More about balancing business, humanity, and restraint in cancer care

For reasons of space, my Kaiser Health News column this morning couldn't include one section, which notes that oncology has become an ecosystem of multi-billion-dollar public, private, and nonprofit ventures in pharmaceutical development, imaging, acute care, and more. This ecosystem draws upon and then reinforces broader cultural biases that promote overly aggressive approaches to diagnosis and care. I wanted to add some more discussion, and one revealing advertising table. More here

It's not just the money: combining humanity and restraint in cancer care.

Me at Kaiser Health News. 

Health reform raises central ideological questions about the size and scope of government, about progressive taxation, about the individual mandate and more. It's easy to forget that cost control will be a huge challenge, no matter how these ideological matters are resolved, indeed under any health system. Finding the right combination of humanity and restraint will be particularly hard in addressing life-threatening or life-ending illness. Economic incentives, American culture, a changing doctor-patient relationship and fundamental uncertainties at the boundaries of clinical care conspire against our efforts to provide more humane, more financially prudent care. 

The necessity and the difficulty of these tasks were underscored by a beautiful New England Journal of Medicine essay, Bending the Cost Curve in Cancer Care, by Thomas Smith and Bruce Hillner. Their essay received favorable attention from health policy journalists. Yet because it didn't push the usual partisan buttons, it didn't receive much wider attention. That's too bad, because Smith and Hillner raise many issues that apply beyond the realm of advanced cancer care. For instance, they offer a brave model of skilled providers identifying specific opportunities to reduce costs within their own specialties. They also present suggestions to address the burdens imposed by cancer overtreatment and undertreatment on patients and society as a whole.....

KHN cut for space a beautiful chart I will blog elsewhere. Otherwise that is my take. And props to Smith and Hillner for a gutsy effort to take cost control seriously within their own specialty. And thanks DFA colleagues for responding to my queries.