The history of science is littered with a recurring theme of unintended consequences tarnishing man’s great technological advancements.
As a physician I have often pondered the unintended impact that many of the advancements of medical science have had on our society. Our achievements have blessed us and improved lives but also have created conditions that cause problems for our system.
At present I can think of no issue in medicine that has more of an impact on human life and the health care system than cancer. Cancer is a disease that touches everyone’s life at some point. In popular culture a cure for cancer is something that is often imagined as a sentinel moral and scientific achievement for our species.
While I agree with this idea I also see a cure for cancer as a great challenge for our health care system. I believe that the unintended consequences of curing cancer would be unparalleled and potentially could be a tremendous shock to our health care system.
The system would have to absorb all the patients whose lives would be saved. One need only look at the recent history of medicine and the state of our health care system to assess the potential side effects that outright curing a disease that kills about 21 percent of Americans might have. Already the rapid increase in life span we have experienced (The average life span is 78.4 years, up almost a decade from the 1960s) has not come without unintended consequence of cost and strain on our system. As human beings live longer and treatments grow more and more sophisticated and expensive the costs of their care grow more and more.
For example 30 years ago a diabetic patient may have died from a heart attack at age 50, but today modern medicine now very likely will keep this patient alive through an emergency with clot busting drugs and procedures. Now he will live longer, perhaps much longer.
Imagine the cost and impact this will have considering the staggering cost of years of care for a medically complicated patient. He will need years or perhaps even decades of insulin, statins, beta blockers, ace inhibitors, anti hypoglycemics, follow up primary care visits, needed labs, urinalysis, hospitalizations when infections or complications arise, yearly podiatry visits, yearly opthamology visits, nephrology visits, endocrinology visits, cardiology visits, care for whatever else might come up in a medically complicated patient and perhaps even several years of nursing care at the end of the road.
Obviously in moral terms we can all agree that it is a wonderful thing, but the facts are the facts and years more of care will cost precious, and limited, resources. As this scenario happens in vivo every day thousands of times over in our hospitals the strain on the system grows greater and greater. The proof is in the pudding: keeping sick people alive longer may be the right thing to do, but the costs of their care are taking a massive toll on our system. For example right now Medicare is set to run out in 2029. To me that is a terrifying fact.
Now imagine what happens if we cure a disease that ultimately kills 21 percent of the American population. That fifth of our population would live on to ultimately die of something else and in the meantime they will need nursing care, doctors, drugs and diagnostic studies.
We have already seen that as people live longer based on recent medical advances the rates of Alzheimer’s and other dementias is rising at a staggering pace. Many people now live in nursing homes for years at the end of life in a state of chronic illness, bouncing between nursing home and hospital. The costs of care in the last months of life especially for the chronically ill are staggeringly expensive and inefficient.
Keep in mind that while often times cancer strikes people with otherwise good health, it tends to strike older individuals as well as people with many other illnesses. We would be curing many people who were likely to have other chronic diseases. For every one otherwise healthy adult or child that cancer would save there would be at least as many very sick or very elderly who want and deserve treatment so they can live. After all, who should be the one to tell them they can’t have it? (curing cancer also raises countless social and ethical questions like this, which is another blog entry altogether!).
I believe a cure for cancer would be unprecedented not only as a moral and scientific achievement, but also as a potential major shock and threat to our already strained and faltering health care system. The burden a cure for cancer would throw onto our system could seriously tarnish the shine of what would be one of man’s greatest achievements. We have already experienced this effect with other medical advances.
It would be a shame if the consequences of curing a disease that is the scourge of mankind would be strained resources and worsened care across the board, especially for the 60 percent of people who will never have cancer in their lives. Like all great achievements the good of curing cancer would undoubtedly outweigh its harm and obviously man should do everything he can to achieve this. As a species we must continue to advance and find ways around the unintended consequences of our gains. In that way we can minimize the fall out and reap the benefits of our well intentioned efforts to improve lives and serve humanity.