» Health Care Costs

The Wall Street Journal Health Blog today posted a couple of articles (here and here) on the costs and the effectiveness of preventative medicine in the US and Germany.  The articles outline that despite their high costs, preventative medicine programs do not actually help to prevent any disease such as colon or breast cancer.  In fact the article on Germany, based on research by the German magazine Der Spiegel, claims that the only people who benefit from the screenings are the doctors who are paid fees to perform the test.  For example, there are no randomized trials (the gold standard for medicine) demonstrating benefits for patients who under go regular colonoscopies.  In the US researchers looked at a prevention program performed with 200, 000 Medicare participants.  They found that it didn’t improve patient’s health and it didn’t result in fewer doctor and hospital visits and therefore less cost. 

For anyone who came to our dinner event last March these articles shouldn’t come as a suprise.  Preventative medicine is a misnomer.  It doesn’t actually prevent anything.  You could have a colonoscopy every single day for a year, but doing so would not lower your chances of getting colon cancer.  Preventative medicine is really early detection and screening.  It simply tells you if you already have the problem (this is an important role but it clouds the issue in peoples minds).  True preventative medicine is all about the lifestyle choices you make.  Each one of us has the keys to determine if we develop or don’t develop any of these chronic diseases such as heart disease and cancer.  We should be (and do in our office) advocating lifestyle intervention; that is the key to making America (and Germany) healthy, and in the process saving billions of dollars, not costly screening tests.

MSNBC just posted an article on the upcoming FDA decision to approve new pyschiatric drugs for children.

For this discussion I’m going to leave aside the questions of 1.) whether these drugs are safe and effective (many groups are questioning whether enough studies have been done to determine the long term effects of the drugs), and 2.) do children need to be taking them or is there a better way to help them?

Just like efforts to promote Lipitor for children, we are again seeing drug manufactures attempting to push medicine designed for adults onto younger and younger children.  This time it is a drug that many studies show has no greater effectiveness, or less side effects, then current drugs on the market.  What is the motivation behind this push then?  Well these older drugs were first developed in the 1950s, meaning that they can be bought as generic.  The cost for them is around $100/month.  The newer drugs cannot be bought as generic, they sell for between $300/month and $500/month.  These drugs had combined sales of $14.6 billion last year.  With approval for use in children that number could conceivably double.  My question is what motive beyond money could there be to approve new drugs (that haven’t been long term tested, even beyond 6 weeks) for children, and promote there use over older, known drugs when there is basically no difference in effectiveness between the two?

If these new drugs are approved by the FDA, there are two groups of people I feel sorry for.  The first, of course, is the children who take it, especially if these drugs turn out like so many others who are not properly tested (or are and those test results are buried), and have dangerous long term effects that we don’t know about now.

The second group is the doctors who perscribe these drugs.  In many cases all the information that doctors receive about a drug, its effectiveness, side effects, etc.  are from the manufactures themselves.  Most doctors, especially general practitioners, simply do not have the time to do due diligence and study every single drug they prescribe.  There are too many.  They are forced to rely many times on marketing materials they receive from drug reps, whose job it is to convince the doctors to prescribe their medication, in the case of these psychiatric drugs cost 2-3 times more but show little to no increased effectiveness.  For a more indepth view of the lengths that drug reps go to sell their products check out this article from ABC News.  It interviews a former rep for Eli Lily who sold Zypraxa, one of the drugs we’re discussing here.  He describes the lengths he went to sell doctors on drugs.  In another article a chiropractor from Michigan posts a blog describing his interaction with some pharmaceutical reps.

In the end we all pay the price if these drugs are approved.  The children who take them unknowingly face the unknown consequences of long term use of these drugs.  We, the public, have to pick up the tab on the increased cost of using these medications over the ones currently prescribed.

Update:  The panel voted to OK the psychiatric drugs just a couple hours ago.  The FDA doesn’t have to take the recommendation, but does anyone think that they won’t?  Again, there is too much money riding on it for them not to.  Don’t forget, many of these same folks who determine supposedly impartially determine what drugs get approved eventually leave the FDA to work at the drug companies themselves in high paying positions.  They definitely don’t want to endanger that golden parachute.

In a completely related note, the Wall Street Journal reports another research psychiatrist has been accused of not disclosing the fact that he receives money from the drug company, GlaxoSmithKline, which make the drug Paxil.  He was researching on a NIH grant the effects of Paxil on pregnant women.  /sarcasm| I’m sure that GSK was paying him out of the goodness of their heart and expecting nothing in return in regards to his research, even though it could be worth billions to them if her returns the “correct” outcome. /sarcasm\

For our first look at ways to save money by preventing America’s Most Expensive Health Conditions we are going to take a look at number 9 on the list - Back Problems. It is estimated that 32 billion dollars was spent on the care of back problems last year including 17 billion on outpatient and 8 billion on inpatient medical care.

Like many conditions there are a numerous ways to maintain the health of your body to prevent low back pain. One simple action, of which their are numerous programs and resources available, is exercise, specifically core stabilizing exercises. These exercises, which can be performed in the home, help to protect the lower back by preventing improper and promoting proper movements of the spine. The savings of this type of exercise are demonstrated in a study by the University of Florida with the Brooke Army Medical Center. It found that soldiers that utilizing a simple low back stabilization program had a 40% less rate of back pain over soldiers not using the program. This resulted in a savings of over 4 million dollars over the 4 year period of the study.

The best way to prevent lower back pain is to maintain the health of the joints and nerves of the spine with chiropractic adjustments. Most of the time back pain is the result of a chronic problem which builds over weeks, month, even years, until it reaches a threshold where pain finally occurs. The problem is there long before the pain starts. By intervening in the early stages of this process we can much more quickly, easily, and cheaply fix the problem, and then address the lifestyle issues that cause it, rather than waiting until it becomes much more serious.

Chiropractic care has been shown to be the treatment of choice for low back pain for both success rate and cost effectiveness. A study published in the Archives of Internal Medicine, looked at the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal specific utilization of health care resources within a large managed-care system. This study found that individual members with chiropractic coverage had a 12% lower annual medical care cost than those without it. The researchers concluded that access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Some additional findings included:

• Back pain patients with chiropractic coverage had fewer inpatient hospital stays than did those without chiropractic coverage (9.3 vs 15.6 stays per 1000 patients).
• Patients who had coverage for chiropractic care for back pain had fewer magnetic resonance imaging tests compared with those without chiropractic coverage (43.2 vs 68.9 magnetic resonance images per 1000 patients).
• The rate of lower back surgery among patients with chiropractic coverage was lower as well (3.3 vs 4.8 surgical procedures per 1000 patients).

The key to back pain, like most health conditions, is to take an active role in your health. Don’t wait until you are in pain or are sick, do something to help yourself now!

As the uncertainty of the economic crisis continues, many of us are being forced to cut our expenditures and look for places to save money. For many people one of the first things to go are healthy lifestyle options such as gym memberships, trainers, fresh (organic) fruits and vegetables, well checks at the doctor, etc. A recent article by Forbes outlines exactly why this is the wrong way to approach saving money. It details the 10 most expensive health conditions is the US. They are as follows:

1. Heart Disease - Estimated Spending $76 Billion
2. Trauma Conditions - $72 Billion
3. Cancer - $69 Billion
4. Mental Disorders - $55 Billion
5. Asthma and COPD - $53 Billion
6. Hypertension - $42 Billion
7. Diabetes - $34 Billion
8. Osteoarthritis - $34 Billion
9. Back Pain - $32 Billion
10. Childbirth - $32 Billion

What do 8 out of these 10 conditions have in common? They are all determined in a large part by your lifestyle! Outside of Trauma and Childbirth (I suppose you could include Childbirth as a lifestyle condition, but I’d say it’s a good one) you have control over your chances of suffering from one or more of these conditions.

What does this have to do with saving money? Over 50% of all bankruptcies in this country are due to medical expenses (and the majority of those are by people who have health insurance). By choosing to eliminate health promoting activities from your life in an effort to save money, you are actually costing yourself money in the long run by increasing the chance you will have one of these super expensive conditions. You can look at it like a retirement account, a little bit of investing in yourself now will pay big dividends in the future.

Over the next few weeks we’ll look at each of these conditions and talk about ways you can approach your lifestyle to prevent them.