or private.

When the insurer is connected to the regulatory agency the possibility for corruption and conspiracy is greatly increased.  Call me paranoid but I think I have a point.

* (I have no opinion about the effectiveness of Avastin, only that the story smells suspicious to me.)
Lancet Oncology,Lancet Oncology,
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