February, 2014
Understatement
By Michael J. Katin, MD
"The President.....shall from time to time give to the Congress Information on the State of the Union, and recommend to their Consideration such Measures as he shall judge necessary and expedient" Constitution of the United States of America, Article II, Section 3.Rules of capitalization may have changed, but ever since George Washington's address to Congress on January 8, 1790, Presidents of the United States have presented their views on the country's priorities. These have been annual, rather than "from time to time " presentations although between John Adams' fourth presentation on September 11, 1800, and Woodrow Wilson's address on December 2, 1913, these were written and submitted to Congress rather than read aloud by the President. When President Wilson was incapacitated and unable to deliver speeches in 1919 and 1920, the oral tradition was revived only by a single address by Calvin Coolidge in 1923, the first to be broadcast live on radio, and then not again until Franklin D. Roosevelt's on January 3, 1934, and thereafter early every year up to and including President Barack Obama's presentation on January 28, 2014 (well, technically not. The first annual address of Presidents Reagan, Bush 41, Clinton, Bush 43, and Obama were not entitled State of the Union (States of the Union?) addresses, but nobody seems to care).
Is anybody still reading this? If so, it is of interest to evaluate the content of recent State of the Union (States of the Union?) addresses in terms of what they contain as well as what they do not contain.
Last year's address included the concern that "the biggest driver of long-term debt is the rising cost of health care for an aging population." References to medical research included that "today, scientists are mapping the human brain to unlock the answers to Alzheimer's (and) .developing drugs to regenerate damaged organs." Fast forward to 2014. This year, brain mapping is no longer an issue (presumably it's been completed) and the only mention of cancer is in the context of its being a pre-existing condition ("Because of this law (the Affordable Care Act), no American, none, zero, can ever be dropped or denied coverage because of a pre-existing condition like asthma or back pain or cancer." I would have thought that having cancer as a pre-existing condition might have a little more impact. It also needs to be mentioned, in fairness, that the President stated that "Congress should undo the damage done by last year's cuts to basic research so we can unleash the next great American discovery" but after he comments that "Federally-funded research helped lead to the ideas and inventions behind Google and smartphones." It would seem that the research that should be restored would best be directed to allow tech company executives to get even more ridiculously rich. In terms of the health field: I would agree that innovations such as Google and smartphones have potential to improve patient care, but in an indirect way. He later mentions that "There are entire industries to be built on vaccines that stay ahead of drug resistant bacteria or paper-thin material that's stronger than steel." Strictly speaking, it would be vaccines against toxins produced by drug-resistant bacteria, but close enough.
But whatever happened to vaccines against cancer? Whatever happened to comments about molecular profiling or genetic modification or, Heaven forbid, adaptive radiation therapy?
I don't expect the President to be knowledgeable about every detail of oncologic science and I'm sure he knows a lot more about the Doha round of trade talks, climate change, or quantitative easing than I do. I would expect, however, that there are dozens if not hundreds of persons employed by HHS and NIH that could suggest some specific topics to use as examples. One would have to be overly obsessive-compulsive to go back to the entire series of State of the Union (States of the Union?) addresses from President Obama starting in 2009 (although, strictly speaking, that was an address to the Joint Session of Congress) to find out that the word "cancer" was mentioned only in the 2011 speech ("I'm not willing to tell James Howard, a brain cancer patient from Texas, that his treatment may not be covered") and there is one reference to biomedical research ("We'll invest in biomedical research, information technology, and especially clean energy technology -- an investment that will strengthen our security, protect our planet, and create countless new jobs for our people.") Amazingly, the only mention in 2012 about public research dollars was that they "helped develop the technologies to extract all this natural gas from shale rock " and the only reference to medical technology was that "Rules to prevent financial fraud, or toxic dumping, or faulty medical devices, these don't destroy the free market. They make the free market work better." Interestingly, Adam Rapp, a testicular cancer survivor from Illinois, who received treatment under his parents' insurance plan, was an invited guest to the session and was not mentioned by the President, although many of the other guests, including Warren Buffet's secretary, were acknowledged in the speech.
I agree that childhood obesity is a major problem that can be addressed to prevent some (but hardly all) health problems for the future generation, but should it consistently get more attention than cancer treatment?
Ironically, one must go back to two of the media's least favorite Presidents to find any type of emphasis on medical research. . In President George W. Bush's final State of the Union address in 2008, he appeared enamored of the fact that "In November, we witnessed a landmark achievement when scientists discovered a way to reprogram adult skin cells to act like embryonic stem cells....I call on Congress to pass legislation to ban unethical practices such as the buying, selling, patenting, or cloning of human life." Whereas it is probably certain he did not actually witness these skin cells turning into stem cells, at least he referred to an actual experimental event. We have somehow survived without legislation banning cloning of human life, but we may look back at a lost opportunity. It was, however, the dreaded and despised Nixon himself, who, in his 1971 State of the Union Address, outlined this remarkable vision: As a fourth great goal, I will offer a far-reaching set of proposals for improving America's health care and making it available more fairly to more people. I will propose:
- A program to insure that no American family will be prevented from obtaining basic medical care by inability to pay.
- I will propose a major increase in and redirection of aid to medical schools, to greatly increase the number of doctors and other health personnel.
- Incentives to improve the delivery of health services, to get more medical care resources into those areas that have not been adequately served, to make greater use of medical assistants, and to slow the alarming rise in the costs of medical care.
- New programs to encourage better preventive medicine, by attacking the causes of disease and injury, and by providing incentives to doctors to keep people well rather than just to treat them when they are sick.
I will also ask for an appropriation of an extra $100 million to launch an intensive campaign to find a cure for cancer, and I will ask later for whatever additional funds can effectively be used. The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal. America has long been the wealthiest nation in the world. Now it is time we became the healthiest nation in the world.
It appears that with all the other crises around, curing cancer is not going to be one of the main goals of our government. If only Watergate had never happened.
