December 7, 2007

Early Diagnosis And Treatment Of Medical Conditions

Having just recently attended a meeting at the Boston University Alzheimer’s Disease Center, which I find to be exceptionally entrepreneurial, collaborative across many disciplines, departments, and even schools, and innovative, I am struck by the huge opportunity our health care system has available by focusing on good genetic risk assessment, prevention screenings, and early diagnosis and treatment for medical conditions.

We have made considerable progress over the last 20 years in covering preventive screenings in health plans, and in publicizing the importance of screenings such as mammograms for breast cancer, colonoscopies for colon cancer, and Pap smears for cervical cancer. We also are getting more people than ever to test for blood sugar to test for diabetes.

However, we still have too many medical conditions that go undiagnosed until it is either too late to treat them, or prohibitively expensive to do so. The investment in early diagnosis for many treatments is hugely positive for a health plan. For example, I learned that a diagnosis of breast cancer at Stage 1 results in a $1,500 per month treatment cost. A later-stage diagnosis results in a $9,500 per month treatment cost. The HealthCheckUSA blog provides more details about the specific benefits linked to health screenings of all kinds.

Furthermore, some experts believe preventive health screening should start with children, as pointed out in Boston’s WBUR Weblog.

But even before diagnosis is the process of determining when an individual is at higher risk. Genetic risk assessments have been around for a while, but the medical community generally did not share the results with the individuals studied. What I have learned through both Boston University and my own reading is the recent significant growth in the movement toward not only doing genetic risk assessments for individuals, but sharing the results with them. In November, The Wall Street Journal Health Blog highlighted different companies working to provide these genetic assessment tools to the general public. The blog questions whether or not this technology is ready for widespread use and asks readers to evaluate the cost.

With respect to Alzheimer’s, Boston University and other centers of excellence, as well as many other great research centers, continue to find ways to get better predictability on the risks of an individual getting Alzheimer’s later in life.

What does a person do with this kind of knowledge? At a minimum, there is an emerging consensus that engaging in general healthy behaviors and focusing on particular kinds of diets will reduce the risk of getting Alzheimer’s or, at least, delaying its onset.

Beyond engaging in healthy behaviors, a person at greater risk of Alzheimer’s is probably going to want to get a memory assessment done earlier than others might. Memory assessment clinics are operated by a number of different medical organizations, including Boston University Alzheimer’s Disease Center. The good news is that the research community tends to believe that earlier diagnosis and earlier treatment will eventually pay off in slowing the progression of this horrible disease, and potentially reversing it at some point in the future. A Duke University research study cited in Head Strong blog adds credibility to this theory.

The discouraging news on preventive screenings and on memory assessments is that, even when coverage exists, the penetration rate of these screenings, compared with the population that should be getting them, is very low. There are many reasons:

  • In some communities and for some population sectors, awareness of the need for screenings is low.
  • In other cases, there is limited availability or the availability is inconvenient or too costly.
  • Health plan reimbursement levels, including Medicare and Medicaid, do not make doing these screenings particularly lucrative for primary care providers.
  • In still other cases, there are cultural obstacles to getting screenings. For example, we know that messages to women of certain ethnic or religious groups on why they should get cervical cancer screenings have to be carefully crafted and delivered.
  • There also exists concern about privacy and the loss of health and/or life insurance coverage if a genetic predisposition is identified. It is important for policy makers and elected officials to build and strengthen legal protections against discrimination for people identified as genetically at risk for a particular health condition.

I continue to be frustrated by the relative lack of attention in the presidential campaign to the value of preventive screenings. Most of the candidates are talking about them, but they are doing so as a subset of a broader message about insurance coverage. If we do not address the healthy behaviors, screenings, immunizations, and health care access issues, broader coverage, even if it is affordable, will redistribute the progressively larger health care burden and bring the whole health care system down.

Alzheimer’s, in particular, deserves a lot more of our attention. Behind cancer and heart disease, it is the highest-cost medical condition, and it will get worse, given the fact 330 Americans are turning 60 years old every hour, among our baby boomers, and, at least today, over 50% of those of us who reach age 85 will have Alzheimer’s disease.

There are a lot of very exciting developments in the Alzheimer’s arena. I am very proud to be associated with the exciting work Boston University Alzheimer’s Disease Center is doing in this space.