The Last Word On Nothing

Among my fondest childhood memories are the hours my family spent discussing B cells and T cells while cruising the highways on our family car camping trips.

My mother, Irene Check, is a scientist; both she and my father got their doctoral degrees in microbiology, and my mother has a specialty in immunology – the study of the body’s defense against disease. What I remember most from our childhood conversations is my mom’s excitement about science: B and T cells are the main types of cells that do the work in the human immune system, but when my mom talked about them, they sounded like more than mere cells; they sounded like superheroes.

These days, however, my mom is a lot more than a scientist: she works on the front lines of health care reform. My mom directs an immunology laboratory in a hospital, which means that she runs tests to try to diagnose what’s wrong with patients’ immune systems. And while her love of science is what got her there, she now spends as much of her time cutting costs and trying to prepare for health care reform as she does using her scientific knowledge to help sick people.

This year, for instance, a neurologist at my mother’s hospital called her lab to order a test to scan a patient’s genome for genetic predispositions to Parkinson’s disease. What the doctor didn’t realize was that this test cost $20,000. My mom’s lab had to call up the doctor, break the news, and work with him to figure out what to do next.

The doctor was shocked when he heard about the test’s price tag. But when he learned that there was another way to do the test that took a little more time, but cost a lot less, he agreed to do the test the cheaper way instead.

My mom told this story yesterday in a prize lecture at a meeting of the Association of Medical Laboratory Immunologists in San Diego. Listening to her talk about the case, I realized that most our societal conversations about health care reform completely miss the boat.

Not long ago, doctors had no idea what a diagnostic test cost, and lab directors didn’t need to tell them. Now, everyone is more aware of the price of everything, and of the need to make sure that every decision made on behalf of a patient makes sense, both medically and economically.

No matter what happens to the health care reform legislation passed last year, which is working its way towards a Supreme Court challenge, this is not going to change. The collision of increasingly sophisticated and expensive technologies with cost-cutting pressures lies at the heart of most of our societal debates over health care, from controversies over mammography screening to the question of whether regulators should approve the use of the expensive biotechnology drug Avastin in breast cancer. Health care reform is happening now, as my mom and other health care workers all over the country are witnessing every day.

If you told my mother back when she was a student that her love of science was going to put her in the thick of this battle, she probably wouldn’t have believed you. It’s an interesting dilemma for today’s would-be doctors and scientists: in a more cost-conscious society, how will they best help their patients while trying to save money?

For the rest of us, the meaning is clear: health care reform isn’t coming tomorrow, or ten years from now. It’s already here, whether we like it or not.

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Photo: Irene Check in her office during the 1980s, courtesy Irene Check.