Todd Hixon | August 25, 2015
There are two exciting frontiers in healthcare today, and they require opposite mindsets. So, the healthcare system needs to operate with two personalities. No cure is in sight.
One mindset is high-tech, high-cost medicine. High tech medicine is experiencing dramatic success treating many cancers in many people and curing some major diseases. For example, two new Hepatitis C drugs can cure late stage Hepatitis C in a high percentage of cases, at a cost of upwards of $50,000 per patient (over $1,000 per pill in some cases). And, my friends working on personalized medicine tell me that about 25% of cancer patients can now benefit from targeted therapies based on genetic and protein expression analysis of their tumors. E.g., at the December, 2014 Forbes conference we heard the personal account of a young woman who was diagnosed with late-stage lung cancer, then learned that her tumor’s genetic profile fit with a known treatment, and in a few months she was in complete remission, with modest side effects (more).
High-tech medicine creates a mindset along the following lines:
• If I get sick, medicine will cure me. So I can indulge in risky behavior (most lung cancer and hepatitis C result from risky behavior), and if I get sick, I can expect the medical system to fix the problem.
• The doctor is an expert. The path to a cure is to find the best doctor with the best technology.
• Cost of treatment can be very high. How much is it worth to save a life and end suffering? As a friend put it, the cost of a Hepatitis C cure is about the same as a fancy sports car: an easy choice. If the patient cannot pay, then insurance or the government should cover the cost, because everyone should have access to the miracle of medicine.
Alice Walton’s post last Saturday points to the other mindset, the preventive medicine mindset: much of today’s disease burden is preventable if people avoid risky behaviors and engage in healthy behaviors. Alice reports on a large meta-analysis of studies of Alzheimer’s disease patients which concludes that people who avoid risky behaviors can reduce their risk of Alzheimer’s disease by up to two-thirds. The study also cites five healthy behaviors that reduce risk of Alzheimer’s and notes that part of Alzheimer’s risk is genetic.
Risk of most of the other major chronic diseases, e.g., diabetes, cardio-vascular disease, pulmonary diseases, cancers of the lung, skin, and gastro-intestinal tract, can also be reduced substantially by avoiding risky behaviors and adopting a few healthy behaviors. See prior posts for more: 1, 2.
The preventive medicine mindset is pretty much the opposite of the high-tech medicine mindset:
• My best chance of a healthy life is to adopt healthy behaviors in order to avoid disease.
• The doctor is a coach. The path to health is to work with a doctor from an early age to learn how to manage my health, and receive coaching and feedback as I do so.
• The cost of this treatment is comparatively low, but it must be paid in advance, before symptoms are manifest. Institutional payers must decide to make an investment. And the hardest part: the individual must discipline him or herself to adopt and maintain healthy behaviors, which is largely a personal responsibility.
The tide is rising for both mindsets today. In the startup world, which is always a good beacon for change, we have had several years of strong IPOs for bio/pharma startups, personalized medicine companies off to a good start (Foundation Medicine, 23andMe), and at the same time digital healthcare companies are booming, and many of them are focused on wellness or finding and intervening early with people who at risk for chronic disease.
The high-tech mindset still has greater momentum, however, probably because it has been the dominant paradigm of U.S. healthcare at least since World War II. But, our health system is now spending 80% of its resources on chronic diseases, and it needs to prepare for a wave of people with Alzheimer’s disease and other dementias as the population lives longer and large cohorts reach age 65. Considering these facts, the logic for investing more behind the preventive mindset seems very strong. So the system struggles with two personalities and limited resources. Perhaps high-tech medicine will find a cure for health system schizophrenia?
Source: Forbes
http://www.forbes.com/sites/toddhixon/2015/08/25/the-schizophrenia-of-american-healthcare/