May 6, 2015 in Home, Home
OP/ED by Kimberly Lord Stewart. I received a press release on a social media
survey of 2,000 doctor’s opinions on Mehmet
Oz, MD, from a social media polling company called SERMO. Even
for social media, I was struck by the level hostility from Oz’s highly educated
peers. Quack and a
new kind of Turkish Delight were
among the derogatory Twitter comments on whether he should retain his position
at Columbia University and/or even keep his medical license.
Granted social media is the dumping ground for snarky comments that few would
ever say to anyone’s face, but one comment was particularly telling:
I see Dr Oz discuss nutrition-related topics, I am saddened by his turn to the
I don’t discount that Dr. Oz has made some mistakes, for which he was called on
the U.S. Senate’s blue carpet. But, is the clash between the way doctors
practice medicine so polarizing that teaching good nutrition is
now considered a black mark on one’s credibility?
Given the polarity, it isn’t surprising to hear of the glum comments on the
future of personalized medicine in Lancet from Dr.
Victor Dzau, president of the US
Institute of Medicine (Personal
View, Lancet, May 7 2015).
Dzau said though patients could dramatically improve health and productivity,
there are few incentives to develop widespread practices that would reduce heart
disease, diabetes, high blood pressure and stroke. He was commenting on data
released by the University of Southern California Schaeffer Center for Health
Policy and Economics, which found that personalized medical interventions to
prevent heart disease, diabetes and cancer could generate $773 billion worth of
heath gains in United States. This massive dollar figure wasn’t only for
targeted therapies, but also for identifying those at highest risk of
developing a disease and finding preventive measures.
The dollar figures refer to a health simulation model study—developed by
Professor Dana Goldman, Director of the University of Southern California
Schaeffer Center for Health Policy and Economics, Los Angeles, USA— which uses
screenings and risk prediction technologies to identify individuals at highest
risk of developing specific diseases. The model predicts the monetary value of
health, ie years of healthy life, which are generated by PPM interventions. For
instance, it scored reduction of the incidence of six diseases (cancer,
diabetes, heart disease, high blood pressure, lung disease, and stroke) in the
US population by 10% and 50% between 2012 and 2060 if PPM were implemented.
Now the really disturbing news. While preventive PPM innovations hold huge
promise, Dr. Dzau says there are few incentives to develop them. “The current
reimbursement environment in the US health care system is characterized by
near-term budget pressures, and discourages the development of preventive,
personalized, and precision medical interventions in favor of treatments that
generate less value overall, but provide greater returns in the short term,”
says Dr Dzau.
A PPM intervention plan that reduces the incidence of these six diseases by 10%
would generate $96 billion from diabetes and $70 billion from cancer in the form
of longer, healthier lives over 50 years. A PPM innovation that reduces heart
disease incidence by 50% would generate a staggering $607 billion in improved
health over 50 years.
Practitioner, we tallied up some additional numbers in the slideshow below
on how lifestyle changes and PPM could improve patients lives, reduce costs and
improve productivity. All of these numbers are from studies collected at the
Surgeon General’s office.
The study by Professor Goldman suggests that reimbursement based on a test’s
value, rather than cost, could strengthen manufacturers’ incentives to bring
preventive PPM diagnostic tests to market more quickly. “In the USA, private
insurers’ incentives favor interventions with immediate benefits and short
payback periods. But the real benefits of PPM innovations accumulate over a much
longer time, as individuals enjoy living longer in good health. Our predictions
show that developing a model that generates positive returns for private payers
could benefit everyone,” the study says.
One has to ask if the demand for greater returns is any less troublesome than
Dr. Oz parsing out medical and nutrition advice on his show? For once, Americans
are actually taking an interest in their health. In light of the harsh criticism
following the television doctor, it seems there is much more work to be done on
how prevention is perceived and practiced. Then and only then can American
healthcare move toward a PPM model that puts prevention first and profits last.
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Materials provided by Lancet, for access to the abstract and full article, click