Cancer Drugs vs. The One Best Way
In my March Atlantic column I used my personal experience with breast cancer to illustrate broader concerns about the development and availability of cancer drugs. Here's the beginning:
If I lived in New Zealand, I'd be dead.
That's the lead my editor wanted me to write, and I have to admit it's great. Alas (for this column, at least), it's not exactly true. But neither is it false. And the ways in which it's partly true matter greatly, not just to me or to New Zealanders but to anyone who might get cancer or care about someone who does.
The American health-care system may be a crazy mess, but it is the prime mover in the global ecology of medical treatment, creating the world's biggest market for new drugs and devices. Even as we argue about whether or how our health-care system should change, most Americans take for granted our access to the best available cancer treatments — including the one that arguably saved my life.
As readers of The Future and Its Enemies know, I have long-standing concerns about the threats to innovation posed by centralized technocracy. I'm the fortunate beneficiary of an unusually dramatic advance against cancer--one developed because of the determination of a relatively obscure academic, with basic research largely funded by Revlon philanthropy and development done by a young and somewhat shaky biotech company. (The story is told in detail in Robert Bazell's book Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer.) Herceptin is the sort of breakthrough that would never have emerged from a purely centralized system.
The column came out during the debate over "comparative effectiveness" research funding in the stimulus bill. Such research can provide valuable information within a competitive system. Within the context of a nationalized health system, however, such information is often used to justify rigid rationing schemes that stifle technological progress and hamper individualized treatment. Few of the readers who objected to the column made sophisticated arguments about comparative effectiveness, however. Most were just angry that The Atlantic had printed a piece implicitly questioning single-payer "universal" systems--and they wrote a lot of letters. In a new piece on The Atlantic's website, I respond to some of the most common arguments.