Last year we learned that the number of people dying from cancer in 2017 was 2 percent lower than expected. Just about everyone’s guess was that a raft of remarkable new cancer treatments, $150,000 per year, was the reason.
Last month we learned that cancer death rates were down another 2 percent in 2018. And yet, in 2017, life expectancy of Americans fell by a month, while in 2018 it rose by about a month.
This paradox conveys a critical lesson: Diseases like cancer account for less of the suffering and loss of life than we think. Societal failings account for more lost years than we care to consider.
That some experts misunderstand the source of our cancer progress, which is probably due mostly to declines in smoking, is less important than how easily we equate finding new drugs to treat specific diseases with ameliorating the conditions that plague us.
In both 2017 and 2018, more than 80 percent of our cancer progress was offset by rising death rates from conditions unlikely to be improved by drugs discovered with test tubes and microscopes.
In 2017 for instance, suicides rose by 4 percent, deaths from diabetes by 2 percent. Poverty, not genetic mutations, underlies each of these conditions. Depression is 4.5 times more common, and diabetes nearly twice as likely, in people living below the federally defined poverty cutoff than it is among people with incomes four times that level. By 2030, obesity will afflict nearly half of US adults.
Deaths from overdoses rose almost 10 percent from 2016 to 2017, claiming 70,000 lives. Fifty-thousand of these were opioid overdoses, and accidental deaths overall were up 4 percent. In 2018 overdose deaths did finally trend downward, but still claimed the lives of 67,367 Americans.
“Deaths of despair,” as the Nobel laureate economists Anne Case and Angus Deaton have called them, will not be solved on a prescription pad. That is where the opioid crisis started, with an idea that pain relievers could solve society’s failings.
The levies of unaddressed poverty are an overwhelming counterbalance to the gains we are making in treatment of individual diseases like cancer. The life expectancy of the poor lags behind that of the wealthy by 6 to 10 years in every state in the country. But the typical new cancer drug lengthens survival by weeks to months.
In fact, the fall in the cancer death rate is partly due to this disconnect, because counting up cancer deaths is a cold art. When deaths due to poverty, obesity, addiction, and depression rise, cancer death rates automatically fall, because the two categories of death share risk factors. Essentially, if people at higher risk of dying from cancer die earlier of something else, they do not die of cancer.
This correlation is a grim reminder that incremental progress in a disease can do more than distract from the catastrophic failures of our society, it can reflect them.
Today our national health statistics look like a Red Queen’s race: The Food and Drug Administration is approving many more drugs each year, particularly to treat cancer, but life expectancy is at best holding steady.
It might be that scientists by their nature are far more fascinated by discovering new knowledge than finding a way to restore us to where we once were. But in many ways that is the task before us.
The opioid epidemic is new. Obesity is a phenomenon our grandparents would not recognize. Smoking is a self-inflicted wound, even though its links to cancer were already understood in the 1950s.
And yet even today our efforts are meager compared with the tolls of our inaction. Kentucky, for instance, has a 40 percent higher death rate from lung cancer than the national average. In 2019, it still earned an F grade from the American Lung Association for its tobacco control efforts.
Brilliant scientists and the latest genetic sequencing technologies are not going to produce enough new drugs to solve the consequences of our societal apathy either. And even if they could, the economics cannot work out.
New drugs cost more per person than our economic output per person. And we cannot help solve the problems of the poor by inventing drugs they cannot afford.
Many new drugs are for very rare conditions. A new gene replacement therapy came on the market last year at a price of over $2 million per person. In the third quarter of 2019, about 90 children received it. During that same quarter, about 12,000 people, including hundreds of children and young adults, took their own lives.
We are simply not going to be able to test tube our way through society’s health problems. The progress we require will come from exertion, not invention.
Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center in New York.