Therapeutic nihilism and fatalism in the face of cancer are about to take another hit this week.
Cancer death rates are decreasing unabated. It appears that cancer care has reached an important tipping point, an effect of both prevention (e.g. colon cancer screening) and treatment.
There is one cloud about the data, which is a data collection problem and a good argument for minimizing bureaucratic involvement in health care.
The VA's participation in national cancer surveillance, on which this morning's story is based, has come into doubt. As far as I can tell, reading between the lines, this is based on a sad misreading of HIPAA's confidentiality provisions. We must accept the existence of a bureaucracy, as well as the fact that it is a living organism that must assure its own survival.
The VA has a long history of providing poor quality care at bloated cost with a huge administrative overhead and bureaucratic mucking about. What better way to hide it by hiding your outcomes and blaming a law whose intent never extended to public health registries. Hopefully the states have the power to compel the VA to participate in registries.
The absence of VA patients would be expected to lower cancer incidence but raise survival. Since the registry data is supposed to be published later today, I cannot yet tell if VA patients are included in the most recent report, but knowing the lead time required to analyze this type of data, I think we are probably dealing with data unadulterated by bureaucratic meddling.
So overall, good news. The profit motive in medicine, while causing significant unanticipated problems (costs, insurance etc.), has been able to deliver some significant improvements in survival, lifespan and quality of life.
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Two other related studies on this topic. Last week, a report by the Milken Institute on the cost and toll of chronic illness estimated that decline in obesity rates could lead to $60 billion less in treatment costs and $254 billion in increased productivity. Also last week, we heard from the Yale School of Public Health that if one spouse exercises, quits smoking, stops drinking alcohol, receives a flu shot, or undergoes a cholesterol screening, the other spouse is more likely to do the same. Perhaps there is a business case for targeting married working couples in the obesity wars.
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