Prescription drugs, revisited (or, what cancer and the Patriot Act have in common)

While watching last night's multi-network "Stand Up To Cancer" telecast, I found my mind drifting back to yesterday's post on prescription drugs. As celebrity after celebrity paraded out onto the stage to tell personal stories of how their lives had been affected by cancer, I couldn't help but feel a sense of déjà vu.

For as long as I can remember (really, since the National Cancer Act of 1971 signed by President Nixon), we have spent incredible amounts of effort and untold millions (Newsweek's Sharon Begley estimates it at $200 billion) trying to find the ever-elusive "cure for cancer". While progress has been made on some fronts (death rates from breast cancer and colorectal cancer have fallen precipitously since 1975), success has been uneven and we are far from finding the silver bullet cure (death rates for melanoma, lung, liver, and pancreatic cancer have increased significantly, in some cases almost doubled). As Begley writes (emphasis mine),

In 1975, the first year for which the National Cancer Institute has solid age-adjusted data, 199 of every 100,000 Americans died of cancer. That rate, mercifully, topped out at 215 in 1991. In 2005 the mortality rate fell to 184 per 100,000, seemingly a real improvement over 1975.

But history provides some perspective. Between 1950 and 1967, age-adjusted death rates from cancer in women also fell, from 120 to 109 per 100,000... In percentage terms, the nation made more progress in keeping women, at least, from dying of cancer in those 17 years, when cancer research was little more than a cottage industry propelled by hunches and trial-and-error treatment, as it did in the 30 years starting in 1975, an era of phenomenal advances in molecular biology and genetics.

Unfortunately, any successes have been fleeting, as new carcinogens are introduced into our environment daily, and preventive behavior in general has made little progress. You can spend as many millions as you want trying to find a cure, but if the root of the problem is unchanged (or getting worse), you'll make little real progress. It's a harsh Sisyphean reality that any weed-picking gardener knows well.

One need only look to cardiovascular disease to find the proper analogy. Thanks mostly to a significant decline in smoking, its mortality rate has decreased 70 percent since 1975 (credit goes again to Ms. Begley for the statistics). By targeting the cause, we were able to solve (or at least make significant progress toward solving) the problem. I can't possibly know what all the causes of cancer are, but I do know that we are much better served searching for and targeting them, rather than continuing to try to find a "cure".

This is where I come back to my prescription drugs post. In general, I believe that we have become a nation that is incredibly good at treating symptoms, but woefully inadequate at solving underlying problems. Not feeling too happy today? Don't bother asking why, just pop some prozac. Short attention span? Here's some ritalin. Cholesterol hitting the roof? Don't pass on the steak and eggs just yet, just take some lipitor and don't look back. (Yes, I'm getting a little rant-y here, but I think it's justified).

I've long complained that the problem with most government policy is that it is too reactionary, rather than pro-active. Affirmative action and the Patriot Act are frequent targets of my ire, for exactly that reason. We declared war on drugs without bothering to ask what made drug use so prevalent (could it be that recreational drugs and prescription drugs go hand-in-hand?). We fought a war on terror--and sacrificed personal freedoms--without wondering why we were the target of a terrorist act in the first place (it's best that I not go down that road).

When our banking system collapsed, we never really got to the root causes of why. We all pointed fingers at each other, then threw billions of dollars at the problem in an attempt to treat the symptoms (and get our banks right back up lending again). Nobody bothered to ask if we'd simply become overindebted as a society, addicted to credit. We just wanted to make sure we could get our credit system "fixed".

I now believe that this reactionary dynamic, which I'd previously ascribed to bad government and flawed politics, is more pervasive than I'd originally appreciated. Our nation is very poor at asking the tough questions and looking at itself in the mirror. We would rather throw money at trying to treat a symptom than actually try to change the behavior that led to the disease in the first place.

I was refreshed, then, to see one portion of the Stand Up To Cancer telecast featuring NYC Mayor Michael Bloomberg, touting the benefits of anti-smoking education and legislation. For one part of the night, at least, we were focusing on preventing cancer, not on treating it. Now if we can only focus on preventing ourselves from lapsing into reactionary policies, maybe we won't have to deal with the symptoms of our problems in the following decades.


[Newsweek]