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Paying for the illusion of cheating death

Medical ResearchDiseases and IllnessesHealth InsuranceLung CancerBiologyJohns Hopkins UniversityAmerican Cancer Society

Anyone who wants to know why health care costs continue to soar need look no further than the recent recommendation by the American Cancer Society that current and former heavy smokers discuss lung cancer screening with their doctors. The guidelines were based on the National Lung Screening Trial, which found that three spiral CT scans given over three years reduced lung cancer deaths by 20 percent. The New York Times called the finding "an enormous advance in cancer detection."

A 20 percent reduction in deaths sounds pretty good. But if you actually look at the results of the study, you'll find that there was one fewer lung cancer death for every 320 smokers and ex-smokers screened. Contrary to what you may have been led to believe, being screened for cancer is not a benefit. It is a benefit only if it helps you avoid death — and the vast majority of the time, it doesn't.

Oh, and how much longer did Mr. or Ms. "1 in 320" get to live, anyway? Nobody knows — but smokers, and even ex-smokers, are not a group known for their amazing longevity. There are plenty of ways besides lung cancer for cigarettes to kill you.

Then there is the little matter of cost. A CT scan costs anywhere from $300 on up. There are over 90 million smokers and ex-smokers in this country. Screening all of them for lung cancer would cost many billions of dollars.

Remember, we're not paying for the medical interventions we're getting now. If a preposterously expensive screening program claiming to deliver a tiny reduction in risk to folks who have displayed an arrant disregard for their own lives for decades can be called an "enormous advance," it's time to consider the possibility that we already have picked all the low-lying fruit.

As one whose background is in evolutionary biology, two things are obvious to me. First is that our bodies evolved to function, and to function very well. They didn't evolve to malfunction. Second is that they evolved to function for a time — and then to die and get out of the way of the next generation.

In Psalm 90, it says, "The days of our years are threescore years and ten, and if by reason of strength they be fourscore years, yet is their strength labour and sorrow; for it is soon cut off, and we fly away." In other words, at the time that was written, if you didn't die from accidents or violence or infectious disease, and you were in generally good health, you could expect to live to be about 80. Today, if you don't die from accidents or violence or infectious disease, and you are in generally good health, you can expect to live to be … about 80. We still grow old and die. That hasn't changed.

What has changed is that we seem to be devolving into a nation of hypochondriacs whose approach to health and disease incorporates the worst of both worlds. On the one hand, too many people cannot be bothered to practice the behaviors that don't cost anyone else a penny, and which have proved to promote health and longevity: exercising, eating sensibly, and refraining from smoking and excess drinking. On the other hand, they demand endless, expensive medical interventions — not just regardless of cost, and not just regardless of how great a role their own foolishness has played in bringing on their disease, but regardless of whether said medical interventions are doing anyone any good.

Healthy individuals, and healthy societies, look outward. This fussy, fearful, inward-looking preoccupation with signs that can be measured only by trained professionals operating fantastically expensive equipment is not "health." It has far more to do with infantilizing people and making them easy to control.

That fact is, we will all die of something. We need to get over that fact — and get on with living.

Patrick D. Hahn is an affiliate professor of biology at Loyola University of Maryland and a graduate student in the Science Writing Program at the Johns Hopkins University. His email is patrickhahn@hotmail.com.

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