Looking a person in the eye is lot more demanding than some people realize. On a very practical level, our superb article this month on ergonomics (p. 74) spells out the insidious effects of a long career doing just that as an eye surgeon. On a more philosophical level, it’s something we’re all going to need to get more used to.
At opposite ends of the massive health-care financing mess that we all face are researchers, who deal in data, and the media, who trade in stories. Two stories this month at opposite ends of the country illustrate the latter’s role.
ABC News reported on a 24-year-old father in Cincinnati who died days after contracting a dental infection for which he had a prescription, but no health insurance or funds to fill it. The same week, a very moving LA Times column described the final days of a terminal cancer patient who gained precious months of life only after his insurer relented and reversed its decision not to allow an experimental treatment. The columnist, David Lazarus, posed the critical questions: “What price do you put on a life? ... Who decides when your time is up?” For that, we go the researchers and the nascent field of evidence-based medicine.
Late last month, the Lancet Oncology Commission, a group of some of the world’s leading cancer specialists, from patient advocates to economists and health-care professionals, published a report that attempts to define the challenges of “delivering reasonably priced cancer care to all citizens.”
Among their findings, the group calls for a “radical shift” in cancer policy. “Political tolerance of unfairness in access to affordable cancer treatment is unacceptable. The cancer community needs to take responsibility and not accept a sub-standard evidence base and an ethos of very small benefit at whatever cost; rather there should be fair prices and real value from new technologies.”
This profession faces the same challenges. William Smiddy, MD, and colleagues last month published their findings on “Economic Considerations of Macular Edema Therapies” in Ophthalmology. Their findings on dollar costs per lines of vision saved offer a sobering perspective on the value of current treatments for DME, BRVO and CRVO.
It’s no revelation that we have hard, hard choices to make about paying for our health system. The option of relying on the beneficence of an insurer, as in the case of the terminal cancer patient, probably won’t last much longer. Somewhere between the hard data and the soft news stories, we have to find a middle ground. One that doesn’t devolve into talk of death panels and the cowardice of applauding the notion of letting a person without health insurance die, as was done at recent political debate. How many of those people could look that Cincinnati father in the eye and applaud?