A problem of social injustice  pg. 4

And if the problem is inequity, and at its core I believe it fundamentally is a problem of inequity that drives disparities, we need to consider even the extraordinary possibility that, at its heart, maybe disparities are related to human rights and civil rights.

Won’t deciphering the genetics of abnormal growth through The Cancer Genome Atlas project, for example, help reduce disparities by leading to more rational and successful treatments?

Weeks: Obviously it is a critically important challenge in oncology now to move from a one-size fits-all to a more tailored approach to treatment. But my guess is that this movement is going to make care in specialized centers even more important. It’s going to make cancer care even more expensive, and if anything it’s going to widen rather than narrow the pre-existing gaps.

So I think there is a moral imperative to address inequities at the same time that we are pushing forward the science, otherwise the situation will get worse, not better ...

Careful studies have shown that when African-American patients, for example, are treated in the same way as their white counterparts, their outcomes are very similar.

The gaps that we are seeing are not about biology. They’re about failure to get what we know works to the patients who need it. And as what we know works changes over time, those disparities are not going to go away. This is not a problem of genetic differences. This is a social problem.

Freeman: The peculiar thing about progress without equity is that the cutting-edge progress tends to widen disparities as opposed to narrowing them. The things that you discover are going to be very costly for an individual patient—to have a genetic profile, for example.

I think we should push forward with this work, and I’m certainly in favor of spending what is necessary to move our understanding of carcinogenesis at the molecular level ahead… But the moral problem is that as we do that we don’t seem to be paying attention to applying the technology to all people.

Weeks: I think the message that we need to communicate to our leadership is that, as in all other investment strategies, it’s crucial to have a balanced portfolio.

I’ve found that to be a useful metaphor, actually. It goes back to something that we all understand in our daily lives, which is the importance of pursuing multiple options at the same time.

Even though the science couldn’t be more exciting and absolutely should be pursued, it needs to be combined with research that will allow us to… get effective treatment to the patients who are not getting it today.

And one of the appealing things about that is that it has the potential to yield health benefits immediately, as opposed to a long-term benefit which is where the exciting basic science is taking us.

Freeman: If you go back to 1971, President Richard Nixon declared a war against cancer… (He) believed that the war would be over in approximately eight years… He likened it to putting a man on the moon.

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