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A Better Chronic Disease Approach -1

There is much talk about a parallel health system. This adversarial approach will probably not get very far because the U.S. healthcare system is the largest industry in the world. Instead, we must play "nice" and support the existing system - at least on the surface.


How do we do this while integrating into the "standard of care?"


There are a couple of ways, but the one I will focus on is by using evidence. I know "evidence" as a tool for persuasion is overrated. However, a statistician told me that the movement can grow organically if we flip 2% of the population (doctors, patients).


I am working to obtain non-controversial terms for this movement. My thinking is along the lines of "chronic disease early interventions."


 

The science

Acute diseases come on suddenly. Examples are a broken leg or other type of trauma. There is no incubation period as the "disease" or medical problem has an obvious and sudden source.


Chronic diseases may appear to come on suddenly, too. However, this conclusion ignores the basic principles of nature. For example, our climate makes a gradual shift from summer to winter. Someone who wants to sprint the 100-yard dash does not run it in 12 seconds without training. Changes or improvements take time. Importantly, making even minor improvements when nearing the limits of human capabilities takes tremendous effort. Whereas, the same time gain at the beginning of a training program is easily achieved.


The classic experiment is the growth of bacteria in a petri dish.

"When we modeled the initial growth of the bacteria V. natriegens, we discovered that an exponential growth model was a good fit." Exponential = log-linear.



The red "x" is true log linearity. The blue dots reflect a diminishing supply that limits the growth rate in this case. This same trend probably holds true for chronic diseases, the development of which is initially log-linear but may be impacted by any number of physiological factors, including diffusion, nutrient supply, and the action of our immune system.


Regardless, the point is that disease onset is not sudden; it only appears so when the "population density" of the disease reaches some threshold. The dotted line represents this threshold. Below the dotted line, thus, earlier into the disease process, signs and symptoms of the disease may not present.


Our current healthcare system operates predominantly in the "symptoms" domain concerning chronic diseases.


Interestingly, the area associated with "Asymptomatic" is approximately 9 times greater than the "Symptoms" area. Note what our CDC says about chronic diseases.


"The Centers for Disease Control and Prevention (CDC) estimates that 90% of all health care costs in the U.S. go toward treating chronic disease and mental health."


Here are a few slides that help make the case that healthcare needs to devote more effort within the asymptomatic area.


  1. 60% of American adults have it least one chronic condition. And the percentage for our youth is around 40%. That means devoting efforts to curb chronic disease in the general population is NOT a waste of time. One in two people coming for a clinical visit have a chronic conditions.


2. The existing model for healthcare delivery has failed as evidenced but the short and declining life expectancy of Americans, especially when compared to citizens in other developed nations.



3. The projections for future chronic diseases are grim. These projections reflect an understanding that our polypharma approach is NOT reducing chronic disease. In fact, the opposite could be argued.




I recently wrote about Ozempic and projections in obesity and diabetes. Despite this drug that is supposed to reduce the incidence of both, projections for both these conditions are expected to rise - guess how - log linearly.


 

A logical and tenable solution.


A step in the right direction is to adopt a narrative that we are NOT either health or sick. Instead, we all reside somewhere on a health-disease continuum. This model affords many advantages or the existing one as it both:

  • preemptive, and

  • efficient with respect to medical resource allocation.



More blogs to come on this topic.


 


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