That was the challenge that Dr. Arthur Kellerman laid down to people attending the AACR Science of Cancer Health Disparities conference in Miami on September 30.
Dr. Kellerman, an emergency room physician, told a sobering story of his patient Diane, who arrived in the emergency room in pain. Asked to describe what hurt, she pointed to her right breast. When her gown was lifted, doctors and nurses could see a huge cancer that had broken through her skin. Uninsured, she had tried to treat it with over-the-counter salves. She died two months later.
He said that, like Diane, 1000 Americans die every week because they don’t get health care that meets medical standards.
In his keynote address, Money, Maps, and Moms, Kellerman pointed out that the United States spends more taxpayer dollars per person than any of the countries like France or Canada with government health care, yet ranks far below them in outcomes for that care.
In terms of amenable mortality — deaths of people under 75 that could have been prevented with timely and effective health care — the United States is now last among 14 Western European countries, Canada, Australia, New Zealand, and Japan.
109.7 of every 100,000 Americans die from treatable conditions, compared to rates in the three leading countries of 64.8 in France, 71.2 in Japan, and 71.3 in Australia. If the United States could have matched the average amenable mortality in those three countries, 101,000 fewer people would have died over two years.
Dr. Kellerman quoted James S. Marks of the Robert Woods Johnson Foundation, who wrote, “Why Your Zip Code May be More Important to Your Health than Your Genetic Code” in talking about the importance of geography or place and its impact on cancer incidence, treatment, and access to care and the influence of environment on diet, exercise, and other potentially cancer-causing exposures.
In another story, Dr. Kellerman talked about a homeless patient who came back to the emergency room with infections around the protruding screws that had been placed in his legs a couple of weeks before to treat broken bones. After his surgery he’d been discharged back to the street, with no place else to go.
Both orthopedic and internal medicine residents were called down to readmit the old man and both adamantly refused, getting into a loud argument in front of the patient and the entire ER over whose job it was.
A wise attending physician finally picked up the phone and asked for a number. “Are you going to call the chief resident?” one of the doctors asked. “Don’t worry. He’ll back me up. We’re not admitting this guy.”
“No,” the older doctor said, “I’m calling your mother to see what she would do.”
Blushing, both residents reached for their admitting orders.
Finally, Kellerman issued what he called the top cancer challenges for the twenty-first century:
- Money: Health care and cancer care costs too much. We need to deal with costs making sure that people are getting the most effective care, not just the care they can afford.
- Unequal treatment: How many more lives could we save if we simply delivered, consistently, the things that work.
- Geography: We must unravel the effects of place on cancer incidence, treatment, and outcomes.
- Professionalism: We must kindle a fierce commitment to professionalism in the fields of medicine and public health. Our patients depend on us to do our best. We owe them no less.
Arthur L. Kellerman, MD, MPH holds the Paul O’Neill – Alcoa Chair in Policy Analysis at the RAND Corporation. Prior to that he was Professor of Emergency Medicine and Associate Dean for Health Policy at the Emory School of Medicine in Atlanta. He founded the Department of Emergency Medicine at Emory and was its first Chair.