Chicago, Il. — From the moment you arrive at O’Hare International Airport, you realize that the annual convention of the American Society of Clinical Oncology (ASCO) is an economic windfall for the Windy City. ORD, which is 20 miles from the McCormick Place convention center, is alive with signs, banners, and booths, all advertising some aspect of cancer treatment.
Indeed, to spend any time at ASCO’s 50th annual convention is to be impressed by the sheer size of the effort; hundreds of millions of dollars have poured into the city because of this conclave. McCormick Place is full, the hotels are full, the restaurants are full. In addition, one sees large contingents of foreigners amid the throng; the Japanese, notably, have a substantial presence at ASCO. And at a time when Americans worry that the soft economy is getting softer, it’s heartening to see a surge in economic activity; Chicago, at the moment, is attracting money from around the world.
In fact, health issues are always a driver of economic activity, for one simple reason: Everyone cares about being healthy and wants to do more, and spend more, to achieve health. Well, almost everyone–there are some exceptions. We’ll come back to those exceptions in a moment.
Yes, fighting cancer, of necessity, is a big business. And yet it’s a good and virtuous business, too, because fighting cancer is a lot better than letting people die of cancer. In the words of Dr. Richard L. Schilsky, a past president of ASCO,
The sober reality is that 1.6 million Americans will be diagnosed with cancer this year, and the number of new cancer cases will increase by nearly 40% by 2030, due largely to our aging population. One of every four deaths in the United States is caused by cancer, which this year will claim the lives of nearly 580,000 Americans, making it the second leading cause of death in the country.
Progress is being made, Dr. Schilsky continues, but only slowly:
Cancer-related deaths have continued to decline in the United States by 1.5% per year over the past decade, and a person diagnosed with cancer today has a better than two-thirds chance of being alive 5 years from now. Scientific breakthroughs in cancer are occurring at a breathtaking pace and are being translated into new drugs and devices that benefit patients more quickly than ever before.
So yes, there’s hope. For example, some big news out of ASCO this year was the discovery that an existing drug, goserelin, could protect the fertility of women afflicted with cancer. Given that, every year, some 16,000 women under 45 get breast cancer every year, this is very good news, indeed.
Another piece of good news: Speaking to ASCO on Saturday, Lee Hood, co-founder of the Institute for Systems Biology in Seattle, described how blood biomarkers can distinguish malignant tumors from benign tumors, thus saving the system billions of dollars by eliminating false-positives in screenings–to say nothing of human heartache.
So any American interested in health–for himself or herself, for all of us–ought to be interested in ASCO. And so one might be inspired to think: What if Chicago had apermanent ASCO convention? And not just a convention–what if Chicago made itself into the place to go to be treated for cancer? There’s plenty of competition for that status, of course; cancer-treatment facilities abound all over America. So Chicago would have to really put something on the table–such as a cure.
Admittedly, it’s optimistic to be speaking of a cure when more than half a million Americans are dying of cancer every year, but then Chicago, to be sure, was built on optimism. When the city was founded in 1837, it stood on what was then the nation’s far frontier. Then came the railroads, and the stockyards, and manufacturing. Even the Great Chicago Fire of 1871, killing 300 people and destroying half the city, failed to stop its forward progress. By 1890, Chicago had surpassed Philadelphia to become America’s second-largest city. In 1942, scientists at the University of Chicago were the first to split the atom.
But then, in mid-century, Chicago began to plateau, even shrink. In 1950, its population peaked at 3.6 million; that same year, America’s total population amounted to 150.7 million. Today, Chicago’s numbers have slid by a fourth, to 2.7 million, while the population of the country as a whole has more than doubled. To put the data another way, in 1950, one in 25 Americans lived in Chicago; today, just one in 115 live here.
Population isn’t the only measure of a city’s greatness, of course, but it’s not a bad measure. Certainly the ASCO throng is an economic benefit to the Windy City, and if it had a greater permanent population of researchers and scientists, its economy would, in fact, be all the stronger. And more than likely, we would see greater progress toward treating cancer.
So how could it be made to happen that the big “C” of Chicago stands for “Cures,” as well as “Cubs”? Yes, perhaps it’s a little ambitious, but every city needs an economic-development angle. New York has finance, Las Vegas has gambling, and San Francisco has tech–so what does Chicago have? The stockyards are gone. The manufacturing is mostly gone. In fact, Illinois ranks 31st among the 50 states in business climate–not encouraging.
So as we look to other cities for inspiration and instruction, we might start with Las Vegas. In 1931, Clark County, encompassing Las Vegas, had a population of around 8,000. Then Nevada legalized gambling, the money poured in, and today Clark County numbers more than two million. Vega$ is a rich city, or at least it’s full of rich people. It was a change in the gambling law that meant a huge change in the city’s fortunes.
Sometimes cities can take off, to be sure, even without a legal change. San Francisco is such a place: The legal environment didn’t change, but the technological environment sure did.
San Francisco has always been beautiful, surrounded by water in three directions, and it has a wonderful natural harbor on the Bay side. Yet after World War Two, the city’s economic activity was choked by particularly burdensome labor unions; as a result, its port-traffic migrated elsewhere on the West Coast and the city declined.
From 1950 to 1980, San Francisco’s population shrank steadily. Indeed, in traditional economic terms, SF had been doing just about everything wrong. And still it has high taxes, tight controls on commercial development, and a huge homeless population, the rights of which are well protected by its activist fringe. So by these reckonings, the city should be shrinking further. But instead, it’s booming.
The reason for the boom, of course, is tech. The tech boom has been happening in Silicon Valley for some four decades, and the wealth has spread everywhere in the Bay Area. In other words, the city got lucky; the historical accident of San Francisco’s proximity to Silicon Valley made all the difference. Techsters may work in the Valley, but they prefer to party, and live, in the city. Taxes, regulations, and crime are a concern, but obviously not so great a concern as to thwart San Francisco’s economic renaissance. Yahoo’s Marissa Mayer, for example, lives in San Francisco and commutes 40 miles south to Sunnyvale, in the Valley, and then 40 miles back.
And so we are reminded: An economy can flourish, irrespective of other variables, if a single idea brings people together. If enough people think that something is important, whatever it might be, and gather in one place to work on it–or to play, or to retire, or to get treated–well, that’s enough to bring the money showering down. In other words, a popular idea becomes a powerful engine for economic development.
That’s what has also happened, as a further example, in Houston. The Texas city was already strong in energy, of course, but it has added a new strength: health. The Texas Medical Center (TMC) has preserved downtown Houston’s vibrancy; TMC employs 106,000 people, attracting millions of patients from the US and around the world, pumping billions into the local economy. The famed MD Anderson Cancer Center, a part of TMC, which pledges to “make cancer history,” is well-represented here at ASCO.
So how could Chicago gain ascendancy over Houston, and all the other medical meccas? That’s a good question, although again, we can note that it already has a head start in the form of the annual ASCO convention. The ultimate answer, of course, will be found in words heard in a movie about a Chicago baseball team: “If you build it, they will come.” That is, if Chicago, or anyplace else, pioneers a better treatment for cancer, the money will follow.
In other words, we can think of a new push against cancer as an economic development effort. We might not know in advance how we can succeed in alleviating cancer, but scientific history tells us that the more effort we put in, the more results we will get out.
For example, America made a conscious decision to create a polio vaccine in the late 1930s; it took two decades, and a lot of expense, but we did it. In the 80s, we launched a major campaign against HIV/AIDS, and that’s been successful, too. So what happened to cancer? As we have seen, we’ve made progress, but not enough. Maybe we just need a harder push.
Back in March, Illinois Sen. Dick Durbin introduced an American Cures Act. That legislation, if it were to gain momentum, would be a shot in the arm for the Illinois life-sciences industry. So yes, the leaders of Chicago, and of Illinois, ought to be pushing for, say, a Medical Cure Enterprise Zone for Chicago, building on Durbin’s idea and adding more elements–including FDA streamlining, tort reform, an X-Prize, and anything else that might help–so that Chicago could be a Las Vegas of cures. Of course, there’s nothing stopping other cities, too, from seizing on the same idea–even whole countries.
The basic idea is simple: There’s a near-unlimited demand for effective medical services. So why not seek to produce the medicines that will satisfy that demand? The net wealth of America is more than $80 trillion, and it’s estimated that there’s another $20 trillion in American cash stashed overseas. Wouldn’t it be cool if that money came home to work on medicine? And then there’s the rest of the world, with all its money–another $200 trillion or so. In other words, there’s a lot of capital, a lot of it just sitting in low-yield investments, waiting for something useful to do.
Yes, it would take vision to see the economic and scientific potential of a Cure Strategy for Illinois, or for America. But no more vision than we have seen in Chicago in past centuries, when the city came up from just a dot on the wide prairie.
Yet unfortunately–tragically, in fact–the trend lines seem to be going in the opposite direction, even here at ASCO.
The vast bulk of the attendees at this conference are determined and earnest doctors and scientists; most of them, even in casual conversation, will volunteer that they have a family history of cancer, and that’s at least part of their inspiration. Of course they have such a history–everyone does.
Yet sitting atop ASCO, and sitting atop national healthcare policy as a whole, is an ominous overlay of politics. If most of ASCO consists of scientists talking about science, some of ASCO–too much of it–is scientists talking about politics. It would seem, in other words, that some cancer doctors have gotten the idea that they should subordinate the healing arts to the political arts. That is, if the Obama administration says that we must “bend the cost curve” on healthcare, then ASCO ought to be part of that effort.
It’s indeed unfortunate that politicians seem a lot more interested in the cost curve than in what might be called the cure curve. This difference of vision, costs vs. cures, makes for some jarring juxtapositions here at ASCO.
As one walks into the main entrance of McCormick Place, one sees a flat-screen monitor, detailing the work of ASCO’s Conquer Cancer Foundation. That sounds great; it’s heartening to see militance in the minds of cancer-fighters. Yet then, just a few steps away, in the Grand Ballroom, one confronts a panel discussion dedicated to cost-controls, even price controls, on cancer drugs. The argument is that we simply can’t afford new cancer drugs, and so we must cut back. Sorry, cancer patients! As an aside, one can only wonder how ordinary cancer patients across the country would be reacting if they knew that some of their doctors were talking like that.
Yes, it’s true that the US spends more on healthcare, as a percentage of GDP, than any other country in the world, but so what? Why is it worse to spend money on healthcare as opposed to, say, lipstick or yogurt or golf carts? Does anybody complain about spending in Las Vegas? Or in Silicon Valley? Besides, new cancer drugs account for roughly one percent of total healthcare spending–is that too much to pay?
As Robert Goldberg, vice president of the Center for Medicine in the Public Interest, a New York City-based advocacy group, observes, “Over the long run, nothing will have economic value if it doesn’t have social value.” That is, people won’t spend money if they don’t think they’re getting real value for it, and real value, in healthcare, is eliminating disease and being healthy.
Moreover, a healthy society is a society that is more prosperous economically. A group called MyLifeIsWorthIt.org estimates that some 14 million people are alive today because of better cancer treatment, and that their longer lives, over the past two decades, have increased US GDP $4.9 trillion.
And so we come back to the idea of healthcare as economic development. We just need leadership to pull it all together. We need leadership to pull together a Cure Strategy for Chicago, for Illinois, and for all of America.
Can we do it? Sure we can. We’ve done it before. Yet still, in 2014, it’s an open question as to whether we will, in fact, decide to go forward to greater health–and wealth.