The Socratic Method May Save Health Care

Whether shepherding Plato through deep philosophical exercises or pondering life’s fundamental mysteries with Bill and Ted, Socrates’ preferred teaching method involved posing challenging questions to engage his pupils’ intellect along a path toward Truth. Over the past 18 months, leaders in the executive and legislative branches of the US

Joseph Alvarnas, MD | Image: City of Hope

government have released a series of requests for information (RFI) intended to engage stakeholders in a search for wise counsel and creative solutions to some of the greatest challenges faced by our health care system. Even though we are witnessing extraordinary advances in anticancer therapeutics, genomic diagnostics, and risk assessment tools—and we see demonstrable progress on the road toward better patient outcomes—we still stand at the edge of a great precipice. We face some deeply challenging questions. Questions that are central to the future of our health care system. As care technologies advance, how are we going to pay for them? As cancer care disparities persist and deepen for underserved patients, how can we ensure that our system becomes fairer and outcomes more equitable? How do we ensure that health care coverage translates into the lifesaving access that patients actually need? How can we afford the newest technologies that now arrive at unprecedented cost?

HHS released 2 RFIs related to Medicare Advantage (MA) that were intended to identify ways in which the quality of care delivered to beneficiaries could be improved, network design could be modernized to enhance patient access, and how care outcomes can be communicated with greater transparency. As ranking member of the Senate Committee on Health, Education, Labor, and Pensions, US Senator Bill Cassidy (R, Louisiana) released an RFI on the question of how to manage the emerging portfolio of gene therapies, including the difficult questions of how to pay for these costly therapeutics and who should bear financial risk for product acquisition costs. An RFI from the Biden administration seeks input on how and whether march-in rights should be used as a means of driving down the cost of drugs that were developed using federal funds. How do we balance the push toward more affordable care with the patent protections that foster risk-taking and innovation from pharma?

There are few easy answers to any of these questions, but a failure to grapple with their complexity would undermine the well-being of patients, slow the development of innovative anticancer drugs, and exacerbate existing care disparities. These federal agencies have taken an important first step by engaging stakeholders in a search for more creative solutions to these unanswered challenges. If we continue on our current path, without a significant reimaging of our care ecosystem, we risk falling into an abyss of eroded patient access, thwarted innovation, and immovable disparities from which little good will arise.

This issue is 1 of 2 you will receive this month, and among 12 you will receive in 2024. Evidence-Based Oncology is expanding its publication schedule, as the questions about who pays take on greater importance in oncology. We will explore these questions with leading industry experts, thought leaders, innovation creators, patient advocates, payers, and policy makers. Through this powerful cross-pollination of ideas, we believe that creative, sustainable solutions to the great challenges of cancer care will emerge. As Socrates noted in a lesson as relevant today as when it was first spoken, “Wisdom begins in wonder.” Welcome to this path toward discovery.