Dr. Kevin Most: New studies and budget bill
The new budget bill was passed and it will have an impact on the health of the US. The law had a lot of notoriety about the tax cuts to individuals and appeared to be the main focus but the ripple effect will be felt beyond our paychecks. The new bill eliminates the individual mandate portion of the ACA. This eliminates the fine for not having health insurance. What many think will happen is it will destabilize the already shaky individual market. It will certainly cause an increase in premiums, as many of those who will decide to go without insurance are the young healthy which are needed to balance the cost of the ill. Estimates are that somewhere between 5-13 million may go without insurance, this may cause many insurance companies to get out of the marketplace business. This will force less choices and higher premiums. Remember many areas of the country have a single option in the marketplace.
Probably the bigger concern is what may happen later. Many economists are predicting an increase in the federal deficit which may impact cuts in Medicare, Medicaid and other public health services. Medicare and Medicaid account for 30% of the federal budget and thus any increase in the deficit will have these programs on the radar for cuts. Remember also that Baby Boomers are hitting the Medicare books at a rate of 10,000 per day. It is not clear what will occur but many speculate that the options include increasing the age of eligibility for Medicare from 65 to 67, increase in the cost sharing or reducing benefits. The decreased pay to hospitals will also impact the health of communities as the razor thin margins of most hospitals will be shaved even more. This will limit hospitals from reinvesting in the tools needed to care for those who present for treatment.
These possible cuts have a double impact, not only is there less money spent on healthcare, but patients will be receiving less care for chronic illnesses that will have catastrophic consequences. I have said it before, it costs pennies to control blood pressure each day for many patients, it would cost millions to care for the patient who has the devastating stroke due to not taking their blood pressure medication. Now place them in a hospital that has not been able to reinvest in the equipment or staff needed and the impact now becomes a reality to actual patients.
The impact on the economy is even larger as working individuals will see a decrease in their productivity be it from the uninsured with illness to those insured but will be needed to care for their senior parents.
It was unfortunate that this was pushed thru so quickly and with a main focus on income tax. The implications of this law will be felt beyond the tax cut.
In the past we have tried to share new updates on screening or treatment for many illnesses. We struggle everyday as we try to find ways to identify illness earlier and that we find new ways to treat or prevent illness. The treatment we are looking for is, more accurate with less side effects, yet as good if not more effective as the current treatment. With the screening we are looking for noninvasive or minimally invasive ways to identify a illness early before it has an opportunity to spread or cause damage. These areas are all done by brilliant physician scientists across the country, a lot of work is actually done here in the Chicago area where we are blessed to have 4 major research and teaching hospitals as well as dozens more that participate in clinical research for many different diseases. We should all thank those courageous individuals who have a disease and have decided to participate in a clinical trial so that others in the future will have improved treatment options.
I thought I would touch on two areas that are new and should be of interest to all of us. One we control and one we can participate in.
Let’s talk about the one we have some control over. A study that came out in the well-respected journal Lancet last month, shares the impact that obesity and diabetes has on Cancer. This was a large study that went on over a 10 year period from 2002 to 2012. It looked at patients in 175 countries and looked at the data from over 14 million cancer patients. In most countries and hospitals, we have what we call a cancer registry. This is a data collection area that allows data to be collected in a uniform way so that comparisons around prevalence can be studied from many different angles. Age, sex, race, geography, life style the list goes on. This data allows us to extrapolate predictions and risk factors for many types of cancer.
The study reported in Lancet shares with us that obesity and diabetes are in fact risk factors for a few cancers. It found association with obesity alone like colon cancer, breast cancer and kidney cancer. It also found some associated with both diabetes and obesity like colon cancer, gallbladder cancer, liver and pancreas cancer. These were not the only risk factors but they played a role as the rates were much higher in individuals with obesity and diabetes than those who did not have those conditions yet ended up with the disease.
The reason to bring this up is that for many of us weight loss is an option. With diet and exercise many of us can lose weight. This weight loss is good not only to lower our chance of cancer but it also lowers our chance of Type 2 diabetes and lowers our risk of heart disease. The data point they used was a BMI of 25 or lower. That is a good goal for all, however improvement in a downward trend will help even if you do not hit 25. Diabetes risk rises fairly sharply with a BMI of over 35. If you don’t know your BMI there are calculators if you Google it. Working on your weight can impact your life in more ways than you can imagine.
Now let’s discuss something you can participate in that will make an impact for generations to come. We know we have far too many diseases that we don’t identify early or treat well. We shared above how important it is to have data to look at when we find disease to see if we can identify causes, often this is difficult as the information is fragmented, in many different places and not complete or uniform. A country wide study is kicking off that will accelerate research and improve health and we are looking for at least one million volunteers to join. Most of the time we discuss recent studies it is focused on a disease that has already occurred and we are looking at a single disease and how to identify it earlier or treat it better. This program will have a much wider and deeper scope to illness and treatment
The study kicking off here will be open to all over the age of 18, healthy or ill, urban, suburban or rural. The goal is to gather data on individuals in all stages of life and in all environments, in all stages of health, and use that data for precision medicine. Collecting data correctly in this population will allow it to be used beyond a single illness, beyond a specific age group or population. The goal of collecting organized data will allow it to be used from cancer all the way to the common cold. It will allow researchers to organized data they have never had before and will make an impact on the health of the world for generations to come. It will allow doctors to make more precise decisions in their care plans.
So what is it, the program is called “All of Us” and it is a research program that has been in the preparation stages for many years and will soon begin. It is organized and funded by the NIH, National Institute for Health. It is about using data to move to precision medicine. The goal is to have data collected on one million individuals across the US. To put this in perspective, much of the data we have about heart disease and treatment for it, came from a study that is still going on called the Framingham Study. That study named after a small town in Massachusetts, it had 5,200 individuals and a narrow focus on heart disease. This program will have 1 million individuals from many environments and a focus that is not limited to one disease. With great data, recommendations will be made for treatment of illnesses based on environment, lifestyle, biologic make up including genes. This will allow us to predict which treatments and prevention strategies will work best. That is Precision Medicine.
Let’s take an example. You have high blood pressure and despite exercise and weight control, you need to be placed on a medication to lower your blood pressure. Now we have some data which may give us a slight advantage to choose a medication based on a few things like race or sex, but what if we had data that said, based on the data points from 250,000 individuals, this is the best medication for you at the lowest dose that will control your blood pressure with the least side effects. Or better yet what if we said based on the data we have we predict you will have no side effects from this treatment. That is the goal of this study, no longer would use just data from drug company studies on a smaller population, we would have data that takes into consideration a lot more than simple response to a medication.
Another good thing is it will hopefully lead to better commercials where the list of possible side effects actually scares you from taking the medication at all.
This program will allow researchers to look beyond a single disease, it will open up opportunities for this data to be used by many for many conditions. The importance of good quality data captured in a standardized way will allow for the advancement of treatment and screenings that will impact health care for generations to come.
Let’s take another example, we have discussed in the past the rise in colon cancer in individuals under the age of 50, recently we discussed Eddie Olcyzk and his current fight with cancer at the age of fifty. Although the vast majority of colon cancer patients develop the illness after the age of 50, we have seen an increase in those younger. However those cases are scattered across the country, in many health systems and all with data in different silos Think forward now and with the million individuals in this study, it will allow a researcher the ability to pull out those with colon cancer under the age of fifty and look for data that will lead them to a conclusion to screen some specific individuals sooner. This would allow earlier identification in those that need it versus screening every one early with low yield. The data will be standardized and in a single site so the researcher is not working with incomplete, fragmented data, this is what will advance medical care faster.
How can you get involved, become a partner!! They do not see the volunteers as subjects in the study they see them as partners working towards a goal. Partners will be asked to fill out a questionnaire about their health history, lifestyle, environmental exposure. They will be asked to go to a local enrollment center where some basic information will be collected as well as some blood and urine. If you participate you will be given your test results as well as a summary of the national results. You will choose if you want to share them with your doctor. Your data will be protected by numerous safeguards. For example not only will the data be encrypted but the results will be separate from the other data collected
You can find more information at the website, www.allofus.nih.gov . It is important to use the NIH website as the web site www.allofus.org is actually an anti-Trump website. You will be hearing more as this is expanded in 2018, and partners are being sought out. Northwestern Medicine is currently one of the active collection sites in Chicago. If you want to participate now you can go to www.nm.org/joinallofus to learn more and sign up. The goal will be to have multiple collection sites in the Chicago metro area and to sign up over 100,000 here locally over the next few years. Other systems in Chicago area that will be participating include UIC , University of Chicago, Rush and NorthShore. Hopefully the Chicago Metro area patients will stand up and participate in this great program.
This is something simple you can do to help the health and wellness of generations to come.