Dallas Cowboys quarterback Dak Prescott made the news the other day without ever touching a football. He came out in favor of federal legislation that would require Medicare to pay for a blood test that can detect 20 different types of cancer. Prescott's mother died of cancer, as did the mother of Democratic Rep. Terri Sewell of Alabama, who is sponsoring the legislation.
A recent article in the Austin American-Statesman describes how two million people a year are diagnosed with cancer, but often too late to do anything about it. Prescott believes in the test so much that he had the Cowboys' entire staff screened at his expense, which was considerable as the tests range between $2000 and $3000 a person. Cowboys staffer Tad Carper is glad he did, though, because it caught his case of cancer of the tonsils. Presumably, he had his tonsils removed and that took care of the problem.
This particular test has not yet been approved by the Federal Drug Administration, but if the proposed legislation passes it would automatically be paid for once approval is given. It's not hard to figure that this would add several billion dollars to the annual cost of Medicare, which is already one of the primary budget-busters in the federal budget. But who cares if it saves lives?
We all care, or should. From an engineering point of view, this is a classic tradeoff, in the sense that we face a decision which will favor one good at the expense of a different good. On the one hand, more cancer screening will help us find, and hopefully treat or cure, more cancers, leading to longer lives. On the other hand, more money spent by the federal government that it doesn't have will lead to less money somewhere else, or inflation, or some other less well-defined but nevertheless negative fiscal consequence sooner or later. And there's always the possibility that the tests may turn out to be, if not a total boondoggle, at least a lot less effective than we hoped.
Paralysis in Congress (legislative, not literal) being what it is, the chances of this bill getting approved are iffy at best, as it has come up several times in the last few years and never made it into law. But let's take this idea to the limit.
Suppose we found some genetic test that would not only predict cancers, but would outline our entire medical history, to the extent possible. Obviously, it couldn't predict things like a person taking poison at the age of 43, but there are many diseases, the main killers of heart disease and cancer among them, which have a strong genetic component. This pipe dream is already somewhat realistic today and will only become more so in the future. Wouldn't it be a great idea to profile every baby at birth and lay out his or her entire medical life history at the get-go?
On the one hand (here we go again), you could take steps to forestall diseases that a person might be especially prone to. My wife had breast cancer, which was treated, and now she is cancer-free. But some women carry genes that make them especially susceptible to breast cancer. And some of those, on discovering this fact about themselves, decide to undergo pre-emptive double mastectomies.
But what if you find out you'll die of lung cancer at the age of 43, say? At this time, most lung cancer is basically untreatable except in a palliative sense. Or what if you're going to get Alzheimer's when your 72 and die at 85? There's no treatment for that either.
I once read a short story whose author or title I can't recall (what if your memory starts to fade when you're 71?), but the gist of it was a dinner party at which a magician told the fortune of everyone at the table, and they believed him. He laid out exactly what was going to happen to them from that day forward. I forget the rest of the story, but the point was that knowing the future is a two-edged sword. Yes, you can forestall some things that would be good to know about in advance. But other things are truly inevitable, and knowing them would cast a pall over one's entire future and possibly lead even to depression and suicide.
Pancreatic cancer rates are increasing for unknown reasons, and it is one of the most insidious and deadly types of cancer, often being asymptomatic until it's far too late to treat. And even if caught in the early stages, it spreads so fast that surgery usually doesn't help. The most famous recent victim, Judge Ruth Bader Ginsburg, was accidentally diagnosed with pancreatic cancer as a result of an examination for something else, and following her surgery for it she survived for an extraordinary eleven years, far above the norm for such a situation. So having a blood test for pancreatic cancer under the present conditions of treatment protocols would in most cases just let you know earlier that you were going to die of it. Sometimes ignorance truly is comparative bliss.
This brings to mind what the 18th-century wit Samuel Johnson said when he heard that a former acquaintance was going to be executed soon. "Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully." Perhaps it would be a good thing to have a populace with minds concentrated by the knowledge that they are going to die at a future date certain. But we all know we're going to die sometime anyway, and there's all the difference in the world between knowing that, and knowing when and how.
It's up to Congress to decide whether a blood test for many types of cancer should be made available for everyone on Medicare. But if that does come to pass, you can depend on it to have unintended consequences, some of which we may regret.
Sources: The article by Nicole Villalpando, "Dak Prescott: Medicare should cover cancer test" appeared on p. 1 of the Saturday Feb. 1, 2025 edition of the Austin American-Statesman.
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