Cancer Clinical trials Medicine Science Surgery

Bloviations and pontifications on the state of cancer research, part 1 (of 2)

Readers who don’t like me might think that the title of this post refers to what I am about to write. I know, the title perfectly encapsulates the verbose style that is my stock and trade. In reality, though, it’s referring to a couple of articles floating around the blogosphere of which I’ve become aware and about which I’ve been meaning discuss because of their similarities. One is a pretty worthless piece of conspiracy-mongering; the other, although it makes some appropriate criticisms of how we go about cancer research, comes to a wildly incorrect conclusion about what we should be doing differently.

The first article was brought to my attention by Kevin, MD. Normally Kevin is one of my favorite “just the facts” sort of medical bloggers, but this is one of those occasions when I have to say that I highly disagree with his comment of “interesting take” on the article to which he linked, entitled Why There Will Never Be a Cure for Cancer by L. Vincent Poupard. It’s not an “interesting take.” It’s a brain-dead take. In essence, Poupard argues that a “cure for cancer” would devastate the U.S. economy, an utterly ridiculous proposition if you look beyond the simplistic claims. Here’s what Poupard starts out with:

The billions of dollars that are raised pay the thousands of doctors that conduct the research. It also pays for the salaries of people that raise more money for cancer research. It also pays the salaries of hundreds of people that advertise for these organizations.

It all sounds impressive–until it’s pointed out that the total budget for the National Cancer Institute this year will only be around $5 billion–in a budget of around $2.9 trillion–less than 0.2% of the entire federal budget. It’s been estimated that, if you add the investment of charitable foundations and big pharma, the total spent on cancer research amounts to approximately $10 billion a year, give or take a billion dollars or so. In contrast, the gross national product in 2006 was over $13 trillion. To argue that eliminating this would somehow devastate the economy is a bit hard to justify. Not that that stops Poupard from trying, though:

It was once estimated that one out of every thousand people in the United States work in some field that is linked to cancer research. If a cure for cancer were to be found, it would have a strong, negative effect on the economy in the United States.

If a cure for cancer were to ever be found, the medical community would see shrinkage of staff unlike any that it has ever seen. Unemployment would skyrocket as thousands medical, advertising, and charity professionals lost their jobs. Homelessness in areas where research was centered would also increase.

Support for this failed industry would cause for a raise in taxes to help support the influx of newly unemployed. This raise in taxes would then, in turn like other raises in taxes, bring more people under the poverty level in the United States.

There most likely will never be a cure for cancer. A cure for cancer could be one of the worst mistakes for the United States economy.

Whoa! No wonder big pharma, its dark minions, NCI-funded lackeys like myself, and other physicians don’t want a cure for cancer! Think of the economic carnage! Poupard’s argument, is, of course, a load of crap. For one thing, if a single cure for cancer could ever be discovered (a highly unlikely prospect, given the heterogeneity of the many different diseases lumped under the term “cancer”), whoever discovers it is likely to rapidly surpass Bill Gates in terms of wealth. That’s a lot of incentive. Second, cancer doctors are human too. We see patients suffer and die from cancer all the time, and most of us have or have had family members suffer and die from the disease. Just by statistics alone, one-third of us can be expected to be diagnosed with cancer sometime in our lifetimes. To imply that we would suppress a “cure” just to protect our hegemony and income requires a leap of faith beyond what I’m willing to make.

But let’s assume that we cancer doctors are indeed all money-grubbing, cold-hearted greed-heads who don’t care about our patients and would indeed suppress a cure in order to protect our income. Or not. It’s really irrelevant to the sheer idiocy that is Poupard’s article. The reason is that Poupard neglects one very simple consideration: Cancer costs the economy big time. For every researcher or caregiver working in the cancer field, there are many more who can’t work due to cancer and whose treatments re costing big bucks. Besides the billions of dollars spent on surgery, chemotherapy, and radiation every year to treat cancer, there are other costs. For example, a recent study published in JNCI estimates that just the cost of the time that cancer patients spend pursuing treatment costs the economy $2.3 billion a year.

Now, imagine if there were indeed a cure for cancer found tomorrow. Let’s say that it’s a drug and that it eliminated even advanced stage cancers. Almost overnight, all the billions of dollars spent on research would be redistributed elsewhere and all the person-hours lost to cancer would be available to the economy. Health insurance costs would fall, leading to decreased rates, and Medicare and Medicaid expenditures would fall, helping with our long-term fiscal liabilities due to these programs. I’m not claiming that curing cancer wouldn’t cause major disruptions in our health care system. I note that interventional cardiologists are getting a bit nervous over a relatively modest drop in coronary intervention rates. I also note that the rise of interventional cardiology has played havoc with cardiac surgery as a specialty, with cardiac surgeons losing a lot of business to the cardiologists.. Even so, I can’t think of a scenario where the benefits of curing cancer would not far outweigh the temporary dislocation of those of us who make our living treating cancer and researching better treatments.

Indeed, even if a cure for all cancers were found, there would still be a need for oncologists to administer this cure. Moreover, there would definitely still be a need for surgeons like me, at least in breast cancer. The reason is simple: Most of the surgeries that I do still consist of biopsies to diagnose breast cancer. The need for these biopsies would not go away, “cure” or no “cure.” So, yes, the number of physicians and ancillary staff would decrease, but perhaps not as dramatically as Poupard assumes. In addition, health care workers, even though specialized, are not “unredeployable.” If a real cure for all cancers were found, residency programs and medical schools would quickly adjust and steer trainees to other specialties. In fact, oncology might become a more desirable specialty because oncologists, who previously couldn’t cure metastatic solid tumors, now would be able to, leading to a lot less dealing with incurable patients and a lot more dealing with curable patients. Established physicians could also be redeployed into other specialties. For example, I could always go back to doing general surgery. I might have to do a little training or apprentice with another surgeon for a while to refresh my memory and skills relating to operations that I don’t do that often anymore, but I could certainly do that. Similarly, although it would not be easy, I could change my research focus. My skills in molecular biology and in running a lab could be put to use studying many other questions.

The bottom line is that the conspiracy-mongering idiocy of the type shown by Poupard and so many alties comes from a deep-rooted distrust of the system and frustration that we haven’t found a cure yet, rather than any rational analysis. It turns out that some in medicine share this frustration. They do not, however, direct that frustration into criticisms of the current system of funding cancer research. Some of their criticisms are valid, some not, but unfortunately they come to an incorrect conclusion about how to fix the perceived problem.

That, my readers, will be the topic for part 2. It will be especially fun because it allows me to set straight the bloviations of a blogger with whom we’ve had dealing before, who really, really doesn’t like me.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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