Winning the war on cancer? US death rates show broad decline | Hacker News Reader

Winning the war on cancer? US death rates show broad decline

arstechnica.com

15 pointscwan11 comments

I remember reading a story a while back about progress made on deaths from heart attacks versus progress made on deaths from cancer. The key thing they zeroed in on was the fact that heart research focused on prevention first. They determined early on that it was too late to do anything once someone shows up in the ER with a heart attack. So, heart research focused on prevention.

While cancer was stuck in trying to cure the disease once someone had it. Overall the article stated not much progress had been made on cancer relative to progress made in heart attacks.

So I'm a little suspicious that cancer can now claim we're winning because of prevention. If you stop smoking it's helps BOTH cancer and heart attacks. I remember the group who pushed people to stop smoking, forever, was the heart association. Remember that little heart logo on all the ads?

This is overall good news, and I hope the researches focus more on prevention and research into what causes it. I find it tremendously interesting that "the cure" has been our focus for so long in medicine. I think drugs like Penicillin that cure got us stuck in that meme because they were so much a miracle. However, prevention is another tactic that's probably not been effectively utilized to keep us healthy.

I'm somewhat encouraged by the way that cervical cancer has been approached as a model of prevention. We've seen huge declines in death rates because of effective screening and management, and hopefully the HPV vaccine will push this even lower.

I'm also hopeful for the results of the whole-genome analysis of cancers that are going on right now. Hopefully we'll have some better ideas of the factors that might predispose you to a given tumor, and can find ways to manage the risk and catch this earlier.

I have a friend who is in his 30s with stage 4 colon cancer and it's pretty hard to get excited about the progress that's being made. They told him when they started that 5 years ago he would have been expected to live under a year and now it's 3-5 years. That's great but still not what anyone hopes for. He has kids who are all under 10.

I wonder if early screening will become more of a normal thing for people who can afford it. I'm not sure my friend could have afforded it but for cancers where the first signs of it indicate that it's too late it might make sense for some people.

That's a horrible story I'm so sorry to hear that about your friend. I think you're right on track that prevention and screening is our weapon against these things. Screening and prevention costs way less than "the cure".

If you read Christensen's latest book "Innovator's Prescription" he analyzes the medical industry through the lens of disruptive technology, and concludes that the forces of disruptive technology have been dismantled which keep prices high. The is such a unique perspective in this health care debate because it's basically been framed as "You pay the high price", or the "Government pays the high price". However, Christensen is giving us a third option saying fix the economic engine and disruptive technology will drive prices down over time and things will get better too. Neither side of the debate can guarantee this either.

His idea is that Doctor's cost a lot of money, but when you have to have the very best analyze what's wrong with you have to pay it. Doctor's jobs are very hard and time consuming. However, certain types of care can be provided without a doctor for things that are well defined. Prevention is just such a thing. Screenings are just such a thing.

The problem right now is that technologies that enable us to screen better are often wrapped up so that you can only go to a doctor to get them. Things like MRI's and CAT scans require prescriptions from doctors. The price of a CAT scan has remained the same since it was invented. 1970 technology the same price!? Where else in our free markets does this happen?

Prevention is more easy to provide without having to tackle the prescription system, but screenings are very important part of medicine in the 21st century.

A CT from today is very different from the first CT scans in the 1970's.

http://www.imaginis.com/ct-scan/history.asp http://en.wikipedia.org/wiki/File:Ct-workstation-neck.jpg

The only difference being image clarity, 3D? Yes it's improved since then, but so does everything we create. The underlying technology hasn't changed that much. By this logic we should continue to pay 1950s prices for a TV because a cathoray tube today is different from a cathoray tube from 1950. What's interesting about our TVs, VCRs, computers, etc is that not only do they get better, but they get cheaper too. Ever noticed how LED and plasma TVs existed before 2006, but it wasn't until their price dropped below a certain level that everyone started getting them? Point being that these technologies have to come down in price before we can scale them to a large audience. Right now they cost way too much, and are not available to a large enough audience to really start making health care better overall. Lowering disease prevalence, raising life expectancy, etc.

Here's one problem with screening: A colonoscopy is a $2000+ procedure, and insurance won't always pay for it unless it's medically necessary.

So, if you have a family history of colon cancer and you've entered the age range where screening typically starts, you may be out of luck. Yes, treating cancer is vastly more expensive than screening for it. So why not pay for regular screenings? I think health insurance companies (and employers) probably do a cost analysis and determine that the cost of detecting and catching stage 1 colon cancer in a screening is more expensive than the cost of waiting for it to develop into something that requires treatment, because by that time there's a very good chance that the worker will no longer be at the same company.

I'm hopeful the costs and effectiveness of non-invasive imaging technologies and auto-analysis will come down in the next 10 years to the point where "screenings" can be done for a fraction of a colonoscopy. But, of course, the manufacturers of the current generation of imaging technologies -- the Siemens and Intels of the world -- are perfectly happy with the jaw-dropping price tags that hospitals and clinics have to pay and pass onto the consumer. If some smart startup comes along with a cheaper solution, just buy 'em out or use monopoly muscle to take them out of the picture.

OK, end of rant. Back to our normal programming.

Colonoscopies cost loads of money because they are performed in a Dr's. office. Insurance won't pay for them because they don't want you to actually go to a Dr's. office. Screenings can come down in price if they can be performed outside of Dr's. offices which they completely can. We need to separate these things out so we can move insurance out of the day to day choices about your health. That way you are in control of our health and improve your health on your own dollar with your own choices. It won't happen overnight, but getting people to think about the problem differently is the first step.

Interesting thing to note is that even if cancer rate is "steady", it means we're doing better in general. More people are dying from cancer because people are living longer to die from cancer, with lower risk of dying from other things. Great to see it go down in addition to this, of course!

I've heard there's malarkey to do with how they account for deaths and cures. If you survive a diagnosis for five years or something they count you as cured. In a lot of cases what we really have is a lot of technology that give people six extra years of life, at high cost and a lot of discomfort.

That's called looking a gift horse in the mouth. Progress requires the intermediate steps. Complaining that we're not making progress because all we've done is gotten closer to conquering cancer and we aren't actually done yet is a great way to ensure we stop making progress, at least if the people allocating money start thinking that way.

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