I was recently invited to attend a scientific programme related to medical imagining, the exact details of which I won’t bore people with. The talks were the usual mix you can expect from this sort of thing; nutters going on for far too long, research so far outside your expertise you can’t quite figure out where the excitement is, and so on. Yet, all were fascinating in their own way with amazing insights into the work done all over the world by academics, postdocs, and research and project students, and with a good healthy dose of slagging off industry.
The entire thing was ended with a public lecture by Sir William Castell. His speech was, frankly, wonderfully inspirational. It jumped around, as such speeches do, but generally covered much of his life and the research work he and colleagues had been involved in since the 1980s. So it nicely demonstrated how far we’ve come, and how an understanding of biology brought about by scientific and engineering innovations had changed even how we talk about medicine in the last century. We’ve evolved even further from making a rigorous analysis of symptoms of a patient to understanding the core of human biology – understanding the cells, chemical interactions, genetic markers, brain function – in order to assess how we go about treating illnesses. Things we take for granted today have been spawned from this research and innovation (and the context is vital in padding out the blog).
One of Castell’s key points – not that I blame him, being an accountant by original training – was that new innovations should make healthcare not necessarily “better”, but more affordable. That we should open it up to new markets not just of millions but of billions across the planet. The inner idealist in me did feel uncomfortable in treating the world as a “market” of four billion when the population is actually seven billion, but that’s the game we play. This stuff doesn’t buy itself, after all, says my inner cynic.
As always, there were questions at the end. And I was going to say something, but it didn’t quite form in time – it wasn’t until I had time to think walking home that I got something vaguely coherent enough to ask. Even then, it wasn’t short or pithy enough for a Q&A session – perhaps, just slightly, more suitable to raucous debate at the drinks reception. In hindsight, I can’t figure out if it should have been raised, or whether it would have been a can of worms best left closed for that night. Still, I decided to write it down here, albeit in slightly blog-ified form.
Early on in Castell’s speech he mentioned a quick statistic, and this was what niggled at me for the rest of the lecture. My inner cynic and inner idealist fought over it, and that’s what made it worth thinking about. It’s a simple statistic to grasp; the United States spends 17% of its GDP on healthcare, the United Kingdom spends 9%. The numbers are true; it’s a 20 second job to confirm them via Google or whatever non-evil company you prefer. This set of figures is what sparked him to say that healthcare needs to be more affordable, and that innovations should move in that direction to open up healthcare to more people, I mean… erm, “markets”. These figures are almost maxed out as to what we can even afford to spend; we need to cut that down while maintaining first-world standards of healthcare. And it’s true, we spend a lot for a modest gain.
But to me those figures say something else entirely.
Those figures say that the healthcare in the United States doesn’t seem nearly twice-the-GDP better. 17% of GDP. Think about that. 17% of GDP to get first-world healthcare in the US. Yet the United Kingdom – as much as the twatbags and little shits of the right-wing tabloids admonish the National Health Service – gets a fairly similar standard with half as much. Even re-jigging the figures into “per capita” doesn’t make the picture seem much more sane. There’s a difference in spend that, no matter how you spin it, is not reflected in the difference in the end product.
Consider. It’s the cultural norm in the United States for people to be able to bankrupt themselves over unpaid medical bills. It’s not only legal, but accepted as a thing that even happens. It’s the only developed nation where this is the case. The entire plot of Breaking Bad – where a school teacher cooks crystal meth to pay for his cancer treatment – wouldn’t make sense in any other country. Up to the introduction of the Affordable Care Act – a law that was actively fought against by certain aspects of the American political culture and still risks being repealed the instant the Republican party gain sufficient power – it was perfectly legal and acceptable for an insurance company to withdraw their support from people with preventable and/or treatable illnesses. Put in another way, it was culturally acceptable and legally permissible for a company to effectively murder someone in the name of a profit. This is unheard of elsewhere in the developed world. Say what you like about the NHS, but here we simply do not hear of situations where people have to choose between paying rent and paying for chemotherapy. Yet, 17% vs 9% of GDP – $8000 vs $3500 per capita.
Consider further. The incidence of cancer in Japan is around 200 per 100,000, while Australia is 300 per 100,000. That’s not an insignificant difference. That’s not a random statistical anomaly. People worry about the supposed “nuclear plume” from Fukushima and the effect that will have on cancer rates; but the brutal fact is that even if it did effect an increase in cancer rates, at the very worst it would require dozens of such Fukushima events every week for years to raise Japanese cancer rates to the same as those in Australia. The difference between those two countries isn’t their respective use of nuclear materials – and their GDP spend on health is remarkably similar at 9%. Something else is going on; and at this juncture it doesn’t really matter what specifically.
So, my question that I would have posed to William Castell – if I could have formed and condensed it all into less than 30 seconds – is this; why bother? Why do we bother with research? What can our research actually do to help people given the above?
We’re working in a background not where the major concern for healthcare in the UK is whether we can research new affordable treatments or develop better patient self-care, but whether the government are going to dismantle the NHS as we know it. Throwing raw money at it isn’t the solution, and new research doesn’t have the impact these days. So why should we bother?
The major differences in healthcare aren’t due to what we know about human biology and medical science. Our knowledge sharing transcends national barriers more in science than any other discipline in the world. I’ve worked personally with people from Hungary, China, France, Spain, Canada, Italy, Germany… and we’ve never secretly wanted to keep our research within national boundaries. What we know is out there, out for everyone to use. Yet, there is still such massive discrepancies in the basics of healthcare available. Not just in comparing western Europe to the “emerging markets”, but within self-declared developed and first-world countries themselves.
The problem with healthcare seems less to do with research and more to do with politics. The United States’ problem with public health has nothing to do with research; it’s because a political faction wants things done their way. The difference in cancer rates between Australia and Japan are lifestyle-based, and nothing to do with radiation and mutation. So, given all this, why bother with research? Aren’t we just a rounding error next to geography and politics? What can research into genetics and hormones and neurotransmitters actually achieve next to the lifestyle choices that contribute to the biggest health problems? Isn’t our time best spent getting everyone up to speed rather than slogging on with the next innovation that will only help the luckiest 1% of the world?
The technology we gathered together to talk about at this meeting could have been funded years ago. Yet healthcare companies weren’t interested; not because it lacked potential, but because it lacked clear intellectual property control. Simply put, they couldn’t monetize it. We were stuck waiting a decade or more for the money to plough into it. We’re ten years behind in our medical imagining techniques because of this. The final result will be be thirty years off rather than five or ten. The problem was not the ability to research the topic at hand; it was entirely based on money and politics.
In making healthcare affordable, our research and innovation is clearly not the problem – it practically has no effect on the situation at all. So why do we still bother with it?