Tuesday, September 23, 2008

Funding Medical Research - the Cruel Calculus of Inequity

The leading causes of death in 2005 (and the number of people who died as a result) in the United States are listed below.

1. Heart disease 652,091
2. Cancer 559,312
3. Stroke (cerebrovascular disease) 143,579
4. Chronic lower respiratory diseases 130,933
5. Accidents (unintentional injuries) 117,809
6. Diabetes 75,119
7. Alzheimer's disease 71,599
8. Influenza/Pneumonia 63,001
9. Nephritis, nephrotic syndrome, nephrosis 43,901
10. Septicemia 34,136

What I would like to point out is that the deaths related to Human Immunodeficiency Virus and AIDS for 2005 totaled 16,865. In 2006, the number of deaths declined to just over 14,600. Please compare to the above numbers.

Now take a look at the U.S. Federal funding and compare.

HIV/AIDS: $2,921,000,000
Heart Disease and all related research: $ 5,510,000,000
All Cancers (including childhood cancers): $ 7,862,000,000
Stroke/Cerebrovascular Disease: $ 342,000,000
Chronic Lung Diseases (including smoking and tobacco research): $ 2,089,000,000
Accidents: $ 729,000,000

You get the idea. There seems to be little rhyme or reason to the funding strategy. In 2005, the government spent nearly over 53% as much on AIDS/HIV research as it did on heart disease research. This, at the same time that deaths due to heart disease were over 38-times as common as deaths from AIDS. When a simple formula is used to compare the amount of money spent per death by each disease (perhaps a better measurement of the tangible emphasis placed on each disease), the results are as follows:

HIV/AIDS: $173,198.93
Heart Disease: $ 8,449.74
All Cancers (including childhood cancers): $ 14,056.56
Stroke (and cerebrovascular disease) $ 2,381.90
Chronic Lung Diseases: $ 15,954.72
Accidents (including childhood accidents): $ 6,187.98

Is this kind of analysis cold and unfeeling? Possibly. Don't believe me? You are welcome to do the math yourself. I got my figures from the National Institutes of Health. Just keep in mind - these are exactly the same kinds of analyses that will be performed by whoever ends up holding the keys to our healthcare alone and without competition.

Another interesting fact about the numbers from 2005: We spent $2.7 Billion on researching "Health Disparities" and another $2.4 Billion on researching "Minority Health Care". I wonder how many lives of all colors this $5.1 Billion might have saved - I am guessing quite a few. It nearly equals the amount spent on researching our number one killer, heart disease.

This same government is the one to which we are asked to entrust our health care under a government-dominated single-payer system. If this should happen, I believe there are two possible outcomes. Either the government will continue this ridiculous and indefensible disparity in the outlays for research funding, out of fear of the rabid special interests, or they will realize that the only pragmatic course is to base funding on the actualities of the impacts of these various diseases. Somehow, I feel sure that those that support AIDS funding well over and above its due will not go quietly.

I ask you to examine yourself. Don't worry, there's nobody around. Let yourself go to the logical place it wants to, without fear of retribution from those who oppose that logic. Ask yourself these questions...

1. How many people do I know personally who have had heart disease, stroke, or cancer?
2. How many people do I know personally who have had AIDS or HIV?
3. How many dollars have I personally seen spent on catheterizations or open heart surgery for heart disease, on MRIs and CT scans for strokes and suspected strokes, on medications for heart disease or cerebrovascular disease, on chemotherapy and/or radiation for cancers?
4. How many innocent children are we willing to sacrifice to childhood cancer?
5. Is it fair that we spend nearly two thousand percent more per capita on AIDS and HIV research than we spend on the number one killer in America, Heart Disease? Or that we spend seventy-three-thousand percent more on HIV/AIDS per capita than is spent on stroke and cerebrovascular disease, a disease that killed nearly nine times as many people?Is this justifiable, by any stretch of the imagination?
6. Is it equitable to spend the same amount of precious federal research funds on researching health inequity and minority health care as we do on heart disease?

I have already made it clear how I feel. Now I invite you to make your own conclusions. Is AIDS research important? Of course. It is critical, however, if we are to call ourselves a nation that practices "evidence-based" and "outcomes-based" medicine, that we either justify this seemingly ridiculous disparity, or that we correct it.

People are dying as we speak. Let's get this right.