Compared to other developed countries, the US already spends the most on healthcare but lags behind in the number of years its citizens remain on the sunny side of the dirt (Avendano & Kawachi, 2014). A recent New York Times article claimed that the US society is perfectly fine with spending $150,000 to garner one more year of life, which was roughly the amount spent in 2000 to help a 65-year-old person gain that extra year (Frakt, 2019). Adjusted for inflation, that extra year would now be about $238,000. Would society still be fine with that cost?
Instead of throwing money at a system that is not really keeping us on the sunny side, perhaps we need to ask a different question. How should the money be spent to get the most bang for the buck or more days in the sun? Dr. Anupam Jena, an economist who also happens to be a physician at Harvard University, raises a very important concern (Frakt, 2019). Where we decide to spend the money is closely tied to the willingness of patients to change their behavior and getting a patient to take medication or undergo a procedure is sometimes easier than getting the person to adopt better lifestyle choices.
How can patients be better motivated to adopt lifestyle changes that would give them more time? Would knowing their risks of health problems based on genetic tests help? Probably not. A study has shown that people tend to treat this information more like a horoscope than medical advice.
Perhaps having the “right” info would better motivate people to adopt healthier choices and get more time. In a study, people considered at risk for developing type 2 diabetes underwent extensive testing (Schussler-Fiorenza Rose et al., 2019), including: surveys about demographics, complete medical history, medications, smoking habits, family history, stress, human body measurements (anthropometry), diet and exercise; oral glucose tolerance test (OGTT); steady-state plasma glucose test (SSPG); beta-cell function assessment; a test looking at hsCRP levels; a test looking at IgM levels; cardiovascular imaging (echocardiography, vascular ultrasound); cardiopulmonary exercise; a test to measure levels of cardiovascular disease markers; wear devices to monitor physiology, activity and glucose; analysis of genomes; measurement of RNA levels (transcriptomics); tests looking at specifically proteins in the immune system; measurement protein levels (proteomics); measure the levels of small molecules (metabolome); and looking the organisms in the patients microbiome. From all these data, the researchers identified 67 actionable “insights.” When presented with the information, nearly 70% of the participants implemented changes to both their diet and exercise habits.
While the study suggests that the more informed a patient is, the more they are likely to take action, there is the issue of the cost of all that testing and interpretation. Would it be necessary to perform all the tests on each individual and converse with them about the findings in order to get them to amend their lifestyle? Would this increase or decrease the amount already spent on healthcare? Is there a simpler testing path that would give the same degree of success (or even better)?
Perhaps the best value may reside in focusing primarily on the molecules involved in every aspect and every moment of our lives, which happen to be proteins. By measuring thousands of proteins simultaneously using SomaLogic® technology, people will have access to the inside scoop on what is happening in their bodies and get a trajectory of their health. Already, a team at Leeds is looking at the power of protein analysis to help people at risk for type 2 diabetes avoid the disease by adopting healthier lifestyles. It will be interesting to see the results.
If the presentation of the right data can convince patients to make lifestyle changes, it sounds like a win-win. Healthier lives and more time, but at a reasonable cost. Sounds like it would be worth it.
Avendano, M., & Kawachi, I. (2014). Why do Americans have shorter life expectancy and worse health than do people in other high-income countries? Annu Rev Public Health, 35, 307-325. doi:10.1146/annurev-publhealth-032013-182411
Frakt, A. (2019, May 20) Is Our Health Care Spending Worth It? The New York Times. Retrieved on May 24, 2019 from https://www.nytimes.com/2019/05/20/upshot/actual-worth-health-care-spending.html.
Schussler-Fiorenza Rose, S. M., Contrepois, K., Moneghetti, K. J., Zhou, W., Mishra, T., Mataraso, S., . . . Snyder, M. P. (2019). A longitudinal big data approach for precision health. Nat Med, 25(5), 792-804. doi:10.1038/s41591-019-0414-6