Chronic illness represents $3 of every $4 of annual health spending in the U.S. That’s about $1.5 trillion.
– Adopting evidence-based interventions for disease preventionLiving Well With Chronic Illness, a report fromThe Institute of Medicine (IOM), issues a “call for public health action” to address chronic illness through:
– Developing new public policies to promote better living with chronic disease
– Building a comprehensive surveillance system that integrates quality of life measures, and
– Enhancing collaboration among health ecosystem stakeholders: health care, health, and community non-healthcare services.
What state has the highest rate of obesity in the land? If you guessed Mississippi, you would be correct. For the seventh straight year, Mississippi tops the list of the “Fattest States in the Nation.” When they first took possession of this top ranking of one of the nation’s most infamous lists of unhealthiness, the rate of obesity was just 19.4%. Now, they are almost unbeatable with a (whopping) rate of 34.4%. Congratulations, Mississippi. You are the fattest of them all.
Most people knowledgeable about obesity in the US know that is it going to take a multi-pronged effort to reduce obesity – one of the leading causes of death in this country because it is the fuel for Type 2 diabetes and associated conditions, such as hypertension, heart disease and stroke.
Folks who don’t really understand the complexities of obesity like to blame the fatties – you have heard it: “they have no will power, they don’t exercise, they don’t this and they don’t that.” These “personal responsibility advocates” are not willing to put on the table societal contributing factors, such as the following:
Ubiquitous presence of fast food restaurants and their seductive advertising ploys
Lack of full service grocery stores in some low income neighborhoods – you can buy alcohol in its various forms, but not fresh fruits and vegetables
Lack of health literacy – because this is not a priority in our schools
Poverty – a Big Mac may be cheaper than a couple of tomatoes from the farmer’s market
Exercise-unfriendly neighborhoods – unsafe streets, no exercise facilities, no support
While Congress tries to control health care spending, lawmakers should be careful to make choices that are pennywise but not pound foolish.
In April, the House voted 236 to 183 to repeal the health law’s prevention and public health trust fund. Republicans said they opposed giving the Secretary of Health and Human Services wide discretion on how to spend this money. But the result is a setback for the first dedicated source of funding for national prevention efforts and could be a missed opportunity to reduce spending even further by preventing the largest driver of health care costs — chronic disease.
For example, while 2 in 3 U.S. adults with one or more chronic condition go online, only one-half of them are looking online for health information. Among the 54% of online adults with disabilities, only 42% of them seek health information online. Among the 88% of people online who are caregivers of loved ones, 70% look online for health information.
The current scientific paradigms that shape our view of chronic conditions are simply inadequate. Clinical medical scientists might think much more seriously about questions like these: Why is it that metformin reduces the risk of heart attack, stroke, and cancer while other drugs lower the glucose and do not protect from these conditions? Why is it that studies of patients treated with insulin suggest an increase in cancer? Why is it that a single dose of metformin or a statin-type drug reduces heart attack size by half in experimental animals? Why are patients who take certain medications for high blood pressure more likely to develop diabetes.
Today, basic scientists have laid the foundations to begin to answer these questions and the answers are important as we work to improve the quality of care. In practical terms, our scientific literature places little value on work that translates new science into practice. That is part of the reason that there is a large gap between what is known and what we do. This is the first of a series of articles that we hope will serve to help in closing that gap. The link between cancer and other chronic conditions is important. If we can reduce the risk of cancer even slightly by refining the way we manage other chronic diseases, then that is important work.
Another reason for this article and Urgent Science is a very personal one. Brian Klepper, the founder of CareandCost, has recorded the struggle that his brave wife Elaine endures with ovarian cancer now. I myself have been cured of a very aggressive type of lymphoma. How many of our friends and family have been struck down by these ailments. We need to improve our rate of translation. We invite you to read this first piece carefully and if you have refinements or additions that will help the broader medical community understand these problems better, we invite you to send us your constructive comments. We promise to take them seriously and use them to improve what we all know about the newest science and how it might be used to help our patients.
Bill Bestermann is a vascular physician at the Holston Medical Group in Kingsport, TN.
From Brian – The germ of today’s extremely provocative post by Bill Bestermann, MD was the moment in early May when he learned that my wife, Elaine, had primary peritoneal (ovarian) cancer. Bill’s focus for many years had been on vascular disease, but he dove into the literature on cancer, metformin and ADMA, and was energized by what he found.
He called a few days later and asked two questions. ”Did you know that diabetics on metformin get cancer at half the incidence of those not on metformin? Or that diabetics with breast cancer on metformin have their cancers ameliorate at triple the rate of those who are not on it?” I didn’t, but these facts intrigued Dr. Bestermann enough that he relentlessly pursued the science.
The article below, not original research but an important synthesis that leads us to a new understanding, is what came out of that effort. It’s message is ground-breaking – genuinely a paradigm shift in how we might think about chronic disease – and is an specifically aimed at practicing physicians. We have provided all citations, with links, not only to allow verification of source information, but also allow the interested reader to dive deeply into the topic. We are well aware that the science in this piece may be beyond lay readers, and we apologize for this divergence from a more general format.
We are delighted and humbled that Dr. Bestermann has allowed us to publish this piece here. It has been peer reviewed and found to be sound by several capable physician-scientists. One of the goals of Care & Cost is to make the science that can impact clinical practice immediately available.
That said, I believe the content in an article of this caliber and potential impact should also be recast and allowed to work through the more traditional physician publication machinery as well.
Originally published 12/2/10 here on The Doctor Weighs In.
When I was a kid, people used to say, “Oh, don’t worry, she will outgrow her baby fat.” And, by and large, I did. I was an average-sized teen and young adult, and, like most Americans, only started packing on the pounds later in life. But things are different now.
As I was developing this site, I mentioned it to my good friend Bill Bestermann. Dr. Bestermann is a very progressive, leading edge and nationally recognized vascular physician. When you talk with Bill, it’s very clear that it really is all about the quality of the care. After he’d chewed on the idea of the site, he called with a suggestion. “You could have a section called ‘Urgent Science’ that clearly describes for clinicians the science behind modern management of chronic conditions. We could develop a straightforward resource that shows what actually works and why, so it can be easily translated into clinical practice.”
That seemed like a great idea. What follows is Dr. Bestermann’s explanation of how it can work, followed by an article he wrote almost two years ago called “The New Science of Vascular Disease.”
We are very proud to offer this approach, and hope that interested physicians with deep knowledge of a particular discipline will send us review articles that can be candidates for this service.
WILLIAM H. BESTERMANN, MD
The science and systems exist today to dramatically improve care and reduce costs. Despite multiple recommendations from the Institute of Medicine (IOM) and others credible professional groups, our system remains focused on the care of acute episodes and our approach to chronic diseases is largely ineffective. We spend nearly one dollar out of five on health care and the rate of increase continues to be a multiple of inflation. Most of the increased spending over the last two decades is related to patients with four or more chronic conditions. We have still done very little to improve the effectiveness of that spending and to improve the health of our friends, neighbors, and families. Education and exhortation have not worked. It is time to get serious about new science, new organizational structures, and new systems.