Last November I was asked to be a panelist at the National Academies Keck Futures Initiative 2013 Conference on the Future of Advanced Nuclear Technologies at the Arnold and Mabel Beckman Center in Irvine, California. We were tasked with identifying improvements in technology and other approaches that will ensure the future development and supply of radionuclides and radiopharmaceuticals for diagnostic imaging and therapy in the United States. Our team included some of the nation’s most eminent clinicians, radiochemists, nuclear physicists, and one ex-truck washer.
The other panelists were good fellows all, bright-eyed, energetic, and courteous and deferential to a fault. The chairman kicked off the proceedings by asking each of us to state the problem as we saw it. Being seated immediately to his left, I went last. I took a deep breath and plunged in:
“First, I want to say as the only non-expert here it is an honor to be included in these deliberations. I can see no reason for my being here, unless it is to ask the questions nobody else is going to ask. There is a large and growing body of medical literature by health technology assessment organizations which has failed to find any clinical benefits for nuclear medicine for a variety of indications, in terms of either patient outcomes or cost/benefit ratios.
“Here in the developed world, we already are close to maximum life expectancy, and most of the remaining gap could be closed by lifestyle alterations. We now spend 18% of our gross domestic product on health care, more than any other civilization, at any time in history. The medical profession pushes hundreds of thousands of Americans over the edge to bankruptcy every year and kills hundreds of thousands of Americans every year. Can we afford to go on regarding medical interventions as innocent until proven guilty?
“The educational materials provided to us for this conference mentioned a clinical trial which found that Radium-223 extended the life of patients with metastatic prostate cancer by five months. The average age of patients who die of prostate cancer is eighty. If this is considered cutting-edge medicine, I submit that it is time to consider the possibility that we have already picked all the low-lying fruit.”
The chairman shot back, “You might not feel that way if you were that eighty-year-old man.”
“If I were drowning,” I replied, “I would want you to jump in a try to save me, regardless of how great the danger was to you, and regardless of how small the chances were of saving my life. Is that the basis upon which these decisions should be made?”
So there you have it – my Mr.-Smith-Goes-to-Washington moment. And – a couple of the chemists expressed guarded support for my remarks, and then we spent the next three days discussing whether Molybdenum-99 or Molybdenum-100 is a better substrate for the production of Technetium-m99.
I’ll close with some anecdotes. A triathlete and professor of mechanical engineering at MIT told me he once wrote a letter to the editor which said, in part, “I have found a drug which lowers cholesterol, increases energy, boosts sexual performance, and has no side effects. That drug is called ‘Triathlon.’” He was subsequently deluged with emails from people wanting to know, “Where can I buy some of this ‘Triathlon?’”
At dinner one night one of my fellow Science Writing Scholars mentioned something about cancer chemotherapy for dogs. When I expressed shock, a radiochemist sitting next to me said, “My dog is fourteen years old. Her body is riddled with tumors. She wears a diaper. I have to change her diaper every day. You do what you have to do.”
An eighty-seven-year-old radiologist told me about an acquaintance of his who had a liver transplant in her fifties. Twenty years later, after the anti-rejection drugs had destroyed her kidneys, she got a kidney transplant. The donor was a man in prison she had never met. I couldn’t help wondering: If we spent less money on transplants and more money on schools, might there be fewer young men in prison with nothing better to do to while away the time than donating a kidney to a total stranger in her seventies?
Beckman Center exterior photo via thebeckmancenter.org
Beckman Center Fountain Courtyard photo by author