The Volokh Conspiracy

Think big picture.

The goals are to reduce the spread or existence of cancer, and they are identifying health care resources such as lack of insurance as the main goal holding them back --

that is, better treatments can only advance the mission so far because the non-insured are having their malignancies discoved far later than those with better resources.

Did you read the accompanying piece? I suspect whether you'd want donations used to advance the treatments available depends on whether or not you are currently covered and available to receive the current treatment.

Think of Society overall though, not just you and yours.

When you learn to think Big Picture, you realize things that benefit your Society overall -- making the current treatment/detection technology more readily available -- your Society is benefitted by having a healthier populace.

Linking to your subsequent post, it's like caring about reducing the overall crime rate in Society by spending more collectively vs. investing personal resources to lock up you and yours behind gated walls with security codes.

Myself, I'd rather live in a healthier society where more children and elderly had coverage. Because overall, in the big picture end result, that too would benefit me as a part of Society. Get it?

The campaign was born of the group’s frustration that cancer rates are not dropping as rapidly as hoped, and of recent research linking a lack of insurance to delays in detecting malignancies.

It's not the American Society To Find A Cure For Cancer. They're concerned with cancer cures, treatment, and prevention. This is no different than their anti-smoking campaigns - they're addressing an underlying cause of cancer deaths. In this case, it's late diagnosis rather than a known carcinogen, but it's much the same thing.

K

Professor, I think you should read your second post on the thread above and look in the mirror. Seriously, do you look for things to get grumpy about?

That's why I won't give to the NRA. Apparently the group supports more than just rifle ownership. As Otto from the Simpsons once said, "That is a blatant case of false advertising." (After walking into a store that sold only pots)

True libertarians know that it is up to the individual to cure his own disease. All the more so since in most cases it is the individual's fault that he contracted the disease in the first place.

So it would be okay for the ACS to use its funds to promote "pro-growth" economic policies (without taking a specific position on what those policies are, as they are not with regard to access to health care), because we all know "wealthier is healthier", wealthier people are less likely to smoke, more likely to be physically fit, etc? If the ACS is going to spend donor money on promoting public policies that reduce cancer rates and improve treatment, perhaps pro-growth is the way to go...

Early detection is the best and cheapest way to improve the quality and extend the lives of countless future cancer patients who have not yet fully developed their cancers. Should the Cancer Society only care about you once you're malignant? Only once the tumor has formed? How about when the final gene mutation in the proto-oncogene occurs? The first mutation?

because we all know "wealthier is healthier", wealthier people are less likely to smoke, more likely to be physically fit, etc?



Check your research, DB.
Most of us out here don't agree with that line. More like, "Your health is your wealth." Then we pity those whose rich lives are effectively killing them and theirs.

Plenty of healthy nonwealthy still out here in America not presenting for treatment in the current capitalist medical franchise. We're not consuming all of China's offerings either.

Say, do you even know many non-wealthy persons DB? It's like you're dismissing the competition without even meeting most of them.

Seems like you're one of those guys who measures the cost of everything, but doesn't know the value of much. Some things you can't buy, but have to earn. And pills can only take you so far. Hth

Well, the empirical evidence is pretty unambiguous that wealthier is healthier up to a certain point. But the point isn't all that rich.

And I'm still looking for a response to the NRA analogy.

The answer to the NRA question is that you need to use some common sense here instead of thinking like a lawyer; the question is really "what do people expect the organization to do", not "can I make some kind of logical connection, however tenuous, between this activity and the organization's mission". People who give to the NRA know very well that their donation will be used in ways connected to guns other than rifles. The same is not true for the American Cancer Society and general health care lobbying. (Or for the American Medical Association and gun control, either. Whatever happened to that, by the way?)

The same is not true for the American Cancer Society and general health care lobbying.

That's odd, because I swear I just read about the ACS doing this in the New York Times (and on the ACS website).

Say, for the sake of argument, that the most cost-efficient way to reduce overall U.S. cancer mortality would be to institute a scheme that would have the government pay for the vast majority of health care. An organization whose mandate and goal is restricted to cancer reduction and cure would appropriately work for such a system.

But reduction of overall U.S. cancer mortality is not the primary goal of most people. Even when it is, it is not a goal that trumps all other goals. Most of us would judge any scheme that reduces cancer mortality by weighing the magnitude of mortality reduction against any harms that the system caused. And many of the things that we value are not health-related.

The ACS is not a person, however, and does not make such a balance. It is a single-interest advocacy group. (It also has a lot of research, educational, ad service activities directed at cancer prevention and cure.) The ACS has concluded (rightly or wrongly) that the most cost-effective way for it to spend certain funds is to advertize for increased access to health care.

On the other hand, each of us can decide whether donating to an organazation whose actions have a penumbra effect beyond cancer reduction best serves our own overall desires and needs. If people withhold donations to the ACS because it does not like these penumbra effects of their advocacy, then the ASC income will fall. This would change the cost-benefit equation for the health access advertising campaign, and the ACS might drop it.

Conversely, by placing itself on the side of advocates of government-financed health care, the ACS might attract even more donations, because supporters of this change who had not previously contributed to the ACS now will give it money. Many of these donations can and will be funneled into projects that directly relate to cancer. It thus might be rational for the ACS to sponsor these ads even if the ads didn't prevent or cure a single case of cancer. This would be analogous to holding a bake sale. The cookies have nothing to do with cancer, but they bring money in that could be used to fight cancer.

Thus, if the ACS construes its mission as fighting cancer regardless of the other medical and social consequences, it might favor a lassiez faire or nationalized health care system, depending on whether which it thought would most reduce cancer. If might favor a democracy or a totalitarian state, depending on which ith thought would mostreduce cancer. It might not care, but would trade its advocacy for cancer-fighting funds, much as other organizations form explicit or implicit alliances. This is no different from any single purpose organization.

Obviously, potential donors would best take the overall effect of a charity's activities into acocunt before making donations.

I would assume that donors to the ACS are giving money to the organization, knowing that they will use their discretionary judgment to spend it in a way to reduce the burden of cancer.

There's discretionary, and there's discretionary.

Donors expect some degree of judgment, of course. But "we expect some degree of judgment" isn't "we give you a blank check to do anything at all". It's still possible to violate donor expectations when using judgment.

I too have given to the ACS and am less likely to do so again. I expect medical research, not policy.

I also feel that the "big picture" comment misses reasonable differences in perspectives. Nice insult though.

Another view is that efforts to redistribute resources must be accompanied by improving the top-end of available medical resources. Discoveries we cannot generally afford today will be cheaper and more widely available in 20 years. I don't deny unequal distribution, but the poor today benefit from the knowledge gained thanks to earlier generations' choices to not exclusively focus on the problems of inequity.

I'm glad we have groups working on policy, but that's not what most people traditionally think of with the ACS. I give to the Red Cross for one purpose, to ACS for another. Other organizations have expertise in education and promotion of "smarter" distribution of existing procedures. Others still are the middlemen, doing social research on how best to employ the products of medical research. Those organizations shouldn't forget that they are part of a menu of groups working on different parts of the problem. Otherwise they duplicate functions and irritate participants in the charity marketplace.

DB,

If you want to support health care research only you can send your gift check to the Un. of Maryland Institutes for Biotechnology and specify which Institute you'd like your gift to support.

Achieving better and more universal health coverage is not "tangential" to improving cancer outcomes and the lives of Americans with cancer. It's not like they're spending the money on beer and pizza parties for everyone born under the sign of Cancer. What they're doing is at the core of their mission.

The money is coming from their advertising budget, not research.

And it seems pretty obvious to me that medical advances do no good if people have no access to them. Now, one can debate what access measures are best. But to say that enhancing access to cancer treatment is unrelated to a mission of stopping cancer seems simply bizarre to me.

But to say that enhancing access to cancer treatment is unrelated to a mission of stopping cancer seems simply bizarre to me.

It depends of whether you are more interested in a little immediate temporary help for a few or greater help for more in the future.

For example, Queen Isabella could have bought food to help a few thousand poor hungry Spaniards in 1492 be a little less hungry, but instead she gave the money to Columbus for research which resulted in hundreds of millions having a better life today in the Americas.

The ACS can help a few of today's cancer suffers live a little longer or it can use the same money to find a cure for cancer so billions of future people will no longer have cancer.

Why does that seem bizarre? Do you live only for the present moment?

Um, Lonely Capitalist, there are already several cures for several cancers. Unfortunately, they are not effective if (a) people can't get them because they don't have access to health care at all or, more importantly and more relevant to ACS's decision, (b) the cancer doesn't get caught early enough because people don't access health care until they're really sick.

David, access to cancer treatment is a subset of access to health care. I can't realistically see an approach that would only increase access to cancer treatment but not other forms of health care. Moreover, general primary health care is intrinsically related to cancer treatment, because that is where the early diagnoses come from. And that is in turn a key to cancer treatment and survival. Colonoscopies and other diagnostics are generally referrals from primary physicians. Surely, the primary physician is at the forefront of the anti-cancer effort

I would think that if the only way to improve some baseball factor was to improve sports generally, the latter would be appropriate.

Same answer: Do people expect the donations to go to birds only, or to their habitat?

Ken, probably depends on their level of familiarity with the organization. If people give to organizations they're not familiar with, well, why would they then complain?

Given that European life expectancies are at least slightly longer than ours and that cancer is the 2nd leading cause of death, the above must either be false, or else the Europeans are doing a better job of preventing the incidence of cancer in the first place.

Not necessarily so. Our murder and (vehicular, at least) accident rates are much higher than Europeans', and as both disproportionally affect young people, they have disproportionate effects on the life-expectancy stats. So, obviously, does the way we define infant mortality.

Re Mr. L's comment about prostate cancer, though: I've heard it claimed that at least part of the difference in (say) five-year survival rates for prostate cancer betw. the US and the UK is due to earlier diagnosis here. That is, while earlier diagnosis is obviously a good thing in itself, with a typically slow-growing cancer like this one, early diagnosis would improve the 5-year survival rate post-diagnosis even if the cancer weren't treated at all. Not sure whether this effect has been quantified, though it ought to be fairly easy.

I thought their mission was to end cancer (through research), not just help people who got it (by expanding government health care). I was wrong.

Yes, Lonely, you were wrong.

From their website:

"ACS Mission Statement

The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service."

They are.
This will help people with cancer to live longer, and maybe for some of them, find a cure. Sounds effective to me.

Oh, puh-lease. By that logic, they could spend their budget lobbying for higher spending on student loans on the grounds that the more people who go to college, the more people who can become medical researchers or doctors, and the more people there will be who can do cancer research.

Technically, it may be true, but it's far too attenuated from their purported mission. I'm with DB on this one; when I give to them, I want them either funding cancer research or treating people with cancer -- not trying to change public policy.

David, access to cancer treatment is a subset of access to health care. I can't realistically see an approach that would only increase access to cancer treatment but not other forms of health care.

Really? I can. Find people with cancer who are poor. Pay for their care.

General access obviously improves cancer prevention. I still find this bizarre. You want your money to go to cancer, but only cancer, and if it possibly helped any other diseases as well, you're very upset?

Well, actually, yes. Why do you find that 'bizarre'? There wouldn't be an ACS, or American Diabetes Association, or National MS Society, if people didn't want to give money for specific diseases, and only specific diseases. People would just give to the National Illness Foundation.

And come on, it's so obvious that people would be upset if the ACS were giving out money to poor people for general health care; everyone would agree that this was a misuse of their funds and a breach of their trust with their donors. Just because they're laundering the misdirected funds through the federal government doesn't make them less misdirected.

From a recent article in the Journal of Preventive Medicine

COLORECTAL CANCER SCREENING LAGS DUE TO HEALTH CARE ACCESS

Ultimately, people will vote with their dollars. And people who give to ACS want their money to go to cancer. But increasing access is going to prevent cancer. I still find it bizarre that anyone would object that it also helps other diseases, coincidentally.

The logical issue would seem to be: is this the most efficient way to reduce cancer deaths? That could be the foundation of a legitimate criticism. Yet people aren't making that argument. One might think that "access" is regarded as somehow liberal so people are ideologically kneejerking against it.

One might think that "access" is regarded as somehow liberal so people are ideologically kneejerking against it.

Well, yes. They're not paying for access; they're lobbying for the government to provide it.

They're not paying for access; they're lobbying for the government to provide it.

Speaking of colorectal screenings, where exactly are you pulling this nugget from? The article clearly says:

It steered away, he said, from promoting solutions that could be viewed as partisan, like mandatory insurance or single-payer government coverage.

That's pretty good bittern, it reminds me of the old discredited ultra vires doctrine for corporate actions.

Most of the Republican candidates have plans to expand health care access. There are free market oriented proposals. From the article, it does not appear that ACS ruled them out.

Then don't donate to this organiation. Geez!

Speaking of universal health care, it's not exactly a big secret that those fabulous European socialized systems aren't nearly as good as the US' supposedly inferior system at keeping cancer patients alive; for example, half of UK prostate cancer cases are fatal compared to a fifth in the US.

Yeah, but the UK spends significantly less per patient on health care. If you look at the four countries with the highest level of cancer treatment, it's the US, France, Switzerland, and (I think) Japan*. Of the four, all but the US have universal health care. There was a big study published a couple month ago comparing health care by country looking specifically at cancer treatment. The researchers determined that in the top tier (the four I listed above) there was no significant difference in care.

*It's been a couple months since I read the study so I'm not sure it was Japan. I'll try to find the link and post it.

The money is coming from their advertising budget, not research.

Money is fungible.

My employer twists everyone's arms to give to the local United Way. They're not as bad as many, though. Anyway, you can designate which specific charity you want the United Way to send the money too, if you so choose. In my state, there are income tax credits for contributions made to certain types of charities. Money contributed through the United Way qualifies for the credit if you've directed it to a qualifying charity. So I, and many of my friends direct our contributions to one of the qualifying charities.

Anyway, a couple of the local United Way board members come in to give a presentation last year, and I grabbed one of the presenters afterward and asked how they fund their charities. He said they determine the level of funding each charity deserves, subtract specifically directed contributions, then dole out the difference. So the only way a charity actually gets more money from a directed contribution is if they're already over the amount the United Way thinks they need.

Actually, it made me feel relieved, since I primarily designated my charity to get a tax credit, and not because I thought they were especially deserving.

The researchers determined that in the top tier (the four I listed above) there was no significant difference in care.

Mily, as I recall, there may be little difference in care but there is a significant difference in outcomes, with the US coming out on top. This, by the way, is to be expected: in the US, big money is spent on people with relatively poor survival prospects, with the expected result that there is higher survival. In, eg, the UK, people with fast aggressive carcinomas have much poorer prospects, because first they are less likely to be diagnosed early, and second, they are more likely to get palliative treatment. In the US, a patient with a glioblastoma multiformae will have surgery, radiation treatments, and so forth; in the UK, the most common treatment is steroids and opiates.

I don't believe the blog post accurately describes the article at all. The article described an the individual who tended to show up at 6 and leave at 2 when he was supposed to be working 8 to 3:30. If this is what was going on, it makes it a "bending the rules" situation, something far different from a fraud situation. An immediate firing and a press release would not seem to be the appropriate first response. Being flexible with this individual could be a perfectly reasonable use of the taxpayers' money.

Would law professors want tenure decisions to be made by how one stamps the time clock rather than the amount of work one does or its results/