Being drugged into prevention
Chronic illness costs the economy more than $1 trillion a year
By Victoria Colliver
San Francisco Chronicle
October 3, 2007
Americans who have common chronic health conditions cost the U.S. economy more than $1 trillion a year, a figure that could jump to nearly $6 trillion by 2050 unless people take steps to improve their health, a study released Tuesday found.
According to the report by the Milken Institute, a Santa Monica think tank, the economic impact of chronic illness goes far beyond the expense of treating disease. It takes an even greater toll on economic productivity in the form of extra sick days, reduced performance by ill workers and other losses not directly related to medical care.
But veering onto a path that emphasizes changing lifestyles along with prevention and early detection of disease could reduce the number of illnesses by 40 million cases and save $1.6 trillion by 2023, the report said.
“The public is telling us the No. 1 domestic issue is health,” said Dr. Richard Carmona, former U.S. surgeon general and now chairman of the Partnership to Fight Chronic Disease, in a news conference in Washington on Tuesday releasing the report.
“The data to stay the course is not a particularly attractive option,” said Ken Thorpe, executive director of the Partnership to Fight Chronic Disease and a professor at Emory University.
The study was funded in part by a grant from the Pharmaceutical Research and Manufacturers Association of America, the drug industry’s trade group. The Milken Institute declined to reveal the amount of the grant.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/10/03/BUDKSGJLP.DTL
Milken Institute: “An Unhealthy America: The Economic Impact of Chronic Disease:”
http://www.chronicdiseaseimpact.com/
Comment:
By Don McCanne, MD
Uh-oh. Are we being dragged (drugged) into a process that places our health care system in the hands of the pharmaceutical industry?
PNHP continues its campaign to reform health care financing in America so that everyone will have affordable access to comprehensive, high quality health care services. Implicit in that is improving the health care delivery system through improved allocation of our health care dollars.
But there is a debate within the policy community as to the best approach for containing costs.
Following is a quote from a message received from Professor Kenneth Thorpe:
“The former (health reform) is true reform, and is focused on generating better value in the health care system - better outcomes at the same or lower spending. The second issue (health care financing reform) is a political one, focused largely on moving money around the health care system. Absent a clear bold focus on the first issue, moving on the health care financing reforms has historically proven problematic.”
Yesterday’s Quote of the Day from Kenneth Thorpe and his colleagues advocated, quite appropriately, for efforts to reduce the prevalence of chronic disease. But then the focus of the article was on “treated prevalence” based on medication use.
Here is another excerpt from the Thorpe, et al Health Affairs article used as the source for yesterday’s message:
“The impact of more aggressive treatment on patient outcomes is important to consider as well. The use of cholesterol and blood pressure medications has increased sharply in the United States over the past twenty years, while hypertension and hyperlipidemia prevalence has declined. Other recent estimates indicate that the additional spending associated with higher rates of medication treatment for hypertension yield overall net reductions in health care spending. Whether more intensive use of medication treatment for other conditions, such as the metabolic syndrome, yields overall reductions in spending remains unknown.”
Dr. Thorpe continues to strongly advocate for disease management as a key to reducing health care spending. His report released yesterday seems to imply that medications are one of the most important parts the solution for reducing the prevalence of chronic disease.
The very same day, the Milken Institute released a report sponsored, at least in part, by PhRMA (Pharmaceutical Research and Manufacturers of America, an advocacy organization). An excerpt from this report:
“The rapid growth of chronic disease is costing us lives, quality of life, and prosperity. The current health-care debate rightly focuses on the extension of coverage to the uninsured and the design of a financing mechanism that is both fair and efficient. We suggest that the nature of services provided — the failure to invest in prevention and early intervention — deserves equal place in the debate.”
Investing in early intervention in chronic disease equates with selling more drugs for hypertension, hypercholesterolemia, early diabetes, appetite suppression in obesity, slowing the progression of arthritis, etc., etc. Just imagine the potential market for the pharmaceutical firms.
A serious concern is that disease management seems to have come to mean pharmaceutical intervention. If we were really concerned about health care spending and about improved population health, we would back up from an emphasis on pharmaceutical intervention to an emphasis on prevention, especially good nutrition and exercise.
I have great respect for Dr. Thorpe, and I approve of his message on the importance of making efforts to reduce the prevalence of chronic disease (though I emphatically disagree with his apparent dismissal of the importance of health care financing reform). It is unfortunate that the Partnership to Fight Chronic Disease, of which Kenneth Thorpe is Executive Director, has included PhRMA as a partner organization. This does not serve to empower his message.