3 ms·

As we see more and more promising therapies like this, that are essentially custom fit to the patient, it makes me all the more worried about the US health care

As we see more and more promising therapies like this, that are essentially custom fit to the patient, it makes me all the more worried about the US health care systems. A treatment like this will be expensive, which in the long run means that we'll have a society where people with money won't have cancer (or at least will have a less deadly version), while the people without money will not. We'll be converting cancer to a problem of poverty. None of this is to say that we shouldn't pursue these advancements, but rather we should start thinking about how we can change our system to ensure that every member of our society has equal access to medicine.

andsoitis 2y ago
> We'll be converting cancer to a problem of poverty. Outcomes are already disparate. ” People in low- and middle-income counties in the United States are more likely to die of cancer than those who live in high-income counties. Eight factors, including lack of access to high-quality clinical care, food insecurity, smoking, and obesity may explain more than 80% of the relationship between poverty and disparities in cancer death rates at the county level, according to a new study.” And ” In low-income counties, the average cancer death rate in 2014 was 230 per 100,000 people, compared with 205 per 100,000 in middle-income counties and 186 per 100,000 in high-income counties.” —- https://www.cancer.gov/news-events/cancer-currents-blog/2018/factors-linking-cancer-death-income-disparities https://www.cancer.gov/news-events/cancer-currents-blog/2018...
- xattt 2y ago
  In Canada, despite free healthcare, some of this comes down to how much personal research you do and how hard you advocate in order to be treated at a high-skill facility. It is still an SES game, because higher levels of education (correlated with income) allows individuals to see beyond “well the doctor told me, so that’s what I’ll do”. Higher SES also comes with the ability for a more flexible work schedule, and the ability to travel to larger city centres where the high-skill care is more likely to be.
s1artibartfast 2y ago
>we should start thinking about how we can change our system to ensure that every member of our society has equal access to medicine. I dont think that is a healthy or reasonable goal, in the US or anywhere. Some care is labor intensive and costly, and simply not scalable to everyone. It is possible that time helps reduce the burden. The only way to have equal care is to eliminate high end care.
- beezlebroxxxxxx 2y ago
  > The only way to have equal care is to eliminate high end care. That's one way to think of it. But you also can just say: the only way to have equal care is to raise the standard of all care to the quality of high end care. That's worth trying to achieve even if it's not logically perfect. Most things in life aren't but trying to get there is still a "reasonable goal". It's just about priorities. The elephant in the room is also access to preventative care. Many people wait until the last possible moment to seek medical care because they can't afford otherwise, or do not have access to local medical facilities. Improving access to preventative medicine and care, which is often cheaper and more simple than cutting-edge procedures, would lower the overall demand on last-minute medical infrastructure, like an ER or hospital, which is often what people think of when someone says "access to medicine". An excellent example of this is Costa Rica, where much more effort is spent on access to preventative medicine and all of the infrastructure required for that. As a result, Costa Rica's health care system rates higher than the US while also spending 1/10th per capita on healthcare. A lot of the healthcare system in America is just what we've ended up with, often as a result of greed and a relatively recent extreme distrust of public options, rather than some sort of clear eyed logical end point of healthcare rationalization. Improving access to medicine and raising the over standard of universal care is still a goal worth trying to achieve.
  - s1artibartfast 2y ago
    I agree it makes financial sense to provide universal access to preventative care and basic (read cheap) healthcare. I think it is counter-productive in addition to being logically irrational to focus on equal access to high end care. It isn't possible and it poisons the well for meaningful change. Not everyone should have access to 10 million dollar care on the social dime. There is no upper limit on possible costs, so actively seeking equality just means banning higher care for those who can afford it. I dont think that the US outcome is the result of greed. companies are just as greedy in costa rica or eurpoe. Rather, US healthcare costs are the result of illogical and schizophrenic policy choices, with incompatible choices that dont work together. I could rant for hours about what those are, if you are interested. At the end, it is like a crowdsourced car that doesnt work. Someone picked a porche engine, and someone else picked bicycle tires, and someone else picked a tractor frame, so it doesnt work at all.
deadbabe 2y ago
Cancer being mostly a problem of poverty is still a substantial upgrade from being a problem that just kills all people with little to no mercy.
martindbp 2y ago
Capitalism and technology will make it cheaper over time, if we just let it. Africans without reliable electricity has magic pocket devices straight out of Star Trek. We can find a way to make personalized medicine dirt cheap too, but you can't force it through legislation.

andsoitis 2y ago

> We'll be converting cancer to a problem of poverty. Outcomes are already disparate. ” People in low- and middle-income counties in the United States are more likely to die of cancer than those who live in high-income counties. Eight factors, including lack of access to high-quality clinical care, food insecurity, smoking, and obesity may explain more than 80% of the relationship between poverty and disparities in cancer death rates at the county level, according to a new study.” And ” In low-income counties, the average cancer death rate in 2014 was 230 per 100,000 people, compared with 205 per 100,000 in middle-income counties and 186 per 100,000 in high-income counties.” —- https://www.cancer.gov/news-events/cancer-currents-blog/2018/factors-linking-cancer-death-income-disparities https://www.cancer.gov/news-events/cancer-currents-blog/2018...

xattt 2y ago
In Canada, despite free healthcare, some of this comes down to how much personal research you do and how hard you advocate in order to be treated at a high-skill facility. It is still an SES game, because higher levels of education (correlated with income) allows individuals to see beyond “well the doctor told me, so that’s what I’ll do”. Higher SES also comes with the ability for a more flexible work schedule, and the ability to travel to larger city centres where the high-skill care is more likely to be.

s1artibartfast 2y ago

>we should start thinking about how we can change our system to ensure that every member of our society has equal access to medicine. I dont think that is a healthy or reasonable goal, in the US or anywhere. Some care is labor intensive and costly, and simply not scalable to everyone. It is possible that time helps reduce the burden. The only way to have equal care is to eliminate high end care.

beezlebroxxxxxx 2y ago
> The only way to have equal care is to eliminate high end care. That's one way to think of it. But you also can just say: the only way to have equal care is to raise the standard of all care to the quality of high end care. That's worth trying to achieve even if it's not logically perfect. Most things in life aren't but trying to get there is still a "reasonable goal". It's just about priorities. The elephant in the room is also access to preventative care. Many people wait until the last possible moment to seek medical care because they can't afford otherwise, or do not have access to local medical facilities. Improving access to preventative medicine and care, which is often cheaper and more simple than cutting-edge procedures, would lower the overall demand on last-minute medical infrastructure, like an ER or hospital, which is often what people think of when someone says "access to medicine". An excellent example of this is Costa Rica, where much more effort is spent on access to preventative medicine and all of the infrastructure required for that. As a result, Costa Rica's health care system rates higher than the US while also spending 1/10th per capita on healthcare. A lot of the healthcare system in America is just what we've ended up with, often as a result of greed and a relatively recent extreme distrust of public options, rather than some sort of clear eyed logical end point of healthcare rationalization. Improving access to medicine and raising the over standard of universal care is still a goal worth trying to achieve.
- s1artibartfast 2y ago
  I agree it makes financial sense to provide universal access to preventative care and basic (read cheap) healthcare. I think it is counter-productive in addition to being logically irrational to focus on equal access to high end care. It isn't possible and it poisons the well for meaningful change. Not everyone should have access to 10 million dollar care on the social dime. There is no upper limit on possible costs, so actively seeking equality just means banning higher care for those who can afford it. I dont think that the US outcome is the result of greed. companies are just as greedy in costa rica or eurpoe. Rather, US healthcare costs are the result of illogical and schizophrenic policy choices, with incompatible choices that dont work together. I could rant for hours about what those are, if you are interested. At the end, it is like a crowdsourced car that doesnt work. Someone picked a porche engine, and someone else picked bicycle tires, and someone else picked a tractor frame, so it doesnt work at all.

deadbabe 2y ago

Cancer being mostly a problem of poverty is still a substantial upgrade from being a problem that just kills all people with little to no mercy.

martindbp 2y ago

Capitalism and technology will make it cheaper over time, if we just let it. Africans without reliable electricity has magic pocket devices straight out of Star Trek. We can find a way to make personalized medicine dirt cheap too, but you can't force it through legislation.