Predict and Prevent: The Right Prescription for Tackling Chronic Disease

If COVID-19 has shown us anything, it’s that we can move with near-lightning speed to tackle health challenges when the need is clear enough. After the new coronavirus appeared, biopharmaceutical innovators joined with academic researchers, regulators, and other government officials to develop, approve, and bring to patients – in record time of less than one year – not one, but several safe and impressively effective vaccines as well as therapeutic antibodies for COVID-19. Now, as we turn the corner on the COVID pandemic, my hope is that we can summon some of the same energy to confront the epidemic of chronic disease. A good place to start is by doing a better job of predicting who is at highest risk of such diseases so we can then channel our resources to prevent them from experiencing major health setbacks in the first place.?

The burden of chronic conditions such as heart disease, osteoporosis, and cancer is immense, and it has grown over the past year and a half as COVID has deterred many people from seeking timely diagnosis and care. Cardiovascular disease, for instance, has long been – and remains – the leading cause of death worldwide, claiming 18 million lives every year. Osteoporosis causes nine million fractures around the world annually. Four-fifths of people experiencing osteoporotic bone breaks – most of them senior-age women – are not diagnosed and treated following their first fracture, even though a previous break increases the risk of a subsequent one by 86 percent. Cancer, finally, is second only to heart disease as a global killer. Early diagnosis often allows for more treatment options and better outcomes for cancer patients, as does biomarker testing.

Unfortunately, our current healthcare system is poorly equipped to handle even today’s chronic disease load, to say nothing of the increased burden we can expect from our aging society in future years. Today, we have a “break and fix” system. We wait until people have a life-altering or life-threatening event such as a fragility fracture, heart attack, or stroke, and then we spare no expense to “fix” them. It might cost tens or even hundreds of thousands of dollars to save a heart attack victim after he or she shows up in the emergency room, but the system will pick up the tab without hesitation because that’s how the system works.?Something breaks, we pay to fix it.?

The trouble is, we can’t afford this system anymore, and we’ll have even more trouble affording it in future years as populations continue to age and as diseases associated with aging become more widespread. Let’s stick with heart disease for a moment. The United States currently spends more than $900 billion on cardiovascular disease. If current trends continue, the cost of treating heart disease will mount even though we know the risk factors, we can use them to predict who is at greatest risk of a heart attack, and we have proven treatments to reduce those risks and keep people healthy. What we need, in short, is a healthcare system oriented toward predicting who is most at risk of “breaking” and preventing those severe health setbacks from happening in the first place.

There’s no simple prescription for reorienting our system toward predicting and preventing disease, but the following three principles should put us on the right path:

• First, successful reform requires collaboration among all stakeholders – healthcare professionals, patients and their advocacy groups, policy makers, regulators, payors, and biopharmaceutical innovators. No single player can change the system on its own. Here’s an example of one such collaboration involving Amgen. We recently partnered with the Quest/Walmart Joint Venture on a pilot project to bring bone health screening and education to people right where they are – in this case, shopping at Walmart! With Amgen’s support, Quest Patient Service Centers located in one dozen Walmarts across three U.S. states are screening eligible older people to identify those who might be at risk of osteoporotic fractures. The pilot just began, and it is already finding that more than half of individuals screened are at increased risk of fractures.
• Second, we must take advantage of our improved understanding of human genetics and disease biomarkers. Amgen subsidiary deCODE Genetics has joined with Intermountain Healthcare, a Utah-based not-for-profit integrated healthcare delivery network, to launch Heredigene?: Population Study, the largest and most comprehensive DNA mapping effort to date in the U.S. of a single population – 500,000 people primarily in Utah and Idaho. The data collected will help scientists identify links between particular gene variants and disease risk, leading to improved understanding, diagnosis, treatment and prevention of challenging illnesses such as breast cancer, colon cancer, and heart disease.
• Third, we must be willing to continuously test potential predict-and-prevent solutions and champion those shown to deliver the greatest value. Amgen’s work on cancer offers a good example. Approximately one in five advanced cancer patients receives treatment that weakens their immune systems and increases risk of infections. Amgen has partnered with the University of Minnesota and Fairview Health Services on an award-winning initiative to gather data from more than 50,000 cancer patients for use in developing new and better ways to monitor health outcomes and quality of care. This work has allowed Fairview to provide better quality-of-care monitoring for cancer patients, and it has provided the foundation for a predictive risk model that oncologists across the United States will be able to use free of charge to help their patients avoid complications from their cancer treatment.

Amgen has invested in 20 experiments around the world aimed at improving our ability to predict and prevent serious disease and to improve patient outcomes.?If initiatives such as these allow us to shift the orientation of healthcare systems even slightly, we’ll be better able to provide quality care to all who need it – and we won’t break the bank doing it.??