Is the disease ideology driving healthcare costs? Check out this new paper published in the JAMA.
The most costly diseases in the USA according to the JAMA (Journal of the American Medical Association) article includes diabetes, ischemic heart disease and lower back pain. These costs have increased dramatically from 1996-2013.
Are the diseases the problem or is the definition and the way we classify and treat diseases the problem. Are they a pathology, or a group of pathologies and is our approach to diagnosis or our treatment of the symptoms we call the disease part of the problem?
According to Wikipedia, ”
A disease is a particular abnormal condition, a disorder of a structure or function, that affects part or all of an organism. The study of disease is called pathology which includes the causal study of etiology. Disease is often construed as a medical condition associated with specific symptoms and signs. It may be caused by external factors such as pathogens, or it may be caused by internal dysfunctions particularly of the immune system such as an immunodeficiency, or a hypersensitivity including allergies and autoimmunity.
In humans, disease is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases can affect people not only physically, but also emotionally, as contracting and living with a disease can alter the affected person’s perspective on life.”(1)
Are these things we classify as diseases the reason the series of symptoms occur?
For example, back pain can have a number of causes, but diagnosing back pain as the problem is clearly missing the fact that there can be numerous mechanical pathologies behind the problem, and as a society we have a poor record of treating the condition of back pain. Earlier today, I spoke with a man who had seen numerous healthcare providers who diagnosed neuropathy, a very generalized diagnosis and was offered treatments that have thus far not offered any relief, yet he found numerous healthcare providers who offered numerous treatments aimed at the symptom, rather than the cause
Diabetes is another problem plaguing our society, which may have links to the fat free craze which replaced healthy fats with sugar as well as the many sweeteners we enjoyed in the past. Currently, the method is toward treatment of the sugar levels, however, diabetes may have other systemic causes not being addressed by the healthcare system, with balancing sugar levels being the current approach to the problem. What is not formerly embraced is the mechanism behind why diabetes exists, which some complementary providers report they have treated successfully by treating the dysfunctional system of sugar regulation, rather than just using insulin.
The growing costs of treating disease may be more about our approach to diagnosis and treatment, which is usually drug based, something that disease classification opens the door to.
This current JAMA article is merely a symptom of what is wrong. Check it out here
December 27, 2016
US Spending on Personal Health Care and Public Health, 1996-2013
Joseph L. Dieleman, PhD1; Ranju Baral, PhD2; Maxwell Birger, BS1; et al Anthony L. Bui, MPH3; Anne Bulchis, MPH2; Abigail Chapin, BA1; Hannah Hamavid, BA1; Cody Horst, BS1; Elizabeth K. Johnson, BA1; Jonathan Joseph, BS1; Rouselle Lavado, PhD4; Liya Lomsadze, BS5; Alex Reynolds, BA1; Ellen Squires, BA1; Madeline Campbell, BS1; Brendan DeCenso, MPH6; Daniel Dicker, BS1; Abraham D. Flaxman, PhD1; Rose Gabert, MPH1; Tina Highfill, MA7; Mohsen Naghavi, MD, MPH, PhD1; Noelle Nightingale, MLIS1; Tara Templin, BA8; Martin I. Tobias, MBBCh9; Theo Vos, MD1; Christopher J. L. Murray, MD, DPhil1
Author Affiliations Article Information
JAMA. 2016;316(24):2627-2646. doi:10.1001/jama.2016.16885
How Can the United States Spend Its Health Care Dollars Better?
Ezekiel J. Emanuel, MD, PhD
Spending on Children”™s Personal Health Care in the United States
Anthony L. Bui, MPH; Joseph L. Dieleman, PhD; Hannah Hamavid, BA; Maxwell Birger, BS; Abigail Chapin, BA; Herbert C. Duber, MD, MPH; Cody Horst, BS; Alex Reynolds, BA; Ellen Squires, BA; Paul J. Chung, MD, MS; Christopher J. L. Murray, MD, DPhil
Modeled Estimates of US Health Spending, 1996-2013
Importance US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time.
Objective To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care.
Design and Setting Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis.
Exposures Encounter with US health care system.
Main Outcomes and Measures National spending estimates stratified by condition, age and sex group, and type of care.