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SPEAKOUT: Preventive care must lead medicine

Michael Salem, M.D.

Published March 25, 2008 at 9:14 a.m.

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In the current election cycle, health care in the United States commonly has been described as being in a state of crisis. Vincent Carroll rightly points out in a March 7 column (“Does prevention pay?”) that preventive care may not pay. The “30-second sound bites” we hear from some politicians include this one: How many Americans can we cover with benefits, and the substantial projected cost savings associated with the practice of preventive care.

Many have predicted cost savings associated with new technology implementation, such as moving to electronic health records. Other postulated cost-saving examples are derived from the transition that is ongoing in medicine from reactive to preventive, or personalized, medicine.

This transition, which is an inevitable trend in medicine today, seeks to take advantage of the information gleaned from the sequencing of the human genome. We are now putting into practice advances in genetic predictive testing for disease, prescribing medicines more accurately based on our genetic makeup, and possible prevention of chronic illnesses, which are enormously costly to manage.

Direct and indirect cost savings are difficult to determine in the short term, but it is worth detailing a few specific examples to demonstrate their value.

Genetic information is being used to customize detection, treatment and prevention at the individual level and, in some cases, is even used to segregate patients to determine who is likely to respond best in a clinical trial of new medications.

Previously, it was unusual for physicians to modify treatment strategies according to a particular patient’s response. Now, treatment strategies are being designed based on an individual’s unique genetic makeup. The former approach lacks precision while the new one reduces uncertainty and error in both diagnosis and treatment.

Each year, 117,000 people are hospitalized for adverse drug reactions and 100,000 die from them. Current dose recommendations often are vague and are based on factors such as age, gender and body weight. A substantial amount of the population also does not respond to a given drug.

A review of patient response to five different drug classes (angiotensin-converting enzyme inhibitors, beta blockers, anti-depressants, statins and beta agonists) found absent or incomplete efficacy in 10 percent to 70 percent of cases, which costs billions of dollars annually.

That so many drugs are ineffective in such a large portion of the population is evidence of both the inherent genetic complexity of humans and the need of the health care industry to do better.

While Carroll quotes a study suggesting that lifetime health care costs from obesity and smoking are lower than for healthy individuals, a recent paper in the New England Journal of Medicine points out that the leading causes of premature death in the United States are personal-behavior related – and overwhelmingly associated with obesity and tobacco use.

According to a recent article in The Economist, the decline in preventable deaths among males in the U.S. was less than 5 percent from 1997 to 2003, compared with Austria, which had a 25 percent decline in deaths over the same period of time.

Leading health institutions have chosen to address this transition practically to preventive or personalized medicine and not wait for political solutions. Similarly, at National Jewish, we have substantial programs offered to Colorado residents and people nationwide to address the behavior-related premature causes of death through smoking cessation (Quitlines®) and weight management (Fitlogix™) programs. These programs include telephone sessions, pharmacologic intervention, activity monitoring and Internet platforms. Rather than catchy phrases, preventive care is requisite to lead in medicine and science.

Prevention is not a short-term pay off, however, but an important pathway to human health.

Michael Salem, M.D., is president & CEO National Jewish Medical & Research Center.

Comments

  • March 25, 2008

    8:15 p.m.

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    Brix57 writes:

    Interesting pure advertisement from National Jewish. So, if we do all the prevention, we will then live forever? We will most likely be poor after paying all that money to National Jewish for all their wonderful prevention of premature death. Last time I heard, everybody dies and death comes whether you try and prevent it or not.

    Welcome to the future of the nanny state.

  • March 25, 2008

    9 p.m.

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    Brix57 writes:

    Dr. Salem's statistic use is rather interesting as he compares Austria (pop. 8 million) with the United States (pop. 300 million). Let's try and find a smaller country and compare that to the U. S.

    The 117,000 adverse drug reactions and 100,000 deaths. So, only 17,000 lived after their doctors prescribed the wrong drug? Sounds more like the doctors may need a bit more training. Oh, that's right, doctors are infallible.

    Perhaps the reason that so many drugs are ineffective is not because of the genetic complexity of humans, but that they didn't work because they were prescribed for the wrong reason?

    Because Dr. Salem is in the business of making more money for his National Jewish prevention programs, we should take his opinion that any other study is false and that his study is the only true one.

  • March 26, 2008

    7:24 a.m.

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    vudumom writes:

    Though I am highly suspect of Dr.'s and hospitals in general,I have to put in a good word for National Jewish.
    My daughter when she was 2 was diagnosed by her Pediatrician with Asthma.After a year on many drugs,nebulizers and steriodal drugs,I got fed up and went to National Jewish.They determined right away that she did not have Asthma.She had allergies and one of them was to mold.The mold came from the humidifier that her Pediatrician said to put in her room and make sure it is running whenever she is in there.The first thing National Jewish told me is to throw out the humidifier and scrub the room down. We had to remove the carpet and mold was growing under the carpet. I remove the windows to clean them and mold was growing between the slots.Also the more humidity in the air the more dust mites,another known allergen.
    After a few months of medicine my daughter has been symptom free except around the allergy seasons.We treat her with over the counter medication as needed.

    I also had a friend who had 2 children diagnosed with Asthma by her Pediatrician.Nothing was helping her children who had been on many drugs for years. I told her to take them to National Jewish.She also found out her children did not have Asthma but allergies.One of her children was allergic to milk. After her experience with National Jewish both of her children are on minimal allergy medication and are healthier than they have ever been. My child also is very healthy. She was very sick under the care of her Peditrician.Since then we have had no problems.
    Thanks to National Jewish I saved my child and my friend saved her children of years of misery because of being misdiagnosed.
    I urge all the parents out there if your children have been diagnosed with Asthma ,Please take them to National Jewish to make sure.Spare them years of misery from drugs they do not need to be on.

  • March 26, 2008

    6:44 p.m.

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    jjez writes:

    Isn't NJH also non-profit?

    One thing really worries me: "is even used to segregate patients to determine who is likely to respond best in a clinical trial of new medications." What's to prevent whoever uses this from segregating those who can pay from those who can't. If I am poor, and genetic testing reveals that I have a gene that MIGHT cause a long-term health issue (say Parkinson's or Alzheimers) what's to prevent our healthcare system from segregating me from treatment and/or insurance coverage (that old pre-existing condition clause)? If I can't contribute to the cost of my care, I don't deserve that care? I can see that happening in this country. I firmly believe that corporate greed is a large contributor to the the rising cost of our health care. Why does the CEO of an insurance provider have to make millions every year? Why does the CEO of a hospital have to as well? Just because they have a Masters Degree in business? I really don't think that health care will be affordable until something is done about the big-wigs ripping everyone off. And once it doesn't cost as much, more people will be able to afford health care. And decent food so they aren't obese. Fresh fruit and veggies cost a whole lot more than noodles.