Science Marches On and Policy Lags Behind

Andrew L. Pecora, MD

In April, I prepared to attend the 2017 American Association of Cancer Research (AACR) meeting expecting that the breakthrough discoveries presented would offer my patients greater hope to defeat the dreaded disease we call cancer. I was not disappointed. The research presented at AACR focused on the fundamentals of cell biology, cell aging, and cell death; how the immune system recognizes and kills cancer cells; and how, in turn, cancer cells avoid immune system detection. It is easy to understand how the body of this research will apply to and benefit other aspects of medicine, such as aging, diabetes, rheumatologic disorders, inflammatory bowel disease, infectious diseases, and neurodegenerative diseases.

The explosion of knowledge sometimes makes you feel as though you were drinking from a fire hose, but no one is complaining. No one I have ever met, regardless of political perspective, wants someone they love to receive anything other than state-of-the-art care for serious illnesses—particularly cancer. In the United States, we have the best science and the best healthcare, notwithstanding opinions to the contrary. What we do not have are rational leaders who are willing to put the health and well-being of our citizens first.

Where do we go from here? Why not start with both parties working together to create a consensus on the problems facing healthcare in America today? This would be a long-butfinite list. We all know we spend too much overall, but we do not know where we spend too much and where we spend too little, which results in less-than-optimal outcomes and waste. Simultaneously, we Americans engage in habits and lifestyles that adversely affect our health and add considerably to costs of care. We have doctors burning out largely because of administrative requirements and payment obstacles. We have inequality in care caused in part by insufficient hospital capacity and variations in technological sophistication. Our laws and regulations impede innovation and physician-hospital relationships that otherwise would improve healthcare delivery. We want new and effective therapies but without the risk or adverse outcomes associated with them. We have so many entities that derive profit from the healthcare system but add little value. In addition to these problems, many patients struggle with the high cost of health insurance or go without.

The state of healthcare today reminds me of the disorganized state of cancer care 30 years ago when I began practicing. We knew very little about the root causes of cancer, and so we applied therapies and technologies that were aimed at the wrong things. We had many flawed ideas about what might work and argued about who had the correct approach without any real data to know for sure. Sound familiar? Now, 30 years later, thanks to science, our medicine is better targeted, outcomes are improving, and arguments among clinicians are diminishing. My greatest hope is that our political leaders also use a scientific approach to improve healthcare policy by focusing on the desired outcome—better clinical outcomes and lower costs of care—studying the data, trying evidence-based solutions, and taking credit only for what works.