There are sometimes when two contradictory thought streams start charging through my brain and I can’t cope. This is one.
I got an email from a PR person for this website http://www.yourcandidatesyourhealth.org/ which tells you your local candidates record essentially for or against embryonic stem cell research. As you might guess, the idea from Research!America and the Lasker Foundation is to encourage people to vote against candidates opposing stem cell research (or at least get them to change their mind. The Research!America folks are a cross-section of business and academic types who like medical research.
And honestly how can any rational person be against them? When the choice is between them and the creationists who were only happy when we all lived in the dark ages, and don’t believe in the Enlightenment, personal liberty, the scientific method, et al. (Not of course that they won’t use the technological fruits of the movements they despise, particularly Talk Radio!).
But on the other hand, any really rational assessment of the health care system shows that we are spending way too much on medical research. The NIH alone is $30 billion a year, and that’s about doubled by private industry. Now we’re adding billions more at the state level. The problem is that the application of the products of that research is downright shoddy, and we’re spending almost nothing comparatively to figure out how to make it better.
It would be much better for the country and the health care system if we took the $30 billion spent on the NIH and the $300 million spent on AHRQ and flipped them. Then we’d really figure out how to apply the stuff we already know evenly and appropriately. We just don’t need more me-too cancer drugs at $4,000 a pop, when we can’t figure out how to get an Rx for aspirin in to the hands of discharged cardiac care patients (or whatever the appropriate cheap therapy is).
I’m convinced that if we put a ten year moratorium on all new medical research today, and spent all the money figuring out how to apply—and then actually applying—our medical knowledge across the board, we’d be much better off. Of course that’s never going to happen, and we need to save science from the hands of the anti-Enlightenment Philistines. But I remain to be convinced that the Research!America folks are applying their scientific resources in the most appropriate way possible.
Meanwhile, Steve Parker tells me about the launch of a new site called www.BreastCancerAwareness.com which is pretty self-explanatory and looks like it’ll be a useful resource.
> And honestly how can any rational
> person be against them?
Oh, I see. Anyone who has a qualm about deciding a human life is not entitled to the protection of law must be irrational, un-Enlightened, and an anti-intellectual Philistine. Because science cannot prove a human life ought to be entitled to the protection of law, then rational enlightened intellectuals ought to be allowed to do whatever they please. Of course, science can’t prove this either. It is a grave error to confuse science with rationality. Science depends on metaphysics for its foundation.
> if we [snip] spent all the money figuring out how to
> apply—and then actually applying—our medical knowledge
> across the board, we’d be much better off.
Related to this, Jean deBlois, an ethicist at the Aquinas Institute of Theology here in St. Louis, makes an argument from Distributive Justice against highly speculative medical research. Millions of people in our own country are suffering needlessly and dying early right now, and this could be greatly mitigated by redirecting a few billions a year. She says it is therefore wrong to gamble billions on “cures” that only a few rich people will benefit from two or three decades from now, if ever. Essentially she’s saying that until everyone has a reasonable shot at 75 healthy years, we should not spend our billions on giving a few people a shot at 90 years.
I will beat our Canadian friend to the punch: federal funding of most pharma and biological research is corporate welfare and ought to be eliminated. It permits them to socialize the risk of failure. If Pfizer wants to spend its shareholders’ money on speculative research and then answer to them for the results, fine. If Harvard can attract grants from AstraZenica, great! But the government should have other priorities.
“I’m convinced that if we put a ten year moratorium on all new medical research today, and spent all the money figuring out how to apply—and then actually applying—our medical knowledge across the board, we’d be much better off.”
You’re absolutely right. NIH is overfunded, CDC is disgracefully underfunded and AHRQ is what’s left of AHCPR after they made back surgery look like a cash cow for surgeons of little or no benefit to patients.
Money seems to go towards developing expensive, last-ditch treatments for desperate, dying people willing to spend any amount of money to stay alive, even if it’s for 2.5 months.
As the number of possible treatment options supported by completed randomized clinical trials increases, the scientific literature becomes increasingly vague for guiding physicians. Almost any combination therapy is acceptable in the treatment of cancer these days.
Physicians are confronted on nearly a daily basis by decisions that have not been addressed by randomized clinical trial evaluation. Their decisions are made according to experience, new basic science insights, bias or personal preference, philosophical beliefs, whatever.
There is a mind-set of cancer culture that pushes tens of thousands of physicians and scientists toward the goal of finding the tiniest improvements in treatment rather than genuine breakthroughs, that rewards academic achievement and publication over all else.