Is a world without disease possible?
That was the question posed by a meeting held at The Royal Society of Medicine in London last month.
I hate to be a killjoy – but the answer is ‘No’. A world without disease would be a world without death.
I’m sure the organisers of the The World Without Disease Summit realise this.
So, maybe the real question is this: “Can we create a world where we stop people getting ill for as much of their lives as possible?”
Granted, it’s not as snappy. But it is a much more serious proposition, because it’s achievable – in theory at least.
That’s not to say it’s easy though. Prioritising disease prevention over treatment never is.
Immunologist Dr Francisco Leon, co-founder of Sanofi company Provention Bio, talked about how auto-immune conditions like Type 1 diabetes and lupus could be prevented in the future by intervening early in the course of disease with new drugs.
Daniel Zakowski, CEO of US allergy prevention firm Ready Set Food, gave an enthusiastic account of how its range of products can help prevent children from developing common food allergies, based on the now proven method of exposing them to small quantities of allergens (e.g. of peanut, milk, egg etc) very early in life.
[Zakowski also gave an entertaining insight into social media strategy – describing how a silly little video they produced titled “This dad hired an interpreter to understand his baby’s stance on going to the doctor…” has garnered millions of views, while others soberly explaining the science …. have not.]
And Christine Lemke CEO of health data firm Evidation outlined the rapidly-growing possibilities for understanding health better, by analysing people’s everyday activity using data from wearables and volunteer surveys. A recent project, for instance, suggests data from wearables could act as an early-warning sign of colds and flu.
These three examples are, of course, just tiny snapshots of what’s happening in disease prevention right now, and don’t have much in common.
There was a common theme running through the day though: how can disease prevention be bumped up the agenda, when demand for disease treatment is growing all the time? Or to put it more bluntly: where is the money for better prevention going to come from?
Populations worldwide are getting older and fatter – and thus less healthy – year after year. But people are only willing to pay so much (in taxes or premiums – depending on where they live) for healthcare.
Given finite resources, would you rather your health bucks are spent on prevention or treatment?
Ken Ehlert, former Chief Scientific Officer of UnitedHealth Group in the US, put it succinctly by explaining that if you put something extra into the purchasing pot, then usually something has to come out of it. Otherwise, premiums rise. Most of the time, he said, people prefer treatments to stay in that pot – at the expense of preventative measures.
Why? Because most people view disease as something random that happens to them, like a nasty lottery, and not something over which they have much control. Under this rather fatalistic mindset, preventative measures have little value. If a disease is going to strike you, it’s going to strike you. However, if you are ‘unlucky’ enough to be struck by a disease, a treatment could save your life.
So, while preventative measures might benefit the population as a whole, treatments benefit the individual. A treatment is more concrete to an individual – and therefore more valuable.
Health economists regularly advise us that prevention is cheaper, in the long run, than treatment.
Earlier this week, the Health Foundation, a UK think-tank, published a sobering report which predicted a further 2.5 million people in England will be living with major illnesses such as cancer, diabetes and dementia by 2040 – up by more than a third on the ~6.6 million who have a major illness now. Most of this rise will be due to the ageing of the country’s population, although its growing obesity problem is a significant factor too.
Miriam Deakin, of NHS Providers, said: ‘Prevention is better than cure. More support and money for public health services are vital.’
There’s no doubt prevention is better than cure, both from a human and a financial point of view.
But where is the money going to come from, when it’s becoming harder and harder to treat those people who need it within existing budgets?
And how can we better incentivise investment in disease prevention – be that public health measures or specific new technologies like blood tests to screen for cancer – when treatment is devouring the lion’s share of the cash?
If we are to aspire to a ‘world without disease’, these are questions that urgently need addressing.