December 16, 2015

The Martian (movie) and cancer

My brilliant oncologist, Dr Sheldon Goldberg, writes several blogs on top of treating patients, staying current with cancer research, reading more than 100 RSS feeds daily, studying Jewish texts and raising a family. His brain must be bigger than most people's, and he can store and access so much information.

Recently he saw the film "The Martian," in which one astronaut is accidentally abandoned on Mars after his colleagues believe he died in a storm. It was a great book and a good movie. Dr G blogged about it here and asked me to share his comments on my blog. His take on the film was wholly different from what I expected, and yet it makes perfect sense to me as a cancer patient.

medical philosophy

Friday, November 27, 2015

The Martian: How much is a person worth?

Recently, I saw The Martian, a movie about a man accidentally abandoned on Mars. The movie is about the struggle for survival, the marshaling of forces to allow the survival of that one man, the sacrifice of compatriots and the politics of rescue.
Cancer patients, and the people who care for them, can feel like they are abandoned on Mars. The feelings elicited by this movie are similar to those we, who care for cancer patient patients feel. When do we call the situation hopeless? When do we give up? How much can we put into the effort for one patient? How much can we spend?
In the movie there is no limit. Billions of dollars are spent, scores of people work without rest, people give up years, in the prime of their lives, to attempt to rescue a single man. In our real, medical world the money, the time, the energy are all limited, The resources are shared by thousands of patients. This places every part of the medical system in the position of distributing a limited, precious resource. The doctor must balance the chance of benefiting the patient against the cost to the system, which could mean denying another patient an equal or better chance. Doctors differ in their approach to this problem.

How can we do any less than our best? Our efforts are not like those in the movie. They are not as good as they should be.. The basis for saving the Martian was adoption of a nonstandard strategy, a strategy that would work, in theory, but was not a usual approach. A methodology that involved unanticipated expense and sacrifice.
Currently, the pressure to follow standard procedures is almost overwhelming. Deviation from such standards risks the label of malpractice. Obtaining insurance coverage for a treatment that is not recommended in guidelines, or for a problem that deviates from the FDA approval parameters is a Herculean task - and getting harder. .

Knowledge and Resources are always limited. The Martian was rescued, he beat the odds. It is very expensive and difficult to take on the odds... sometimes it works.


  1. Anonymous11:54 AM

    Excellent analogy. This is an extremely thought provoking message. Thank you for posting it.

  2. Krista12:20 PM

    I had similar thoughts on this film, but from a patient's perspective...
    The question of when do we give up-even when all the odds seem stacked against us? the answer, in my book and highlighted in The Martian - is NEVER. Instead of curling up in a ball and accepting defeat, He chose to use all his skills and resources to do what he could to survive as long as he could - and that led to a new set of options/obstacles to overcome.
    The Martian eventually had the support of ground crew, who I'd equate with doctors and researchers - while they are very focused on finding solutions - they do not experience first hand what the Martian does.
    I was most struck by the pioneering spirit, teamwork, and fortitude of all involved, especially the astronauts. We cancer patients (and all who've trod before us - in clinical trials and in death) are leading the way, learning something new about effective treatments. I imagine those patients in phase1 trials, taking a drug for the first time and having the bravery and courage and unfortunate circumstance of needing such drugs - represent our astronauts, our martians, our groundcrew on what seems an impossible mission.