Andrew L. Pecora, MD
Oncology & Biotech News
Chief Innovations Officer, Professor, and Vice President
of Cancer Services
John Theurer Cancer Center
at Hackensack University
It would be wonderful if we could provide all of our citizens with the highest quality healthcare at a cost that reduces the percentage of gross domestic product that it now represents, never mind what is projected. It would appear to require magic, however, because fewer of us die acutely at a young age, and thus more of us are living longer, along with an ever-increasing number of therapies and procedures that extend life and increase healthcare expenditures significantly. The current discussion in healthcare cost control is centered on the “two R’s”: Rational and Rationed Care. In brief, Rational Care would allow everyone to receive the care they need because the resources are available at an affordable cost through avoiding unnecessary care. In contrast, Rationed Care accepts that resources at an affordable price are not available for all, so “less effective” care is restricted. The problem here is who decides what care is restricted.
The current ideal is to develop innovative approaches to Rational Care. Before we focus on the two R’s, it is useful to visit another industry, computing, that would appear to be central to the Rational Care solution. Gordon E. Moore, cofounder of Intel, observed in a 1965 publication that the number of components in an integrated circuit doubled every 2 years from time of discovery (1958) to 1965, and would continue to do so for at least 10 more years. Carver Mead, a Caltech professor, later coined the term Moore’s Law, and it was then refined to its current meaning by Intel executive David House that the doubling period of a computer chip’s performance is 18 months. Moore’s Law started as an observation, but later transformed the entire computing industry and became the industry’s goal that led to significant reduction in the cost of computing power to consumers (fueling the personal computer industry), while iteratively increasing the cost of new chip development and production to manufacturers.
In 1837, a British author published the first version of the fairy tale The Story of the Three Bears. Goldilocks, while visiting the forest home of the three bears, repeatedly demonstrated her aversion to “too much” (porridge: “too hot”; chair: “too big”; bed: “too hard”) and equally for “too little” (porridge: “too cold”; bed: “too soft”). What she clearly liked was “just right.” The so-called Goldilocks Principle of “just right” is now used in astronomy to define the ideal distance of a planet from a sun where it is not too hot or too cold for life, and in economics where the proper balance of moderate growth and low inflation allows for monetary policies friendly to markets. For Rational Care to flourish, and hopefully avoid the need for rationing, a Goldilocks principle for healthcare needs to be developed and implemented at scale, and so enters Moore’s Law.
None of us who care for patients with cancer wants to ration care. The hope is if we can eliminate unnecessary care (too much) and thus avoid rationing care (too little), we can maintain and improve quality while at the same time creating value. To deliver on this promise, we need to have tools that allow for real-time point-of-service analysis and decision support. Thankfully, many software capabilities are entering the marketplace, such as COTA, which provides realtime cancer outcome (survivals and cost) tracking and reporting; QuantiaMD, which offers point-of-service physician decision support and education, as well as numerous oncology pathway companies that are providing evidence-based practice guidelines.
Our industry should strive for our version of Moore’s Law, so that every 18 months we double our ability to reduce cost and maintain and improve quality. This could fuel the development of an increasing number of better point-of-service capabilities to improve quality and reduce cost to the consumer, and potentially spill over to helping drug manufacturers create new therapies faster and cheaper. To be transformative, we need to think outside the box, and maybe it will take a computer visionary and a fairytale to guide us.