Americans got some fantastic health news last week: Based on the latest data, U.S. cancer deaths are plunging at the fastest rate ever.
The finding came in a report released Wednesday by the American Cancer Society, which attributed the decline to a reduction in smoking, which has lowered lung-cancer mortality rates, as well as advances in surgery and diagnosis and the arrival of new and effective medicines. Even better, those numbers come from 2017 and should improve with expanded use of the latest drugs and technology.
Our knowledge of and ability to combat cancers has grown substantially in recent decades, and the resulting decline in deaths is something to cheer. But as much as I’d like to savor this victory, I have to point out that these scientific advances and improved outcomes in oncology stand in sharp contrast with other trends. Chief among them, American life expectancy trails other developed nations and outright declined in recent years, even as the country spent more than any other on health care. This disconnect shows how much more needs doing.
One big reason drug companies have flocked toward cancer and gotten a record number of oncology drugs approved in recent years is related to the payoff, which is a function of how our health-care system works. Cancer drugs face limited reimbursement pressure relative to medicines that target larger populations and chronic conditions. That continues to be true even as list prices at launch routinely exceed $100,000 for a course of treatment. Spending on the category more than doubled between 2013 and 2018 from $27.3 billion to $56.7 billion. So you can see why drug companies might favor pumping money into cancer R&D over remedies for other conditions.
New drug development for mental health and addiction, for example, has been glacial in comparison to cancer, even as suicides and overdoses contribute to declining U.S. life expectancy. Nearly 73,000 Americans died from liver disease and other alcohol-related illnesses in 2017, which is more than double the number in 1999. Alzheimer’s disease will only become a more prominent cause of death and financial burden as the population ages, and yet there’s been minimal progress toward a treatment. And while we’re great at compensating companies for the development of multiple cancer medicines in the same category, developers of antibiotics - medications we’ll probably need to ensure the survival of the species - keep going bankrupt. Unless the government ponies up significant cash to support researchers that take on big challenges or changes incentives to better target areas of unmet need, that may not change.
Finances are only a part of the equation. For sure, new technology and medicines to treat cancer have helped tame the disease, but public health efforts arguably deserve even more credit for cutting mortality rates. The near 30% drop in the adult smoking since the 1960s has led to a considerable reduction in deaths from lung and other cancers. Given the high cost of treatment in American hospitals and the price and limited efficacy of many medicines, prevention is always a better deal.
There are plenty of important intervention initiatives that deserve greater funding, including efforts to reduce obesity and lower infection rates of hepatitis C and HPV. Unfortunately, thinking ahead is rarely what the U.S. system prioritizes or where it excels. Money that could flow to those efforts or to what might be the most significant public health issue of all - ensuring that basic care is accessible and affordable - instead gets vacuumed up by high prices and wasteful spending.
The drop in cancer mortality is worth celebrating, but not without acknowledging the context and the costs.