Do you run for cure? How about running for cause.27 July 2016
You probably know people who have had some sort of cancer. You also know many more who will be getting these diseases—you just don’t know who they are. So when you “Run for Cancer”, the money likely goes for those people who have the disease, to find a cure, rather than to the investigation of cause, so that many more people needn’t get the disease in the first place. We certainly need to celebrate concern for the ill, but shouldn’t we show equivalent concern for the healthy, so that they don’t get ill? Is not an ounce of prevention worth a pound of cure?
Part of the problem lies with medicine itself. It is mostly about treating diseases, and since physicians do so much of the research, that’s where the bulk of the funding goes. I asked a surgeon active in breast cancer research about the proportion of funding that went to finding cause. She estimated it to be 1%. (Some physicians even refer to as “prevention” stopping Stage 1 breast cancer from advancing to Stage 2. That’s like claiming that the cause of Stage 2 cancer Is Stage 1 cancer.) True there are diseases such as Alzheimer’s that do better, but how many others are like breast cancer?
And let’s not get started on pharmaceuticals, except to note that there is no money to be made from people who are well, or at least usually a lot less money from one-shot vaccines to keep them well. So developing medications gets most of the big bucks, and siphons off a great deal of the creative talent that could be looking for causes. All around, our health care needs to be better focused on the care of health.
John Robbins has written a wonderful allegory about a cliff that people kept falling over. There thus developed a highly sophisticated effort to treat the injured, involving physicians, ambulances, and hospitals with the latest technological wizardly. Efforts were even undertaken to develop drugs to cure the injuries of the fallen. When some people suggested building a fence atop the cliff, they were ignored, or else dismissed: what did they know about health care?1
Dr Jonas Salk didn’t buy any of this. He never cured any child of polio. Instead he ensured that no child ever had to be cured. His laboratory developed a vaccine that eradicated the disease. We need more money and talent dedicated to stopping diseases, including studying the toxic effects of what we inhale, ingest, and absorb. And by the way, Dr Salk refused to patent his vaccine, with the comment that “Who owns my polio vaccine? The people. Could you patent the sun?” He could have made a great deal of money by ensuring at the outset that only the children of rich parents could get the vaccine. Instead children all over the world became protected rather quickly.
Researching cause can be quite different from researching cure. It is often more like detective work, where samples of one can be perfectly appropriate. After all, find the cause in someone and you may be on your way to finding the cause in everyone.
A 2003 poll by Hospital Doctor named Dr John Snow the greatest physician ever. Partly he earned that with a sample of 2. When an outbreak of cholera exploded in London’s Soho District in 1854, believing that the disease was water-born, even though the physicians who mattered were convinced it was air-born, he plotted the locations of the recent victims on a map. They clustered around one well, all except two, who lived miles away. Like a good detective, Dr Snow visited the home of one of them. A relative told him that she liked the water of that well and had someone fetch it for her. Her niece also liked that water, he was told, and she died too. And where did she live? There was sample Number 2. Finally Dr Snow’s colleagues listened to him. (Sewage seeping into the well—i.e., toxin—was later found to be the cause of the outbreak.). The handle of the well was removed—that was the cure! (for this well at least)—and the epidemic ended.
Some years ago, I heard about an astonishingly high incidence of certain cancers among children in Alexandria. So for this TWOG I went on the internet and found one related article, in the Journal of the Egypt Public Health Association, 2002, under the title “Patterns in the incidence of pediatric cancer in Alexandria, Egypt, from 1972 to 2001.” The article concluded that “The trends in some cancer types suggest the need of a closer examination of the underlying factors and environmental contaminants leading to the disease in children.” Yes indeed, and what a perfect place to research cause. But who is to do that: where is the constituency for cause?2 In other words, where are the Dr Snow’s when we need them now?
If you have lost a cherished member of your family to a dreaded disease, I can well understand your wish to help find a cure for it. But cannot this emotion also be directed into helping avoid the suffering of others? So please, the next time you run for a disease, or fund a research chair, or just donate a few pennies for health care, consider cause. Invest in health.
© Henry Mintzberg 2016. HM is the Founding Director of the International Masters for Health Leadership (imhl.org) and author of the forthcoming Managing the Myths of Health Care (Berrett-Koehler, 2017). Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing here. To help disseminate these blogs, we now also have a Facebook page and a LinkedIn.
1 Robbins, J. (1996). Reclaiming Our Health: Exploding the Medical Myth and Embracing the Source of True Healing. Tiburon, CA: H.J. Kramer, pp 1-2
2 I found no follow-up study, nor any comments on that one.