Just Caring: Precision Health vs. Ethical Ambiguity: Can we Afford the Ethical and Economic Costs?

Abstract

Many see “precision medicine” and “precision health” complementing one another. Precision medicine is critical when we have a life-threatening cancer that could be managed with a targeted cancer therapy. Still, we would rationally prefer whatever medicine might offer that would either prevent the emergence of that cancer or treat it in its earliest stages, the goal of precision health. Dr. Raza, an oncologist, argues in a book titled “The First Cell” that we should abandon paying for targeted therapies for metastatic cancer, and use that money to detect cancer up front using “liquid biopsies” to identify cancer cells in the blood at $500 each, or $100 billion per year. However, I argue that this would be neither a wise nor just use of limited health care resources. Granted, targeted therapies for most patients yield costly marginal gains in life expectancy. Still, we would be sacrificing identified lives for the statistical lives we hoped to save with liquid biopsy tests. We could do Whole Genome Sequencing of the entire population at $3000 per person, looking for the 10% of the population with a heritable cancer, again neither a wise nor just use of limited health care resources. We could fund research to identify biomarkers that would identify cancer patients who would be strong responders to targeted therapies and deny these therapies at social expense to moderate responders. The money saved could be used for targeted precision health efforts. What is really fair? Answering this question requires developing processes of fair and inclusive rational democratic deliberation. What choices are our healthy selves willing to pay for and live with if we develop cancer?