It is true that some off-label drug use is based on very unsettled science and has more risks. But medicine - and not just cancer care - involves lots of hard choices. And the more serious the disorder, often the more likely it is that for every right and wrong treatment choice there are many other practical decisions painted in shades of gray.
Politicians wage broad wars on medicine to claim thin strips of ideological terrain. This would be good political theater if there weren't so many human victims.
When people age, the main valve carrying blood out of the heart becomes brittle. As this aortic valve narrows, it can cause debilitating heart failure, and even death.
Cell-based and regenerative medicine can restore human functions lost to disease, including returning some sight to the blind.
Gene editing will be used to alter DNA to erase the origins of a range of debilitating inherited disorders.
Once an effective drug is approved to treat a deadly condition, introducing a second drug to treat the same disease can be hard. It's tough to recruit patients with a debilitating disease for a clinical trial when a proven medicine is already available.
A true legislative alternative to ObamaCare would support physician ownership of independent medical practices, and preserve local competition between doctors and choice for patients.
ObamaCare has accelerated many of the detrimental trends doctors see in their profession, and introduced new ones.
Reformers in Washington need to do a better job of explaining how market-based alternatives to ObamaCare are a better outcome for the structure and delivery of health care.
America is home to a vast, dynamic life-science industry.
When I was a medical student, a pulmonary professor of mine cajoled me into joining a clinical trial that she was running. The general aim of the tests was to determine whether prolonged periods of short and shallow breathing would cause a person's lungs to go into spasm. It turns out, as I can attest, that they do.
If drug development becomes the domain of government researchers, it's a sure bet that political lobbying will eventually trump scientific promise and commercial viability when it comes to investment decisions.
Even with all its political bells and whistles, the Obamacare plans increasingly resemble Medicaid in terms of networks and drug lists.
Obamacare is making the market for health care less competitive.
One of the untold elements of the rapid decay underway in the Obamacare exchanges is the massive shift toward the Medicaid managed care companies, and away from the traditional commercial insurers like UnitedHealth Group and Aetna.
Obamacare's costly regulations mean that the mix of people who sign up are tending to be older and sicker. Many young and otherwise healthy individuals continue to be priced out of the exchanges, even after the benefit of federal subsidies are baked into their costs.
In short order, Obamacare is evolving into a Medicaid marketplace. Not only in terms of the design and quality of the narrow-network plans that are being offered, but in the actual carriers that sell those policies.
Science offers the chance to cure debilitating and once-intractable disorders like hemophilia and sickle cell disease. But we need to make sure the ability to access these therapies, or the risk that someone can be locked out of them, doesn't widen gaps between the rich and poor.
Many inherited disorders can perpetuate poverty by leading to disabilities that disrupt people's ability to work. In turn, someone's capacity to secure an effective new cure for these diseases can mean the difference between a life led productively, or one plagued by infirmity.
We need to make sure that access to a curative drug doesn't become a yardstick by which poverty is eventually measured. Doing so requires a shared commitment between innovators and the insurance plans that are harder pressed to offer these advances to the poor.
Accurate diagnostics are key to enabling successful public health measures.
As Apple advances the medical promise of its watch and smartphones, it has also made clear that its foremost aim is to steer clear of Food and Drug Administration regulation.
By law and institutional culture, FDA seeks to apply a single tool to its approach to regulation - the requirement for pre-market approval. The agency is accustomed to compelling innovators to submit evidence to FDA and seek permission for marketing.
While faulty information from a digital health tool can influence people to make bad decisions, the risks are far lower than those posed by the usual products FDA subjects to pre-market review.
There's a big difference between apps that help you manage your medical information and draw clues from your own bodies, and those that seek to actively doctor you.
The higher cost of getting a generic drug approved by regulators means that many old medicines don't face competitors. It's only after substantial price hikes that these drugs offer enough revenue to offset the rising generic entry costs, and start to entice competition.
The ACA purposely constrains choice as a top-down means of cost control. Obamacare isn't a consumer-driven, high-deductible scheme. It's hollow coverage.
Obamacare has made insurance costlier and far less comprehensive.
A major part of the conservative plans to reform Medicaid turn on the assumption that states will be better able to manage the program, and deliver its benefits, free from all the intrusive regulation that Washington imposes.
For one thing, Medicaid is an inefficient if not ineffective platform for redistributing income. It doesn't get the dollars to poor people in forms that they can best use. Dollars are laundered through healthcare benefits that people may not need. It also means propping up a lot of healthcare interests rather than individual Americans.
The fact is that Medicaid doesn't even serve well the medical needs of people who should be its principal focus - Americans who are poor in large part because their chronic health problems leave them unable to earn a stable income.
Trying to stretch the mission of a health program like Medicaid, as a way to launder redistributionist goals, ends up serving nobody well.
Before Obamacare, insurance networks typically covered an entire state. Under Obamacare, insurers are able to bid to offer coverage mostly on a county-by-county basis. It means that health plans only need to fashion doctor networks as wide as the county that they're bidding to offer coverage in.
Obamacare mandates a largely uniform structure and set of benefits and insurance design across the entire country. It leaves consumers with very little real choice of the health benefits they want.
One of the noxious features of Obamacare was its forced march into a single, federally designed package of health benefits.
The overly engineered, overly regulated market that Obamacare created resulted in restrictive health care plans that provide little choice, and coverage that is far too costly for what the plans offer.
Creative destruction is an increasingly prominent feature of modern medical practice.
The pace at which fundamental discoveries of basic science are being uncovered is accelerating, as is the speed at which medical practice is being transformed by these inventions.
The period of time between the uncovering of some fundamental scientific finding that underpinned a medical advance, and the realization of the corresponding advance in the form of a new drug or medical technique that improves the health of patients, is being continually hastened.
Over the years, EpiPen's manufacturer, Mylan, made meaningful modifications to its auto-injector pen. The company maintains some important intellectual property around these revisions. Mylan rightly argues that these features differentiate its device.
EpiPen is not unique. It falls into a category of old drugs, many of which should have long been subject to generic competition.
One of the striking features of the early episodes of AMC's hit television show 'Mad Men' is the similarities in the lifestyle enjoyed by the lowest paid members of Don Draper's advertising company and its wealthy partners.
The ability of working class Americans to bargain for health coverage at work gave them access to the same basic packages of benefits as executive management teams.
Before Obamacare, many working class Americans had an upper middle class healthcare benefit that they got at work.
Zika is an addressable threat. While it falls outside of the regular routine of public health preparedness, we shouldn't be scrambling for new resources each time a threat like Zika starts to emerge.
Under Obamacare, doctors have been strained by costly new regulations, intricate payment 'reforms' that tie their Medicare reimbursement to complex federal reporting requirements, and mandates that they install and make 'meaningful' use of electronic health records.
The nature of food processing had changed substantially in America. Much of it owed to corresponding changes in food packaging and the logistics for faster shipping. The scope of outbreak from foodborne illness no longer has a clear geographic boundary.
The spread of HIV through contaminated blood was a tragic illustration of the risk that blood products could harbor undetectable and latent infection that's only revealed once it's widely distributed.
In the U.S, Zika outbreaks are hopefully going to be easy to isolate. The biggest threat is likely to be from the fear Zika sows, especially among expectant moms.