2314 Between Now and Later: Cancer, Time Discount, and the LRM Perspective

 Today, I delved into a thought-provoking book by Takeshi Yoro, a renowned doctor and anatomist from Japan. The book's core theme revolves around the daunting decisions we face when confronted with a terminal illness.

A particular episode from my own life serves as a poignant reminder of this topic. This experience taught my spouse and me invaluable lessons about the approach to time discounting and the Last Responsible Moment (LRM).

Japan grapples with some of the world's highest rates of stomach cancer. Moreover, stomach, lung, colorectal, and breast cancers rank among the top causes of cancer-related fatalities in the nation.

Imagine being diagnosed with cancer and given an estimated three years to live. What would you choose - aggressive treatment or palliative care? The former leans towards a time discount orientation, while the latter might be more in line with the LRM philosophy.

Jan in 2011, tragedy struck our family. My brother-in-law, a prodigious talent who was on the verge of becoming a certified public accountant (CPA), was diagnosed with lung cancer. At the young age of 38, he chose aggressive treatment. As a single man with dreams yet to be realized, it was unsurprising that he made this choice, believing he had much life left to live. He passed away at age 38,Jan in 2012

To answer my earlier question: if faced with the same decision today, I would lean towards palliative treatment, despite my inherent belief in time discounting. Why? Because of my brother-in-law's ordeal. While the anti-cancer agents targeted the cancer cells, they also harmed his normal cells. His health deteriorated rapidly, and despite doctors trying various treatments, his battle with the disease lasted less than 10 months.

With medical technology advancing every day, In the event for me now (Age 47), I would prefer to make such a critical decision as late as possible, drawing from the LRM theory.

One cannot ignore the systemic issues plaguing Japan's medical sector. The prevailing doctor incentive system might partly be to blame for the inclination towards aggressive treatments. This system rewards doctors based on a point system, where each medical procedure or treatment corresponds to a certain number of points. While this might increase healthcare revenue, it often exposes patients to undue risks.

I hope that sharing my perspective aids in your decision-making process, even if you never have to face such a decision.

Lastly, a tribute to my brother-in-law: even during his treatment, he cleared the first stage of the CPA examination. Had he lived a few more months, I have no doubt he would have become a brilliant CPA. His intellect and potential were undeniable.