Why We'll Never Cure Cancer, But Not for the Reason You Think

The Wall Street Journal published a recent provocative but revealing article on its op-ed page (see: Why We'll Never Cure Cancer) suggesting that we'll never cure cancer because of the quality differences among the physicians and labs rendering healthcare services to patients. The basic idea is that even if a cure for cancer is found, some doctors may never learn about it. Below is some of the evidence that the author, Dr. Peter Bach, cites in order to make his point:

• In a study published this year ..., researchers reported that the most-skilled colonoscopists found pre-cancerous growths in 40% of the patients they tested, but the least-skilled found polyps in only 15% of those screened. When it came to the most concerning types of polyps, the most-skilled doctors found more than three times as many of them.
• This summer, a study... showed that experienced surgeons who have done 250 or more prostate surgeries are also very good at achieving cancer control -- almost twice as good as those surgeons who have performed relatively few operations in their career (around 10 or so).
• At the American Society for Clinical Oncology conference meeting this year, we learned that about 10% of the time tumors that are reported to be positive, and thus should respond to Herceptin treatment, are in fact negative. There was another study suggesting that 20% of the tumors that the tests say are negative may actually still respond to Herceptin.

Frankly, there is no news here. Most people will acknowledge that skill and knowledge play a major role in the success of almost any endeavor and the practice of medicine is no exception. It seems to me that the key question is how to direct patients to the most skilled physician and thus improve their chances for a successful outcome of a disease. The logical response to this question is to advise them to "interview" a colonoscopist, continuing with Dr. Bach's example, prior to a procedure. However, the problem here is that consumers often feel uncomfortable "interviewing" a physician for a "job" and may not know what questions to ask.

Let's stick with the example of colonoscopy but it should be duly noted that the quality of labs are also being raised as part of this discussion. Taking our lead from the article above, questions to a colonoscopist prior to a procedure should probably include the following:

• How many time have you personally and successfully performed this procedure?
• In what percentage of cases have you discovered pre-malignant and malignant lesions?
• What is your complication rate for this procedure?

Note the physicians have developed their own bag of tricks when responding to questions. In one such interview that I personally participated in with an orthopedic surgeon, he responded to the first of them in the following way: What do you mean by successfully performed? Nevertheless, simple questions such as these are a good start in helping to find a cure for cancer. At the very least, the questions can serve to illuminate the skill and knowledge of a physician in his or her practice.