Let's look at lung cancer. It is decreasing by 1.8% per year among men and increasing 0.5% per year among women, tracking cessation and adoption rates of 30 years ago quite closely. The overall cost of treating lung cancer was $9.6 billion in 2004, and you can bet it hasn't gotten cheaper since then. Again in 2004, 13.3% of all spending on cancer treatment was on lung cancer.
As 85% of lung cancers occur in smokers (and, sadly for me, in ex-smokers), lung cancer is the poster child for the theory that up to 70% of all cancers are behaviour-related--it is what we eat, drink and smoke that gives us more cancer than anything else.
Hence the healthcare dilemma: New technology will without doubt provide new treatments for lung cancer. But, these new treatments will be expensive. The most cost-effective way of eliminating lung cancer is by persuading people to not start smoking. The second most effective method is by persuading current smokers to quit smoking.
President Obama's healthcare plan intends to use technology to improve communications and reduce errors. But there will also be support for new research. Some of that research will be regarding cancer. So, the $64 billion question is, should research be focussed on changing behaviour or on finding new treatments for cancers? Obviously it will be both, but what should the proportions be?
Organised medicine wants the bulk of money to be spent on changing behaviour. The patient community and some technology providers want the bulk spent on improving treatment. There will probably not be enough to fully fund both. Is there a Solomon in the house?
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