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Comment by elhudy | Hacker News Reader

This could be the most controversial thing comment I've posted on here, but...: Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Even if we find cancer and save their lives now, will that prevent then from picking up smoking again? Will it prevent the heart disease they're going to encounter ten more years down the line? Dragging it out seems like a massive burden on the rest of society. I'm unsure how these studies are being funded but I just wonder if the money is better spent on helping people to stop smoking.

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One of the truisms of medicine is that ultimately every disease and every treatment has a 100% mortality, so we can never truly save a life. What we can do is promote the quality and quantity of life. In the US, the rule of thumb is that it's worth spending $50,000 to keep someone alive for a year, with that being the approximate cost of dialysis therapy. So, to save 10 years of life would be expected to be worth spending a half a million bucks. Which is all to say that an additional 10 years of reasonable quality of life is worth a lot, both to society and to most individuals. The other strain in your comment suggests that people who are presumably in some way responsible for their disease are less worthy of care. This opens up a giant slippery slope. Start with drug use, smoking, alcohol use, being overweight, eating meat, drinking coffee, working too many hours a week... Ultimately only celibate teetotalling vegans are worthy of medical care.

>The other strain in your comment suggests that people who are presumably in some way responsible for their disease are less worthy of care

I am stating that people who are presumably in some way responsible for their disease are not MORE worthy of care. It is only these people who are receiving free screenings - as per the article.

Where do you draw that line? - I mean no person who understand the addictive power of nicotine would make this kind of statement.

For the same reason we attempt to rehabilitate other types of drug addicts; they're still people with families and friends who want them alive for as long as possible. There are many societal constructs which are intended to help people who made poor choices.

I think it's a legitimate question though. I started smoking when I was 9, pack a day by 16.

Those people (or their insurance) are willing to pay for treatment. If the market is there, why not fund some new research into treating lung cancer? Not every incidence of lung cancer is from smoking two packs a day, sometimes it just happens although its more rare. It's the idiots smoking two packs a day that are helping subsidize the research that can help save the person who just gets lung cancer randomly.

I think it's a hard choice between allowing for personal freedoms and improving society for the better by outlawing dangerous drugs like smoking and alcohol. I think there can be a balance by allowing everyone the same level of access to healthcare but increasing taxes on dangerous recreational drugs to subsidize the healthcare system. You can eat fast food and smoke all you want but it's going to cost you heavily financially.

Unlike some other forms of cancer, random lung cancer is exceedingly rare. The vast majority of lung cancer patients were smokers.

As a society we have limited resources for healthcare. So it's worth considering whether we might achieve better net results by shifting some resources from lung cancer treatment to smoking cessation programs.

I'm not sure what you mean by "exceedingly," but:

> Overall, 10 percent to 15 percent of lung cancers occur in non-smokers. (Another 50 percent occur in former smokers.)

> Two-thirds of the non-smokers who get lung cancer are women, and 20 percent of lung cancers in women occur in individuals who have never smoked. This percentage is significantly higher in Asian women.

https://www.verywellhealth.com/lung-cancer-in-non-smokers-22...

As for the smokers, they generally pay higher health insurance premiums so at least they're contributing their share of resources.

Lung cancer is still cancer, and while different types of cancers vary in many ways, they are also similar in many ways. Studies into the detection and treatment of lung cancer can (and have) contributed to the detection and treatment of other types of cancers.

From a practical perspective, setting aside issues like blame and responsibility and the dollar value of one life vs another, studying all types of disease increases our knowledge of human biology, and our knowledge of disease in general.

Keytruda is one example of a therapy that was developed to treat lung cancer (and melanoma), but now looks like it could be effective against other solid tumors that fit a genetic profile.

This is not to argue against smoking cessation (or more importantly, prevention) programs. Just that there are reasons to pursue lung cancer treatment research that go beyond the lungs entirely.

Just to give you a data point. I grew up in a family that smoked in the house. I've never smoked myself.

I hope you aren't suggesting that I should be condemned for the sins of my parents if I should one day get lung cancer.

Also keep in mind that pollution is going to be a large (if not the largest) contributor to lung cancer in the future.

Please read my comment again. I in no way suggested you be condemned. What I actually suggested is that we do an economic analysis to determine how to deploy our limited healthcare resources in order to maximize net benefits.

>>Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age?

Slippery slope I guess (Plus it is immoral). Next somebody is gonna say why should certain kind of people get medical treatment instead of this other people who clearly deserve it more.

There's nothing inherently immoral about rationing healthcare. In fact healthcare is already rationed everywhere for most patients. In the US we mostly ration based on wealth, age, and employment status. But that doesn't necessarily mean other approaches are less moral.

But I think we should ration care based on effectiveness of the treatment not moral deservingness.

> There's nothing inherently immoral about rationing healthcare.

That a subjective statement, it is only true for you and those who agree with you.

>In fact healthcare is already rationed everywhere for most patients.

That is not an argument for the morality of rationed healthcare.

We could make some sort of objective argument based upon ethics though. Suppose the smoker became addicted to cigarettes as a by-protect of being drafted into the military where he served in a distinguished role perhaps saving lives and protecting your freedom. Being a draftee and not particularly well educated, this persons means in retirement were quite limited, often depending on government assistance in various forms.

A different person was ensured to be wealthy by inheritance then draft dodging then engaging in tax evasion, illegal migrant labor, various kinds of fraud and strong arm tactics. Yet this person didn't smoke and is quite wealthy.

Should we invest in healthcare for tobacco users?

Everything is rationed, because the Earth has finite resources. Healthcare is no different. Morality has nothing to do with it.

It is not possible to provide everyone with the best health care possible. For example, only a handful can get the services of the best heart surgeon.

Compromise is inevitable.

Most diseases have some human choices involved. Living in a city with bad smoke, not running every day, poor diet, or drinking.

Maybe you're perfect and run every day, living in the country side, only eat fruits and vegetable and have never had a cigarette or beer your entire life.

But most of us aren't perfect. And honestly if you are the perfect specimen you are going to cost society far more because everyone dies of something. And slowly dying of alzheimer's disease in your late 90's is way more expensive because you'll live in in a nursing home with full time care for your last ten year and you've been using medicare and social security for 30 years.

Dying in your 50's from lung cancer is it's own punishment.

I think you're oversimplifying the situation. Alzheimers could be caused by human choice and 40 years of human life has more than monetary value.

As does the life of a smoker.

And cardiovascular disease and exercise definitely seem to influence Alzheimers. Nigerians for instances have high rates of APOE4 but very low rates of Alzheimers and I think the reason is they also have very low levels of cholesterol.

> Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age?

Are those people really that old?

Imagine if you started smoking at 13 (which is pretty common). If you smoked for 30 years, now you're 43. If you potentially live to ~80, you've barely passed the half way mark.

Not only that but someone at 43 is likely still working and paying taxes, so they are putting money into the system and could potentially be doing that for another 20ish years.

The benefit is only for those from the ages of 55 through 77 per the second sentence of the article.

Ah ok. I'm more of a "comment first, read later" type of guy, so I missed that!

As this was where you made you question, I'll stick with you here in the ruthlessly utilitarian minefield (i.e. people and $$$'s are fungible).

First, a clarification, it's 30 pack-years. There are lots of ways to get to that number. 30 years @ 1 pack/day and 15 years @ 2 packs a day are both 30 pack-years. That number sticks with you even if you quit 20 years ago.

So, especially for the younger end of that range (55yo), people between 55-65 are often in their peak earning years (finally gotten seniority or management) and this is when they are most often finally paying off their debts (mortgage, etc). It's also when they are likely doing peak elder care and also sending their kids to college. So this is the time where they are probably doing their peak economic and social good. If you can catch something that keeps them productive for an additional 10ish years, you've probably come out ahead for it.

Consider passive smokers - not guilty of anything, they just couldn’t avoid it. Like kids in the smoking families...

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