What if I told you a brand new pill had just been released that perfectly burns calories for you, is proven 100 percent safe and permits you to eat whatever you want in whatever portion you desire? This magical little pill - let's call it the Slender Pill - has no absolutely no side effects, will cost about $300 per year and will literally allow you to eat three Thanksgiving Day meals per day while still maintaining your gym-chiseled physique - only without all that sweating at the gym.
Because individuals would be free to choose whether to gorge meal after meal, I doubt there would be much public outcry if Medicare and health insurance elected not to pay for Slender Pills, leaving them instead to be paid for out of pocket. Still, even though I'm no expert pharmaceutical marketing executive, my guess is the makers of the Slender Pill will be doing pretty well for the next few years.
In effect, the Slender Pill removes the specter of health problems that result from overeating, a clearly understood unhealthy habit. Although the Slender Pill sadly does not exist, computed tomography scans may be an analogous miracle worker. A recently completed clinical trial on the efficacy of CT scans in screening for lung cancer may have a similar effect on smoking, according to The New York Times.
The massive $250 million trial enrolled more than 53,000 current and former heavy smokers and found a reduction in deaths from lung cancer by 20 percent. In the history of cancer screening, this is groundbreaking news, considering that deaths from lung cancer in the United States total more than 157,000 per year - more than deaths from pancreatic, prostate, colon and breast cancer combined. Although fewer people are diagnosed with lung cancer than the combination of those other cancers, lung cancer claims the lives of nearly 85 percent of those diagnosed, primarily because of a lack of effective screening. The results of this trial could make a serious dent in those grim statistics.
But unlike breast cancer, to name just one example, the primary cause of lung cancer is not only known but is often the result of a freely made choice: smoking. According to the National Cancer Institute, smoking causes 90 percent of lung cancer deaths in men and 80 percent in women. This particular bad habit is to blame for more than 443,000 deaths per year in the country alone.\nAlthough there is still ongoing analysis of the clinical trial data for a publication to be released soon, let's say for the sake of argument that the data holds and we can save the lives of one out of every 300 heavy smokers screened with CT during a five-year span. How should we as a society adopt this promising but very expensive screening modality into our health care system? If Slender Pills should be excluded from Medicare and health insurance payment on the grounds that they are only made necessary through a free choice to pursue a known unhealthy habit, why should payment for smoking-related lung cancer screening be any different?
One might argue that it is unfair to single out a smoker with a costly financial burden to pay for a medical breakthrough that otherwise might save her life. But at an average cost of $5.51 per pack of cigarettes in the country, a one-pack-a-day smoker spends $2,011.15 per year on his habit. Relatively, a $300 annual screen paid for out of pocket seems a small price to pay for potentially life-saving cancer screening.
In the United States, we value our freedom of choice. In fact, freedom of choice has been a major pillar of the smoking lobby for years. People can choose to smoke, rather than being forbidden to do so by government authority. Similarly, one could argue that a person can choose to be screened for the deleterious effects of the choice to smoke. With newly validated but costly lung cancer screening now available to the public in an era of health care reform in Washington, we have a timely test bed on which to evaluate how to administer a new medical technology most ethically and fairly.
Tom Mendel is a University Medical Student. He can be reached at t.mendel@cavalierdaily.com.
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