Let’s Have a Moonshot for Quality Of Life Health Issues

So we’ve got this moonshot to cure cancer that Joe Biden is working on. I think we ought to have a moonshot for quality of life issues.

Cancer is an attractive thing to go after, because with a few exceptions (lung cancer from smoking, skin cancer from sun exposure), it’s something that just happens to you. Take Susan, for example. Susan took good care of herself, ate right, didn’t smoke, got a physical every year, but one day, bam — breast cancer. You can’t blame Susan for that; it could happen to anyone.

But when Gary tweaks his back lifting something heavy and ends up on disability, there’s a whole chain of judgment that comes into play:

  • Maybe Gary should have gotten his degree instead of working in that warehouse. Yeah, maybe, but somebody’s got to do those jobs.
  • Maybe Gary should have lifted with his legs, not with his back. Yeah, maybe, or he could have done everything right and it was the thirty years of cumulative damage that finally got him.
  • Pretty soon, Gary’s going to be replaced by a robot anyway — the solution is to get people out of these repetitive-exertion kinds of jobs. Yeah, maybe, but where does that leave Gary?
  • Gary may have a bad back, but nobody really dies from a bad back; he should be thankful he doesn’t have something worse. Yeah, maybe, but people absolutely do die from heart disease due to a sedentary lifestyle, and people absolutely do die from opioid overdoses, and that’s reflected in the data.

Even the language we use to talk about this stuff carries an element of judgment. Maybe you’ve heard something like this:

“My father worked so hard in that plant all those years, and every night, his back was sore and his feet would hurt. And I made damn sure I did well in school, because I knew he was doing this so I wouldn’t have to.’”

Or,

“Yeah, the trades look like a good option at first, but you’d better plan to be the foreman or to own your own company by the time you get into your fifties, because your body isn’t going to hold up forever.”

For some quality of life issues, we’ve made great progress — knee and hip replacements have been a godsend to many people, for example.

For other issues, the treatment options are pretty bad. Take back pain, for example. A few years ago, spinal fusion was the state of the art treatment for disc problems in your back. Now they’re saying that it may not actually improve things. There’s actually such a thing as failed back syndrome, where after two surgeries, any further surgeries actually lead to worse health outcomes (on average), and very few of these people ever return to work. So you’re left with physical therapy, painkillers, electrical nerve stimulation, and “just suck it up and deal with it; you knew this was a possibility when you started the job.” Also, take hearing loss. The most common kind of hearing loss is sensorineural, where the hairs in the inner ear are damaged by exposure to noise. There have been studies for years examining the potential to regenerate these hairs after they’ve been damaged, but for the foreseeable future, once they’re damaged, that’s that. For this type of loss, the only treatment available is hearing aids, which aren’t generally covered by insurance.

It’s a tough problem fixing things that aren’t intended to last forever. More often than not, these are injuries of use, not abuse. The Wikipedia page on degenerative disc disease states that “Despite its name, DDD is not considered a disease, nor is it progressively degenerative. On the contrary, disc degeneration is often the effect of natural daily stresses and minor injuries.” If we want to repair things that weren’t designed to be repaired, we’re going to need new tools: new stem cell and gene therapies, new medical devices, new drug therapies, and a better understanding of what causes chronic pain.

All that said, let’s take a political perspective on the issue.

The Democratic party is having a hell of a time trying to connect with working people and with people in more rural areas, who just happen to be some of the people most affected by these quality-of-life health issues. Professions with the highest rates of lost time due to musculoskeletal disorders in 2015 included truck drivers, laborers, and nursing assistants. The top five professions with the most amount of hearing loss include manufacturing, construction, and agriculture. Investing more in research in these areas is an easy way to tell these people, “Hey, we get you.”

Also, despite the economic recovery, we’ve seen a decrease in the labor force participation rate. Sure, some of that is due to boomers approaching retirement, but wouldn’t it be nice to be able to point to something concrete we can do to address that issue?