Tuesday, April 20, 2010

Getting the picture

In discussing the cost of geneticizing complex common diseases, a colleague quipped a few years ago that it would be cheaper to hire a personal trainer for every diabetic than to continue the kind of research that has been going on in relation to this disease. It was a joke, but it wasn't funny because, seriously it is the right idea.

And believe it or not, our nation's less than noble citizens, the health care industry, might be catching on. A story in the NY Times says that UnitedHealth Group is teaming up with the YWCA to implement a lifestyle program--diet and exercize--to reduce the cost of treating people with Type 2 diabetes (which used to be called adult type diabetes, but now kids are getting it too).

All we can say is finally someone is getting with the program! If this were done nationally, the cost of healthcare from an insurance point of view would go down. Tons of wasted high-tech research such as big GWAS and other kinds of studies would not be done and the costs of that research could be redirected towards behavioral intervention, or even studies of how to implement behavioral intervention (so long as the latter were not just more school of public health professor welfare, but instead actually implemented programs).

Doing this would have benefit for everyone (except, perhaps, the genetics industry): countless people would lead healthier, longer lives. Health insurance would drop for everyone (in a properly regulated industry, because premiums amortize group costs to every participant's bill, and the total cost for the groups of insured would drop). And what would remain would be the cases of diabetes that really are genetic. Then, legitimate genetic research would be able to focus on genetic problems.

Cases that really are genetic might involve less genetic heterogeneity, or genes whose mutations showed up regularly in cases, or mutations with very strong effects. These would suggest targetable pathways for therapy, and for various genetic or other pharmaceutical engineering to tackle the problems. That would be the right way to spend health research funds, good for everyone.

Except..... Except that if thousands upon thousands of diabetics lived longer, more active lives, they would also be more likely to get some other degenerative diseases, like cancers, simply because they didn't succumb to diabetes first. And those diseases would need health care with its associated costs. Ah, well, one can't have everything!

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