The elephant in the room
In these days of fiscal austerity you could be forgiven for thinking that the barbarians have finally arrived at the gates of Rome. The angst gripping high income countries as they struggle to deliver affordable cancer care continues to crash against the rocks of onco-commercialization. The US Institute of Medicine has now declared that the USA is in the midst of a crisis in terms of being able to deliver affordable, equitable cancer care.
However, the report is long (very!) on words and surprisingly short a novel, focused policy recommendations. Perhaps this is not surprising. With so many vested commercial, public and institutional interests whatever they said would elicit criticism. Better to keep things anodyne. It does, though, make one sigh when you realize that this report comes some 13 years after Harold Freeman’s excellent Voices of a Broken System, which articulated pretty much the same picture.
If you are rich your cancer outcomes are good and if you are poor they are rubbish. One elephant in the room that everyone keeps dodging is exactly how we are supposed to ‘fix’ our cancer care systems in the face of public policy that seems blindly to be aligned with wealth and not health.
Michel Coleman’s recent article on the medical-industrial complex reminds us that cancer care, indeed all health care, is not a market to be bought, sold and profited from. That’s not to say that there is no place for private enterprise only that it needs to be subsumed into governance and regulatory frameworks that serve the greater public good, not the individual private purse.