The Martian: How much is a person worth?

The Martian: How much is a person worth?

Recently,  I saw The Martian, a movie about a man accidentally abandoned on Mars.  The movie is about the struggle for survival, the marshaling of forces to allow the survival of that one man,  the sacrifice of  compatriots and the politics of rescue .  

Cancer patients, and the people who care for them, can feel like they are abandoned on Mars. The feelings elicited by this movie are similar to those we, who care for cancer patient patients feel. When do we call the situation hopeless?  When do we give up?  How much can we put into the effort for one patient?  How much can we spend?

In the movie there is no limit. Billions of dollars are spent,  scores  of people work without rest, people give up years, in the prime of their lives, to attempt to rescue a single man.  In our real, medical world the money, the time, the energy are all limited,  The resources are shared by thousands of patients. This places every part of the medical system in the position of distributing a limited, precious resource.  The doctor must balance the chance of benefiting the patient against the cost to the system, which could mean denying another patient an equal or better chance.  Doctors differ in their approach to this problem.

How can we do any less than our best?   Our efforts are not like those in the movie.  They are not as good as they should be.. The basis for saving the Martian was adoption of a nonstandard strategy, a strategy that would work, in theory, but was not a usual approach.  A methodology that involved unanticipated expense and sacrifice.

Currently, the pressure to follow standard procedures is almost overwhelming.  Deviation from such standards  risks the label of malpractice.  Obtaining insurance coverage for a treatment that is not recommended in guidelines, or for a problem that deviates from the FDA  approval parameters is a Herculean task - and getting harder.  .

Knowledge and Resources are always limited. The Martian was rescued, he beat  the odds. It is very expensive and difficult to take on the odds... sometimes it works.

A better way to treat cancer patients

There is a better way to treat cancer patients

I am a practitioner of oncology.  When I am confronted with a treatment decision, I attempt to bring the best data to bear on the subject. I avail myself of resources: online text books, PubMed, Web of Science, Clinicaltrials.gov, Eviti advisor. I try to gather and compare  the options  I very much want to see which option will help my patient best (longest lasting, least toxic, most likely to be effective).

But the medical literature does not allow me access to detailed information.  It tells me the outcomes of large groups of patients, diverse in the details of their disease, expressed as probabilities over the whole group and sometimes subgroups, defined by the authors ,that are usually not helpful.  I think that the details may direct the treatment; but details are not available.

Instead of selecting patients who are suitable for clinical trials, we should be constantly improving our treatment, we should be using an iterative correction model,

Patients should be encouraged to consent to have  information that could be related to their disease and its treatment, stored and available for real-time analysis. The data should include a great depth of detail,   Every time a patient comes for treatment we should check the current,  updated  outcome  for that treatment in patients that are most similar to the one we propose to treat. That information should correct our initial proposal.  Once a final decision is made, that patients course becomes part of the growing, searchable and expandable database.  That patients course becomes part of the decision for the  next patient.

There are problems: privacy, accuracy, validity. These problems are the subject of current research [1]

This is a call  for revolution in how clinical data is reported and accessed. I want a  database of raw data, available for appropriate analysis along parameters relevant to  the patient at hand.  I would like to be able to collect information on patient's who are similar to the patient under my care.   The similarities would be defined by the current and emerging understanding of the disease and its treatment. 

The technology exists to start such a program.  As more as learned, the program will improve  Internet service providers already follow this model and the effectiveness of that effort is reflected in the fact that people pay for it and profit from it.  That same process should be used to help save lives.