Unfortunately, that is more true than we like to admit. Not that specific example. I don’t think we’re close to curing cancer with a pill and I don’t think Oncologists are hiding or holding up a cure for cancer but let me give you a scenario from my own field.
A patient with cirrhosis of the liver with progressive liver failure is a gold mine for a Hepatologist (a medical specialist in liver disease). The patient will make multiple outpatient visits, have many billable procedures like drainage of fluid from the abdomen, endoscopy etc. There will be many hospital admissions as complications of cirrhosis develop repeatedly.
If such a patient is referred for a liver transplant at an appropriate time then a liver transplant can be done safely and with good outcomes. However, the patient is unlikely to need the services of the Hepatologist after transplant. The goose will lay no more golden eggs.
The alternative, of course, is to continue with futile medical management until the patient is close to death. At that point when the “goose” is nearly dead, the word ‘transplant’ can be safely uttered. Unfortunately, now the patient is too sick to have a safe transplant . If a transplant is offered as a desperate measure to try and save a dying patient, the risk will be high and the success rate of such transplants will be low. This will further reinforce the Hepatologist’s view that liver transplant is a risky operation, not to be offered except under threat of imminent death.
At the other end of the spectrum is the ‘hungry’ surgeon who is in a competition for numbers since his income is directly linked to the number of transplants he performs. He may see a patient with cirrhosis of the liver but good liver function who does not need a transplant. He manages to persuade the patient to have a ‘prophylactic’ transplant “don’t wait till you are so sick that transplant becomes risky”.
Unfortunately what he fails to tell the patient is that at this time, transplant is actually more risky than waiting.
The saddest part of all this is that it does not take great clinical skill to tell when a patient needs a transplant. Anyone with a smartphone can download a medical calculator app which can calculate the MELD score for a patient with cirrhosis. All you have to do is enter the values for serum bilirubin, creatinine and INR and you get a score. If the score is more than 15, the patient needs a transplant.
Certainly, there are exceptions and it’s not as simple as I have made it appear but it is clear that medicine as practised almost anywhere in the world is not as ethical as doctors like to pretend.