Saturday, April 3, 2010

Feedback Loops in Healthcare Research

The subtitle for this could be "Healthcare Research as if People's Health Really Mattered".

  • I woke up this morning to my wife's coughing, wondering if it is "thrush" making a comeback.  Thrush is a fungal infection of her lungs that is a "side effect" of the medication she was taking during her Hep C treatment.  
  • Carrie also has a suppressed immune system that is the result of the chemotherapy she received for breast cancer treatment that makes her more susceptible to colds and infections from cuts.  
  • One other long-term effect (late effect) is the reduced cognitive function, again one of the "side effects" of chemotherapy.
So since I am so involved in cancer research as an informaticist I am aware of the various programs that are funded to understand and find therapies for cancer.  There are studies that are ongoing, but I wonder about the sense of urgency that is really in place.  There is such a focus on "finding the cure" for cancer that we forget the people who are "getting the cure".  What is the quality of life after such a cure?  This comes up for men and treatments for prostate cancer that leave them incontinent and with reduced sexual function.  They are thinking, "You call this a cure??  Sure, I'm alive, but I have to wear diapers and I can no longer even have, let alone enjoy, sex."  What would happen if people decided that they would rather be treated for the symptoms of the cancer with palliative care than be cured because they did not want to live with such a cure?

So I was thinking/wondering about what it is that drives our healthcare system in general terms.  Being in the US, the primary driver is really about making money.  Students go into med school and choose to be a specialist because there is more money in it.  Pharmaceutical companies invest huge sums of money into drug development because a blockbuster drug will repay the huge with vast sums of money.  The underlying theoretical framework driving these processes is the idea that the only way to really make progress -  in any field - is if commerce is in charge.

Rather than rejoice whenever a new hospital or medical research facility breaks ground we should weep and not rejoice.  It means that more money is being sunk into more "cures" and not in fixing the ones we already have.