Week 72 in the war on cancer has passed. Here is a brief update:
- Dyanne has been in pretty good shape all week.
- She did a CT scan this week and tomorrow she will do an MR scan. We will learn the results on Tuesday this coming week. We are crossing our fingers and hoping for good news.
As the week’s update is short, I wanted to very briefly present an idea I have been thinking about. I am thinking that if this idea was implemented (I don’t think it will, unfortunately), humanity may much more quickly be able to cure cancer. The idea is this: each person who is diagnosed with “incurable” cancer is given a budgete, or a voucher, which he/she can use for whatever treatment he/she wishes. The initial budget, or voucher, is equal to the average total amount that the standard treatment for the disease is costing today. So, for stage IV lung cancer, say the typical treatment cost for a patient over his/her lifetime (around 10 months) today is €40 000. The patient is then given this amount and can choose whether to use it the cost to cover the standard treatment offered at regular hospitals in Norway, or the patient can take the money and go anywhere else in the world and spend the money on treatment there.
Furthermore, for each month the patient manages to survive beyond the median survival of patients with his/her disease, the patient is given an additional check/voucher to cover further treatment costs. The amount of the check/voucher should be equal to the maximum amount the government is willing to pay to per life year saved, divided by 12. In Norway, the government has an unofficial limit for what it will pay for each life year saved. The limit is around €80 000. This means the government is willing to pay around €6700 to cover treatment costs if it means a patient lives 1 month longer than he/she otherwise would have done.
For each additional month the patient survives, he/she will get another check/voucher. If the patient dies, the checks/vouchers will stop.
There should probably be a couple of conditions that need to be met in order to receive the checks. For instance it probably be a condition that the money should be spent on treatment (and not partying). Secondly, it should probably be a condition that the patient documents what treatment he/she undergoes, and this documentation should be shared with the government, so that the health care system, and other patients, can learn from the experiences accumulated by patients.
What would the upside be of such a system? Here are some thoughts:
- In Norway today there are probably around 10 doctors and researchers who are actively working on curing lung cancer. A small number, when we know that around 2000 people die of lung cancer in Norway every year.
- Furthermore, as previously described on this blog, these doctors and researchers work in a system where perverse incentives and targets flourish. The incentives and targets set by Health Minister Bent Høie mean that it is better for hospitals to let lung cancer patients “die on time” rather than trying to save them.
- In sum, this means that Norway’s efforts to try to improve survival rates for lung cancer patients are extremely limited, and mostly futile.
- With a system described above, you would go from having around 10 poorly incentivised doctors and researchers trying to solve the lung cancer puzzle, to around 2000 extremely motivated patients and their caregivers who will try to solve the lung cancer puzzle. This would increase the innovation rate many many-fold, and, I believe, reduce the time humanity will take to figure out how to cure lung cancer.
The system can, of course, be implemented for all currently incurable cancers. Furthermore, the more countries who would implement such as system, the more rapidly humanity is likely to solve the cancer puzzle.
Anyone who would like to argue that the above idea is not a good one, should keep in mind that the current system has produced virtually no improvements for 40 years. The 5 year survival rate for stage IV lung cancer has been stable at around 2% for the last four decades. Maybe there will be some improvements now with the advent of immunotherapies, but the improvements are still minuscule and come at a very high financial cost. What the current system hence has given us is this: lots of dead people and very close to zero innovation. Clearly humanity can, and ought to, do better.