Confusing Empirical and Moral Questions in the Cancer Recommendations Debate

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Recently several seemingly-independent sources came up with a series of new recommendations for cancer screenings, saying that new research shows that we should no longer be screening for certain kinds of cancer at the ages we've been doing so, that it should be fine to wait until later on and save the expense that earlier screenings cost.

These recommendations have led to an interesting debate between those who think the cost of prevention is worth it even if more money gets paid than would otherwise happen and those who think cost-cutting is more important than the number of lives saved, because the number of lives saved isn't worth the cost.

A number of voices on one side in the debate, though, has repeatedly made what seems to me to be a terrible argument. They complain that those who object to the new recommendations are simply ignoring the new data. It's as if they stomp their foot and say that the numbers support their position, so the other side should back off. As I said, this is a terrible argument. If this were an empirical debate, that would settle it, but that's not what the dispute is over, so that argument is simply irrelevant. The very interesting debate that I've seen play itself out, as I pointed out above, is between the following two groups:

A. those who think that, even though it might cost more money in the long run, it's still worth screening earlier because it saves enough lives to be worth the extra cost even if it costs more than it would to catch the cancer later and not pay the cost for a lot of people who didn't need the screenings
B. those who think that the cost of screening all these people who didn't need it isn't going to be worth it in the long run, even if it means some people who would have found their cancer and been able to treat it will die because they didn't catch it soon enough

That's a moral debate, not an empirical one. View A places more value on people's lives (which they insist is still enough, even if smaller than we thought) than the financial cost (and that cost's effect on society). View B places more value on the financial cost (and its effects on society) than the number of lives that would be saved (which they say is too low to be a huge factor). Both views can agree on all the facts and still disagree on what we should do. So it doesn't help to keep insisting that the change in recommendations comes from new data from new studies with hard numbers to back it up. The disagreement still occurs even given the new data.

2 Comments

As long as there are economic constraints on how many people we can save there will always be 'cost of life' decisions that must be made. Any time a treatment starts to get close to the break-even point of financial cost the moral debate will begin. The new data does support (as far as I can tell) 'View B' insofar as before there was an overall financial savings argument to be made for preventative care as well as the lives saved argument before the new data came out, and now it looks like there may be little benefit (in terms of QALYs) for some groups of people.

Whether or not one 'should' do something is always going to be an ethical question, but the answer to that question can and should be swayed by the empirical evidence, which has recently changed.

Right, I'm not trying to make the empirical data irrelevant. Previously we seemed to have a situation where both approaches would favor view A, and now we've moved to one where the empirical data won't settle it, because the two approaches now diverge morally with the same empirical data. My point is that the current empirical situation doesn't seem to settle it the way these commentators have been insisting, because there are still moral questions that you need some answer to before you can take the data to have settled it. If people disagree on those questions (as they seem to be doing), then the data alone won't be sufficient to establish what the best policy decision will be.

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