Thursday, April 05, 2007

Some Problems are Just Hard

There is a remarkable series of letters in The New York Times in response to a series of Op-Ed pieces there evaluating the War on Cancer 35+ years after President Nixon declared it. Each letter declares that the war on cancer requires that we do something specific. For Nancy G. Brinker, who is with a cancer-fighting foundation, all that is missing is the magic elixir of “national will”:

As the articles in “Humans vs. Cancer: Who’s Winning Now?” illustrate (Op-Ed, April 1), there is no shortage of ideas for how to deal with cancer. What appears to be missing, however, is a sense of urgency — an appreciation of cancer as the grave and growing crisis it is — and the national will to confront it.

For David Perlin, the problem is that cancer researchers don’t get enough federal grants:

Scientific discovery that addresses underlying disease mechanisms requires a union of physicians and academic researchers to develop novel approaches that can adroitly explore areas like host genetics while looking out for new etiologic agents.

Unfortunately, such high-risk science that challenges prevailing doctrine has been a casualty in a federal fiscal environment where biomedical financing is approaching 1 in 10 grants.

Ken Zaret, with the Fox Chase Cancer Center, argues that basic research needs more attention:

Despite the temptation to assume that we know enough of nature’s secrets to harness and prevent cancer, those of us doing basic research can see many vistas yet unexplored. It will take years, with many more unanticipated discoveries, before we should fully shift our gaze to translational science.

Mais non, argues M.J. Rosenberg; the problem is that some people need to be paying higher taxes:

Any candidate who cares about what this disease is doing to our people should commit to raising taxes by a specific amount that will finance the National Institutes of Health and other research institutes so that they have the resources to eradicate this disease.

I know that candidates are risk-averse, but anyone who cannot stand up to the misanthropes who would not pay more taxes to save the lives of family members, friends and fellow Americans does not deserve to be president.

A public-health professor argues, unsurprisingly, that public health needs more federal cash:

Behavioral and public health research has shown ways to reduce these disparities, but this research gets minimal support from federal granting agencies compared with their investments in genetics and basic biological research.

Behavioral and public health programs have helped millions quit smoking and could make similar contributions to reversing obesity and its risks for both cancer and heart disease. But the research and the programs are poorly financed amid heavy promotion of the dream of the genetic fix.

Injecting a dark note into the discussion, a woman from Poughkeepsie says that the problem is the suppression by big corporations of research into environmental factors:

But who is studying the cumulative effect of all the cancer-causing agents in the substances we touch, breathe, ingest or bathe in?

Several April 1 Op-Ed writers mentioned genetic vulnerabilities, but what about the environmental factors that may trigger those vulnerabilities?

I’m not surprised by the lack of research on this. The companies that finance cancer research are often polluters themselves.

Who knew it was so easy? The letter writers have all succumbed to the fallacy that problems like cancer are basically engineering ones, and the federal government can and should simply implement the proper design, what Virginia Postrel called The One Best Way. Of course, more resources devoted to one favored response means fewer resources available for other responses, which is a big problem if the favored response turns out to be ineffective. But the belief in solving problems through tinkering with legislation and appropriations runs deep in our society these days.

In fact, cancer is a hard problem to solve; its intractability (despite undeniable improvements in detection, treatment and social acceptance of those who have it) in the face of tremendous resources mobilized to fight it ought to convince any reasonable person of that. The problem is not that the government has failed, or has been captured by big business, or hasn’t sufficiently funded this or that. The problem is that cancer is still an unsolvable problem. The unwillingness to see it this way, and the vulnerability of the public to language invoking a nation's most compelling calling, war (in addition to "war on cancer," recall "war on drugs," "war on poverty," etc.), lead people to demand why the government has not brought its omnipotence to bear on this costly disease (often by throwing more dollars the complainer's way). This is an example of what I once referred to seeing the state, with all its all-too-often ignored flaws, as ultimate problem-solver. Thinking about cancer this way, like poverty or inequality or war or crime or the other things that will be with us for a long time, is a recipe for bitterness, for conspiracy theorizing, for surrendering more of what properly belongs to individual cooperation and initiative to zero-sum politics. There are some problems in society that people of any sort would be hard-pressed to solve, let alone people taking orders from the government.


Blogger Lynne Eldridge M.D. said...

Thank you for pouring out your insights. Your conclusions reminded me of thoughts I had last week you may appreciate.

We were exploring the yucaton pennisula (primarily vacation, enjoying archeological sites). We watched families living in 8 foot diameter bamboo shacks with dirt floors, many in disrepair from the hurricane. At first saddened for the people there, I became increasingly saddened for those of us living here. Despite poverty most Americans have not seen, these people were consuming a diet that was far healthier from a cancer prevention standpoint than most Americans. They had plenty of fresh vegetables they grew themselves. Mangos and papayas were abundant. And, fish was their primary meat source.

We know from studies, that increasing intake of fruits and vegetables from one to two, up to five to nine servings daily, halves the risk of cancer. These people, in their poverty, are getting that.

Prevention, and a change in our choices is the key, not more money. In the U.S. we spend 25 percent more per capita on health care than any other country on the planet. Despite this, we do not make the top 40 in life expectancy. Rather than another government grant, perhaps we need to look at some of the "common sense" practices those with LESS financial resources use, to lower the risk of developing cancer in the first place. Thanks!

Lynne Eldridge M.D.
Author, "Avoiding Cancer One Day At A Time, Practical Advice for Preventing Cancer"

10:55 PM  
Blogger Evan said...

Since I'm an economist, I'm a big fan of prevention, because it's much cheaper than treatment. :)

Elsewhere I have had some thoughts about the life-expectancy data you cite, which partly (but only partly) supports your analysis.

12:04 PM  

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