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Big gains in oncology may be offset if banks move toward another cliff
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Who would have predicted that 2016 would have been such an extraordinary year, with such dramatic implications for our future?
From a hematology/oncology perspective, this has been a most extraordinary year for rate of translational research progress from concept to execution, with a range of important correlations having been drawn between molecular prognostication and the evolution of parallel targeted therapies.
Year in review
My list cannot be encyclopedic, but I am confident that medical history will identify the following as some of the important events in the past year:
The standout theme for the year clearly is the new spectrum of targeted immunotherapeutics, in which clinicians in many fields are able to identify deficiencies in immune function by molecular prognostication tools, and then leverage novel agents to reintroduce or boost immune function in a meaningful way.
This is much more pleasing translational science than much of the past nonspecific immunostimulation, as we finally have a link between identified mechanistic targets of immune dysfunction and the outcomes of T-cell functional modulation.
The particularly unusual aspect, in addition to the cause-and-effect targeting, is the breadth of histogenetic origins of the tumors that are affected — derived from epithelial and mesodermal layers, as listed above — suggesting a much more fundamental set of processes in play. These outcomes are shared across the spectrum, from the adjuvant setting to established metastatic disease.
Beyond medicine
However, there has been more to the year than medical evolution. At a socio-political level, the United States elections, Brexit, and the extreme new politics of Germany and other Western societies will be marked by history as possibly seminal determinants of world culture of this era.
For those of us who struggle along in the domain of health care, we are now finally realizing that we simply cannot afford to provide the care demanded by our populations of patients. Now, we have to figure out how to strike the balance between rationing and rationalizing, and also how to engage the patient communities — and, most especially, the advocacy groups — to learn to recognize the differences between hype and reality, and logical intervention vs. pointless Brownian motion.
In the era of increasing copays and general community expense, particularly in the United States, society is going to have to take the lead in defining its expectations of health care and the boundaries of what interventions are reasonable and what are not.
The Canadians and the British, to cite two pretty sensible populations, have defined — mostly — realistic targets for the health care that they can afford.
Although there are some discrepancies between the medical care of the “haves” and “have nots” in these nations, there is generally a reasonable safety net to provide appropriate evidence-based coverage for the vast majority of their populations, albeit sometimes with delays, and there are even mechanisms to challenge decisions to withhold treatment.
For those who claim that their outcomes are inferior to those in the United States, it is a salutary lesson to study the available data and consider whether the differences — if they exist — merit the expenditure in fiscal and physical terms.
Cliff’s edge
While we in health care are trying to work our way through the morass of escalating costs, I am increasingly troubled, as we come toward the end of this noteworthy year, that there is another emerging wild card in our society that might undo any medical gains that we achieve.
It is very troubling to see that some of our colleagues in the banking world, apparently having forgotten their errors prior to 2008, are starting to make the same old mistakes. “There you go again!” President Ronald Reagan commented in a slightly different context.
Just like in the period prior to the economic debacle of 2008, I am noticing increasing numbers of silly offers of credit cards, game playing with interest rates, and a rush to sell banking products prior to the predicted large amalgamations and rule changes. Surely they cannot believe that, if they try to ruin the world economy again, we will be stupid enough as a society to endorse another round of executive bonus payments that are travesties of logic and decency.
From the health care standpoint, I still worry about the increment in cancer deaths in 2008 to 2010 associated with bankruptcies, loss of health insurance and failure to seek care until too late. That concern is compounded by the uncertainties of the future of Obamacare or its alternatives, with another set of potential downstream delays in cancer care.
However, these issues will be dwarfed clinically and financially if the banks plunge us into another recession. Let’s hope someone in a position of responsibility is watching this pattern, supports the responsible banks that have learned from the past and has a plan to course correct for 2017.
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Carolinas HealthCare System. He can be reached at derek.raghavan@carolinashealthcare.org.
Disclosure: Raghavan reports no relevant financial disclosures.