“There can be no solution to the healthcare crisis that does not address America’s unchecked epidemic of chronic disease, which afflicts more than half our citizens and consumes 86% of the exorbitant $3.2 trillion spent each year on care.”
—Clayton Christensen2
Chronic disease is the leading cause of death and disability in the U.S. Rates of chronic disease have never been higher, with cost of chronic conditions necessitating the vast majority of healthcare dollars spent. Chronic disease is so common that more than half of U.S. adults have at least one condition, accounting for over 85% of annual healthcare spending.
According to the World Health Organization, 80% of heart disease, stroke and type 2 diabetes and 40% of cancer could be prevented, primarily with improvements to diet and lifestyle.
The U.S. spends at least 18% of its GDP ($3.35 trillion in 2019) on health expenditures. If costs continue to rise, by 2050 Medicare and Medicaid alone will account for 20% of the GDP. All projections point to continued rises in chronic disease. If we don’t reverse this trend, we are headed for bankruptcy as a country. The solvency of our nation is at stake.3
The most widely accepted clinical practice guidelines (promulgated by the American Medical Association, Cleveland Clinic and other authoritative medical organizations) indicate that medications, medical devices and surgeries should be used as treatment for chronic disease only after lifestyle intervention (i.e., correction of diet) first does not yield a satisfactory health outcome. Practice guidelines state this, because 70 years of research indicate that most cases of chronic disease may be reversed and eliminated (i.e., cured) by correction of diet. In the words of T. Colin Campbell, PhD, one of the world’s foremost authorities on food’s role in the genesis and reversal of chronic disease:
“Switching to a whole-food, plant-based diet with little or no added salt, sugar and fat, produces astounding health benefits. This dietary lifestyle can prevent and even reverse 70% to 80% of existing, symptomatic disease, with an equivalent savings in healthcare costs for those who comply. This treatment effect is broad in scope, exceptionally rapid in response (days to weeks) and often, lifesaving. It cannot be duplicated by animal-based foods, processed foods or drug therapies.”
Despite its efficacy, however, lifestyle intervention remains untaught to doctors and unavailable to patients. Prescribed instead is the greatly inferior yet highly profitable treatment modality known as disease management. Designed to render chronic disease livable by medicating its symptoms to mask them, disease management does patients a disservice by lulling them into a
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- Christensen, et al. Health for Hire: Unleashing Patient Potential to Reduce Chronic Disease Costs. Oct. 10, 2017. https://www.christenseninstitute.org/publications/healthforhire/?authors=clayton-christensen
- Clayton Magleby Christensen was a Harvard Business School clinical professor and business consultant who developed the theory of “disruptive innovation”, which has been called the most influential business idea of the early 21st century. See https://claytonchristensen.com/
- American College of Lifestyle Medicine website. Accessed April 21, 2020.
false sense of health, even as their chronic diseases progress into co-morbidity, disability and premature death.
Despite its atrocious outcomes, disease management has long reigned as the de facto medical standard of practice. That’s because it is more than just a treatment modality; it’s a business model—a business model that enriches insurers by ensuring that each chronically diseased patient will require greater medical services, for which they may be charged higher insurance premiums, year after year. So successful is the disease-management business model that insurers are loath to disrupt it by providing coverage for its superior alternative, lifestyle modification. Were they to do so, patients’ chronic disease would actually abate and disappear, triggering reductions in society’s need, and demand for, doctors’ services, hospital stays, prescription pharmaceuticals and insurance premiums, which would trigger precipitous drops in earnings for doctors, hospitals, drug companies and insurers.
Of course, this is not the future that the medical industrial complex favors. So, medical schools don’t teach and insurers don’t cover lifestyle modification as treatment for chronic disease. Instead they champion disease management.
The problem with disease management, however, is that it enriches its purveyors at the expense of patients. You see, disease management 4 is the use of medication, devices or procedures to render the unpleasant symptoms of chronic disease tolerable, so that patients may live with chronic disease, even as it advances toward co-morbidity, disability and premature death. As backward (i.e., deleterious to health) as that may sound, disease management has been, and remains, the financial mainstay of the healthcare industry, generating over 80% of all healthcare revenues. In effect, it enriches doctors, hospitals, drug companies and insurers by turning patients into walking annuities that each successive year require greater doctors visits, hospital stays and prescription drugs to treat their ever-progressing, yet reversible, chronic diseases.
How lucrative is disease management for doctors, insurers, drug companies, equipment manufacturers and device makers? It’s very lucrative. Each of America’s 132 million5,6 chronically diseased persons generates an average of $20,800 in healthcare expenditures every year, making disease management the mother lode of healthcare, a $2.7 trillion business.7,8
In sum, this is the reason that doctors, hospitals, drug companies and insurers advocate the use of medications, surgeries and devices as treatment for chronic disease, a health condition whose primary cause is improper diet. It is also the reason that I, in my future communications with you, will advocate and champion lifestyle modification, centered on dietary improvement, as optimal treatment for type 2 diabetes, heart disease, rheumatoid arthritis and the other chronic disease that riddle us, the American people.
4 http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/
5 “More than 133 million Americans, or 45 percent of the population, have at least one chronic condition.” Source: 2009 Almanac of Chronic Disease. Partnership To Fight Chronic Disease. Accessed May 25, 2017.
http://www.fightchronicdisease.org/sites/default/files/docs/PFCDAlmanac_ExecSum_updated81009.pdf
6 “More than 190 million Americans, or about 59 percent of the population, suffer one or more chronic diseases. Over the next 15 years, 80 percent of the U.S. population will experience one or more chronic conditions, costing society more than $42 trillion in medical care spending and losses in employment productivity… Health care costs are concentrated – a person with five or more chronic conditions will cost the U.S. health care system $53,000 a year on average, more than five times that of individuals without chronic disease… The number of people with three or more chronic diseases will increase from 31 to 83 million by 2030.” Source: Overview of New Research on the Burden of Chronic Diseases in the Next 15 Years. Partnership To Fight Chronic Disease. Accessed May 25, 2017.
http://www.fightchronicdisease.org/sites/default/files/IHS%20Summary%20PFCD_FINAL2.pdf
7 $3.2 trillion x 86% ÷ 132,000,000 chronically diseased persons = $20,800/person . Persons comprise everyone—adults, teens, and younger children.
8 “Chronic disease management is one of the healthcare system’s greatest challenges, sapping billions of dollars from payers, patients, and providers each year. Managing the complex needs of patients with diabetes, heart failure, asthma, COPD, kidney disease, and other long-term conditions can cost up to seventeen times more than other patients, which can add up to almost $40,000 per beneficiary per year.” Source: Examining the Challenges of Medicare Chronic Disease Management. Health IT Analytics. Accessed May 25, 2017. http://healthitanalytics.com/news/examining-the-challenges-of-medicare-chronic-disease-management
In sum, this is the reason that doctors, hospitals, drug companies and insurers advocate the use of
medications, surgeries and devices as treatment for chronic disease, a health condition whose
primary cause is improper diet. It is also the reason that I, in my future communications with
you, will advocate and champion lifestyle modification, centered on dietary improvement, as
optimal treatment for type 2 diabetes, heart disease, rheumatoid arthritis and the other chronic
disease that riddle us, the American people.