One Fifth of GDP!

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"

From: Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare

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.

Be Ready Ad and Pat Sajak

That's right I saw the Be Ready Ad in between Vanna and Pat. The Sherpa is a "Wheel Watcher" I am always amazed with people. My mother-in-law was sitting with me and she said "Should I get this test?" I said "Wha???" She said, "Will it let me skip mammograms?" I honestly was blown away by this. Especially because she is a nurse. If you are a nurse, you should be health literate.

Unfortunately, she is not genetics literate. I then went to give her my counseling shtick and tell her that no one in her family has breast/ovarian cancer. "So why does that lower my risk?" she asked? This is why Ellen Matloff has her website. I am certain that this testing has identified many people not normally thought to be at risk because of limited family structure i.e. all men relatives (But they still could have prostate, pancreatic, or even breast cancer)

The real question is, what will happen when 23andMe advertise? What about Psynomics?
I am preparing a talk for the Fairfield County Medical Association. What is it about? Well, I would love to have talked about the benefits of genomics. But the pressing topic for community physicians is "Personal Genomics and Liability for the Community Physician"

I had a physician come to the office the other day, she had heard me speak at her hospital's medical staff meeting. She said "The other day when you and your counselor spoke to us, I have to admit, I had no clue what the hell you were talking about" "But now I think I know what you were warning us about." She then handed me a 40 page set of a patient's testing done at Canyon Ranch.

The genetic testing done included such hot buttons as CYP 450 testing billed as "Detoxification Panel" and the loaded APOE testing. It began to finally sink in. These physicians have no clue what is coming. I could spend my days running from hospital to hospital preaching like Cassandra or I could create something just for them.

Anyone interested in helping please send me an email.

I said....."Well, there is certainly alot here." Has anyone seen this Canyon Ranch panel? The interpretation was done by a very nice physician. Clearly not a geneticist, nor an internist. But he told this 30 year old female patient that she needed a Coronary CT Angiogram. This in my humble internal medicine opinion is a little bit of overkill. Despite this testing, no where on the report was a significant family history. Her family history? According to this PMD...it includes longevity. Both parents into the late 90s. My professional opinion, barring trauma or accident, she'll live long enough to pay for all sorts of bogus screening tests.

When looking for this testing on Google, I only found 3 links! Turns out it is Great Smokies/Genovations behind the testing. Canyon Ranch has these pages hidden on their site. I hate to tell everyone, no matter how many poor studies you put behind a test, you still have poor studies and a poor test. It hesitate to point out that not only is Canyon Ranch involved in this testing.....so are some casinos.

Back to my point....Which is....Physicians will only wake up when a patient walks in their door and puts them at liability/malpractice risk. This is especially troublesome when I am trying to point out how they are actually LESS at risk when they appropriately refer to genetics/genomics services and not to Casinos.

The Sherpa Says: Getting these resort testing panels is a lot like playing craps. Put your money on the pass line and roll the dice. You may get something worthwhile, you are more likely NOT to. That's why the house always wins! These tests only stand to confuse and lead you off the trail of truly personalized medicine.