A common comparison statement when decrying why we don’t collectively commit ourselves to big endeavors, including better healthcare, is, “If we could send a man to the moon, why can’t we XYZ.” If you are in the moon-landing-never-happened conspiracy theorist camp, this comparison won’t work for you, and you probably will become enraged, so stop reading now.
However, even if you do think it happened, this throw-away comparison ignores a few relevant facts about the moon landing era. One is that only 12 people ever stepped foot on the moon over a four-year period at a cost of just over $24 billion dollars (or $2 billion per visitor). That $24 billion today is about $200 billion. To support that effort in the late 1960s, NASA received 4.4% of the federal budget. Today NASA gets just 0.5% of the budget.
Support personnel for the Apollo missions came from more than 500 contractors and multiple thousands of people in the lead-up to and operation of the flights. And these numbers grow rapidly if you extend the timeline back to consider the early work. Some would argue, however, that technological progress would sharply reduce the cost of a moon landing today, perhaps to the total salaries of a major league baseball team. Which, if true, proves that we like baseball better than grand national accomplishments, although of course the money comes from different pockets. Looking at costs also doesn’t account for benefits, most of which are hard to specify and harder to put value on. Yes, there is Tang, although this actually existed before NASA sent it up on Mercury in 1962. There also may have been important impacts on technology and some would say on project management. But it is hard to assert that we wouldn’t have arrived at these another way. We might also remember that our moon effort was a response to Russia’s Sputnik rather than a spontaneous idea.
The bottom line here is that putting people on the moon resulted from a national commitment to do something bold at great expense and great effort. It is this commitment that we no longer seem capable of, whatever the other weaknesses of the analogy may be.
The going-to-the-moon analogy is a cousin to, “If we could save just one life …” which generally means, even if not explicitly stated, that cost should not be a factor if a measurable good results. I recently saw this concept applied to infection control in the form of, “Even one infection is too many,” but not applied to the OR heater-cooler problem where an FDA panel reported that changing the reservoir water daily was “impractical.” Typically, the just-one assertion is applied only piecemeal, i.e., to one issue at a time. It glibly breezes past the overall resources required and the task of setting priorities, instead focusing on a single favorite topic. It thus ignores that more often than not there are other issues affecting far more people than the pet issue at hand. A good exercise in this regard would be to require that those advocating for a particular medical effort report the relative ranking of that issue among all causes of adverse medical outcomes. For example, cardiovascular disease remains the number one cause of death in the United States, but Vice President Joe Biden is engaged in the National Cancer Moonshoot. Yet the requested cancer investment is “only” $1 billion, less than the cost of developing a single cancer drug, and 1/200th of an Apollo-like moon program. Others have raised the issue of whether an engineering problem with a relatively clear goal is actually comparable to a complex biological problem about which we still know so little.
So the next time you hear either, “If we could send …” or ”If we can save just one life …” the answer may be that, yes, we perhaps can, if collectively we really want to, with that wanting to include a willingness to pay for it and endure any associated operational challenges. However, even being willing to pay for something doesn’t make it the wisest way to spend those dollars in term of lives saved. Nor does it ensure success.
We also might remember that we tend to be enthusiastic about those government or private activities that we are enthusiastic about, while decrying other such activities as waste and abuse. Often that enthusiasm is closely related to whether the activity benefits us or whether we’ve suffered a particular loss. One non-medical example is that people with mortgages tend to be enthusiastic about the government subsidy they receive in the form of the mortgage tax deduction. However, they may be less enthusiastic about government subsidies for renters. Similarly, we seem to believe that any tax that impacts us directly is an outrage while taxes that only impact others are a necessity to adequately fund government services. Likewise, a medical issue that we are enthusiastic about apparently should receive whatever resources it takes, provided we don’t have to directly pay for it.
William Hyman, ScD, is professor emeritus of biomedical engineering at Texas A&M University. He now lives in New York where he is a consultant and adjunct professor of biomedical engineering at The Cooper Union.