Dear Presidential Candidates:
Wouldn’t it be great if history’s Alexander the Great was actually Dr. Alexander Fleming, the doctor-scientist who saved millions of lives by discovering penicillin, rather than the other Alexander, who conquered and killed thousands of innocent people? Wouldn’t it be nice if history books mentioned Dr. Mary-Claire King, who discovered the BRCA gene and saved thousands of lives, alongside kings and queens and presidents?
Unfortunately, those who prioritize advances in medicine over the rise and fall of the world’s heads of state do not write the history books.
I realize that discussing cancer or chronic illness will not garner you votes or television headlines. But as an oncologist, on behalf of my patients, I hope you will pay attention to the human tragedy inflicted by major illnesses, which touch every citizen in this country and worldwide.— Jame Abraham, MD
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As a clinical oncologist and researcher, I may have a skewed view of the world and acknowledge I may also have tunnel vision. Yet I believe it’s important for everyone in our society to understand that Americans are 30,000 times more likely to die from a cancer or heart disease than a terrorist attack.1 Obesity is a contributing factor in 100,000 to 400,000 deaths in the United States, making it thousands of times more likely to kill Americans. Tobacco, too, is a lethal weapon in our country and the world.
The reality is the forces that most threaten our livelihood don’t often make it into the headlines and history books. As a doctor who took the Hippocratic oath to save lives, I humbly offer my own health-care perspective for our nation as a whole to consider.
Increase Funding for Medical Research
As a doctor trained at National Institutes of Health (NIH), I can confidently say that the world looks up to the United States for curing incurable disease and bending the curve of human tragedies. This can continue to happen only if we maintain our investment in basic and translational research. From 2003 to 2015, the NIH lost 22% of its capacity to do research due to funding cuts.2
Investment in research is not just a health-care decision; it is an economic decision. According to economists Charles Jones and John Williams of Stanford University, the National Bureau of Economic Research, and the Federal Reserve Bank of San Francisco, the return on investment for publicly funded scientific research and development is somewhere between 30% and 100%—or more.3 Our investments in human genome projects more than 20 years ago paved the way for an entire new industry, as well as a better understanding of and cure for many illnesses.
Access to Affordable Health Care
When I talk to doctors from other countries or take care of patients from around the world, I realize how fortunate I am to live and work in the United States. We have created a health system that is equipped with the most modern technology, most advanced medicines, and the best health-care teams. It is the envy of the world.
In a society with such phenomenal medical care, it is important to make sure that everyone, regardless of income or insurance, has access to the best care possible—whether diagnosed with breast cancer or a heart attack. Access to affordable health care is a human rights issue, for which I haven’t a solution. But if we can send objects to Mars, or strive to find a cure for cancer, we should be able to figure out this important issue.
Address Disparities in Health Care
I’ve worked in West Virginia and now in Cleveland. I’ve seen firsthand the daunting health disparities facing rural white populations and inner-city minority populations. High mortality rates from smoking, obesity, substance abuse, and lack of access are plaguing segments of our society.
As a Kaiser Family Foundation report noted:
Addressing disparities in health and health care is not only important from a social justice standpoint, but also for improving the health of all Americans by achieving improvements in overall quality of care and population health. Moreover, health disparities are costly. One analysis estimates that approximately 30% of total direct medical expenditures for Blacks, Hispanics, and Asians are excess costs due to health inequities.4
Investing in education in vulnerable communities could be the single most effective method of stopping the downward spiral from illnesses, violence, and addiction. A report by the Centers for Disease Control and Prevention (CDC) points out that those with higher levels of income and education have lower rates of several chronic diseases, including obesity and cancer, compared to people with lower education and income levels.
Focus on Prevention and Early Detection
Based on estimates from the CDC and World Health Organization, possibly 30% to 40% of cancers and other chronic illnesses across the United States and around the world can be prevented or detected early.5,6 Behavioral changes such as avoidance of tobacco, alcohol, and drug abuse as well as increased activity levels can reduce the incidence of cancer and many other chronic illnesses.
We have seven drugs, three vaccines, and five anti-infective agents to prevent cancer, in addition to proven methods of screening for breast, colorectal, and lung cancers. Increased investment in prevention and early detection should be a priority for the new president.
Create Global Partnership and Innovation
In a flat world, borders will not quarantine illness. In this global village, all of us benefit from the free exchange of ideas, talents, and expertise.
At the laboratories of the NIH and leading universities in North America, Asia, Africa, South America, and Europe, scientists are working together to understand the intricacies of major illnesses from the Zika virus to cancer. In the Appalachian hills and American inner cities, doctors from Pakistan, India, Syria, Lebanon, and many other countries are giving world-class care to less-affluent patients. A 3-month-old baby in a small village in India is benefiting from the polio vaccine discovered at a U.S. university, and a young mother in Saudi Arabia is cured from breast cancer thanks to a drug developed at the NIH.
Historically, we have carried out this moral obligation by attracting the best talent pool in the world to U.S. universities and research institutes. We need to continue to create an environment for scientists around the world to collaborate and lessen the pain and suffering from incurable illnesses.
I realize that discussing cancer or chronic illness will not garner widespread acclaim or television headlines. But as an oncologist, on behalf of my patients, I hope our society and nation as a whole will be mindful of the human tragedy inflicted by major illnesses, which touch every citizen in this country and worldwide. ■
Sincerely,
Jame Abraham, MD
Professor of Medicine and Co-Director
Comprehensive Breast Cancer Program
Department of Hematology/Oncology
Taussig Cancer Institute
Cleveland Clinic
Cleveland, Ohio
References
1. Centre for Research on Globalization: The terrorism statistics every American needs to hear. Available at www.globalresearch.ca. Accessed October 12, 2016.
2. Federation of American Societies for Experimental Biology: NIH research funding trends. Available at faseb.org. Accessed October 12, 2016.
3. Center for American Progress: The high return on investment for publicly funded research. Available at www.americanprogress.org. Accessed October 12, 2016.
4. The Henry J. Kaiser Family Foundation: Disparities in health and health care: Five key questions and answers. Available at kff.org. Accessed October 12, 2016.
5. World Health Organization: Cancer Prevention. Available at www.who.int/cancer/prevention/en/. Accessed October 14, 2016.
6. Centers for Disease Control and Prevention: Up to 40 percent of annual deaths from each of five leading US causes are preventable. http://www.cdc.gov/media/releases/2014/p0501-preventable-deaths.html. Accessed October 14, 2016.
