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Vulgarity is not Washington’s only problem
I know, I know ... I have become irritated and am, thus, becoming more irritating as your editorial writer, in my repeated entreaties to the powers that be — namely: “Stop being jackasses and try to run the country as if you know what you are doing!”
Of course, my focus should be — and still is — the improvement of health care in the United States, and I will return to that theme in a moment.
That said, as a parent — and recently as a new grandparent — I take offense at the vulgarity and inappropriate behavior that is becoming an increasing trait of the team in the White House producing a ghastly low in rhetoric I do not wish my offspring to hear or read. Someone who is not actively in politics should be able to say, “Enough already, clean up your act, and read a book or take a course on acting like responsible statesmen!”
The rejoinder that the most inappropriate of these clowns was dismissed after only 10 days does not really work for me. I would prefer to see wiser selection from the beginning, and a move toward sensible and responsible government.
Consequences of irresponsibility
Returning to my major focus, my real concern is that political irresponsibility is going to lead to an increase in death rates.
My domain of expertise is oncology, and I have previously reminded anyone who reads this column that cancer deaths increased worldwide in the years following 2008 in association with the financial crash — which, in turn, resulted in employees losing their jobs and, consequently, their health insurance.
This caused increased delays in diagnosis and treatment, or refusal to accept treatment, and led to a serious hike in cancer deaths throughout the world, measured in six or seven figures or more. The downstream effect of delayed diagnosis may not yet have been realized.
In this edition of HemOnc Today, we report on work by Tarazi and colleagues published in Cancer that describes an extraordinarily disturbing observation — namely, the reduction in Medicaid availability in Tennessee appears to be associated with a delay in diagnosis of breast cancer among lower socioeconomic classes of women (see page 9). Even the tyro oncologist or the generalist realizes delayed diagnosis equates with increased stage at presentation. This, in turn, leads to an increased complexity and morbidity of treatment, higher rates of relapse and death, and greater fiscal cost.
Perhaps of more concern to our political leaders — who seem unconcerned about the people-focused consequences of absent health insurance — the increased complexity, morbidity and relapse rate also equate with vastly increased cost of treatment. This will translate to unhappy voters and, hopefully, will affect the ballot boxes in 2018 and 2020.
Throwing away progress
At a more existential level, there is something fundamentally wrong with this whole scene.
For the past 40 years, thousands of oncologists — and millions of patients — have been involved in work leading to improvements in early diagnosis of breast cancer, refinements resulting in breast conservation for the majority of women diagnosed at an early stage, the evolution of lifesaving adjuvant and then neoadjuvant chemotherapy when necessary, and improvements in molecular prognostication that allow us to avoid chemotherapy for selected patients with all the associated physical and fiscal consequences.
Unfortunately for the U.S. population — especially those who are financially disadvantaged for any reason — the absence of some form of health insurance coverage for life-threatening diseases is potentially catastrophic.
Thank goodness Sen. John McCain, R-Arizona, himself facing potentially life-threatening medical issues, had the good sense to refuse to vote in favor of destroying the extant, highly imperfect safety net in favor of no safety net.
Breast cancer is just a metaphor for all life-threatening diseases and, in particular, those that can be minimized or averted by early intervention.
Consider the effect of delays in management of all the cancers that may benefit from screening and early diagnosis, intervention in treatment of diabetes, cardiac disease, occupationally driven pulmonary disease and so many others.
Although the sycophants inside the beltway who support the destruction of the Affordable Care Act may think they are going to save money for the United States at the expense of just a few million lives, they are wrong. They will cascade us into greater risk for national bankruptcy through shortsighted and inept planning, not unlike the venality of the Wall Street bankers and money lenders of the first decade of the 21st century — most of whom are still not in jail.
I wish to be clear: The ACA was heavily flawed and poorly designed, but at least it offered a partial safety net and afforded the chance to move to a more cost-effective model of health care. The intellectual fog that has descended on Washington, D.C., certainly does not have the firepower to fix this problem, so voters beware!
Now, it seems that a cadre of uncaring, venal politicians are prepared to throw all of this progress away, sacrificing potentially hundreds of thousands of women over the next few years.
This may seem unnecessarily dramatic, but I remind you of the number of incident cases of breast cancer in the United States each year. Multiply that by the next 3 or 7 years, and the specter is really alarming.
Reference:
Tarazi WW, et al. Cancer. 2017;doi:10.1002/cncr.30771.
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 he has no relevant financial disclosures.