February 11, 2020
Non-communicable diseases (NCD) such as
cancers, diabetes, heart and chronic lung diseases, account for 40 million
(70%) of the world’s 56 million annual deaths. Practically half of the people
who die from these often-treatable illnesses are under 70 years of
age. While some lack access to care, is that the primary reason so many
are treated when they are seriously ill? The answer isn’t necessarily drug
costs, hidden hospital charges, poor medical care or access challenges - the
go-to villains in this current policy climate. Often, the biggest illness
to overcome is our fear: fear of embarrassment and overcoming social
disparities, stigma and what the physician might find. Fear is the
equal-opportunity culprit that may most likely delay diagnosis and prevent
early intervention.
There are countless studies that show a link
between fear of illness and avoiding care, especially as people approach middle
age, with one recent UK study showing
that as many as a third of people have avoided a doctor’s visit they deemed
necessary. Perhaps ignorance is bliss, but can we afford evasive
behaviors – avoidance – when it comes to wellness and wellbeing? The data
show that we need to reorient to one of the biggest challenges – overcoming the
neglect driven by “fear of finding out,” because it is costing us trillions.
According to a study in the American Diabetes
Association journal Diabetes Care, the economic burden associated
with diagnosed diabetes, undiagnosed diabetes and prediabetes, and gestational
diabetes mellitus topped $400 billion three years ago. While those with
diabetes require active treatment, $43.4 billion was associated with
prediabetes. For the 84 million US adults with prediabetes, the
annual economic burden is $500 per person, according to “The Economic Burden of Elevated
Blood Glucose Levels in 2017: Diagnosed and Undiagnosed Diabetes, Gestational
Diabetes, and Prediabetes.”
When we look at health care costs, the
bullseye seems to be drug costs. But Merck CEO Ken Frazier in
answering a question at the Forbes Healthcare Summit about cancer drug costs
hit on a target we need to address beforehand:
“The most important thing for us to have a
holistic view of value is to have a holistic view of cost, because when you
look at the cost of the natural disease, it’s actually cancer we can’t afford.”
Independent data seems
to back up Frazier’s approach. The estimated cost-savings from
earlier cancer diagnosis and intervention – breast, lung, prostate and
colorectal cancers and melanoma, which account for more than 50 percent of the
newly diagnosed US cancer patients – reaches the billions.
Here we find a bigger challenge. By
seeking to find convenient villains, we miss the bigger picture. Our
primary preventive care system is unraveling into convenient pop-in clinics at
pharmacies and mega stores to address quick symptomatic issues. It’s
likely at point-of-purchase health locations that we treat without time to
explore or follow-up on underlying causes of illness. These new centers of “urgent
care” provide what the market demands - service and immediacy, but time will
tell whether this new path to access translates into better preventive
care.
What would happen if early, regular screenings
were part of a national health policy of reducing late-stage (and expensive)
disease diagnosis? The earlier intervention this would enable would save more
lives and drive down costs, and we wouldn’t need to turn to more expensive
therapies except as last resorts. More importantly, when people see these
unusual physical signs and symptoms – lumps, bumps, soreness, faintness,
persistent sniffles – we need consumers to make an appointment with their
health professional and secure the emotional support necessary to pursue an
answer. Tacitly encouraging a generation to be the ostrich with its
head in the sand is not a preventive disease policy we can afford.
Along with their studies in chemistry,
biology, physiology and medicine, healthcare professionals require training in
providing consumer emotional support. Providers and their office staff
need continuing medical education in the psychology of care, and they should
receive the reimbursement support necessary to make time and investment in
patients’ mindsets a central focus of primary prevention. Along with
patients’ friends and family who have faced similar health concerns, health
professionals on the frontlines of care must break the deadly cycle of
“avoidance.”
There are physicians who are amazing at
communicating with patients in difficult circumstances. These medical
heroes are top-flight clinicians who rely on their medical knowledge as a
foundation for next steps. However, what makes them great is how they
connect with their “patient customers” as partners in the care
process. These healers should be the standard for others to
emulate. By lowering emotional and fear barriers, we will find the
greatest solution to reducing medical costs and increasing survival may be
encouraging people to engage in own self-care.
Somehow, we must face the biggest burden in
human life and cost – our fear of a diagnostic label. Nelson Mandela
offered counsel to our health ecosystem partners – patient advocates, payers,
product innovators, policymakers and providers – who are all dedicated to
improving and sustaining people’s lives:
"Courage is not the absence of fear, but
the triumph over it. The brave person is not one who
does not feel afraid, but who conquers that fear."
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