Rounding out the Moon Shot

It was a great honor for Vice President Biden to visit Duke to discuss the cancer “Moonshot” initiative that he is leading. The language of curing all cancer has given way to more realistic, though plenty bold talk:

Biden said he was not naïve enough to think that all cancers can be cured but pointed out there’s a growing consensus among scientists that “we really are at an inflection point.”

“The science is ready, it seems to me,” Biden said. “Much more has to be done, but I believe we can make much faster progress.”

Our culture will always gravitate to metaphors of war, victory and complete triumph, and so we need to make sure we round out the moonshot to include other places where the science is also likely at an inflection point. Key issues:
  • How to we improve communication of options to patients and families so they can have a role in deciding what therapies and care are best for them?
  • Developing a more coherent system of providing high touch, low tech care that can help patients and families live best. There is some evidence patients are ready to engage treatment tradeoffs. And if we wiped cancer off the face of the earth….there will be an explosion of heart disease and stroke morality, and the caring needs of humans will always be central to our life experience.
  • There was lots of discussion yesterday at Duke about information sharing and determining when the federal government does and does not have a role. A practical information expansion where the federal government does have a role is making available claims data from Medicare Advantage plans to researchers. They are now generally unavailable, so that means the claims data for around 3 in 10 elderly persons in the U.S. cannot be included in research. Making the data available won’t cure cancer, but it could make data sharing efforts like the one described by UNCs Stephanie Wheeler more readily replicable nationally.

I don’t know the correct mix of how the Moonshot resources should be invested. We just need to make sure we round out the discussion of the choices facing our nation: basic science, innovation in treatments, clinical investigation, how to communicate to patients, and how to provide systems of caring that will be needed by patients and families regardless of what disease(s) people eventually die from.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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