Wednesday, February 27, 2008
What are we doing? Why isn't it working? In a recent report by the Centers for Medicare and Medicaid it turns out the US will be spending one-fifth of it's GDP on healthcare. Here is the big question.....Will we be more healthy as a result?
I started this blog to demystify and inform about the field of personalized medicine (A dying term as far as I am concerned....especially because clinicians and the public do not understand it)
Let's call it like it is Genomic Medicine or more affectionately Molecular Medicine. Why are we spending so much and getting so little for it? It is called the One Size Fits all model. Last night I ast at a talk given by a physician friend of mine. We were at a very nice restaurant named Valbella! and I was amazed.......the big pharma mantra keeps on being the same...."This is the right Drug for All Patients"
Growth in public spending, on the other hand, is expected to accelerate toward the end of the projection period as the leading edge of the baby-boom generation becomes eligible for Medicare. From the sectoral perspective, prescription drug spending growth is projected to decelerate in 2007, driven by slower price growth, but is expected to accelerate through 2017 as utilization increases.
Why are we using more drugs? Several reasons. One being lower target thresholds for numbers like cholesterol. i.e. more and more people will have cholesterol numbers "High Enough" to be placed on a medication. Huh? Well we have target numbers to treat for LDL (lowsy cholesterol), blood pressure, blood sugar...etc all based on your pre-event risk of event.
As it stands we like to risk stratify for heart attacks based on everything but family history of heart disease. Therefore, in order to reduce the incidence of heart attacks we need to treat a higher number of patients...... This NNT for cholesterol lowering medications is around 40:1
Why so high? Well from the public health perspective it is not that high a number. You put 40 people on a medication to prevent ONE 10-15k USD cardiac cath. The cost of the other 39 people on the pills? Less than the cath and long term sequelae.
If you really want to lower costs, start identifying those who will maximally benefit from the medication. Then the NNT could turn into 20:1 or maybe even 5:1
This is the power of what genomic medicine can do. That is why everyone at the governmental level is excited. Imagine the cost cutting that could be done for the rock bottom price of a one time 1000 USD FULL GENOME SEQUENCE! When will this happen? Soon....but not immediately. We need some good outcomes data and that may be ready by 2017. We will gradually see genomic medicine evolve over the next 10 years...but we are practicing it in its simplest form already.
The Sherpa Says:
You want Genomic Medicine? Then call congress to pass GINA. You want the power of whole genome sequencing? Then fund sequencing technologies. You want better testing and more evidence behind them? Then get tested through your physician. But if you want status quo, be scared of genetic discrimination, buy online tests to perpetuate the fear, hide those results from your provider, AND believe that your genes are your full fate. This is the uninformed path we have laid out in front of us. Please join me in switiching paths.