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How health care could lower health-care costs

I'm listening to Dr. Paul Ewald explain his theory that deadly diseases are caused by common infections. Take cancer. In recent years, we've tied a lot of cancers to fairly common infections (HPV leads to cervical cancer, the infection that leads to gastric reflux also increases the risk of esophageal cancer, etc.), and Ewald believes that's part of a much larger story: Cancer is usually caused by latent, low-grade infections that persist in the body by weakening cells, and these weakened and damaged cells are easier targets for cancer. To stop cancer, you have to focus on the infections that precede it.

I have no idea if this is true or not, of course. But if it's true, and if those infections can be solved through cheap interventions (hygienic efforts to reduce their spread, targeted medicines to run them out of the body), treating cancer could prove to be, well, quite cheap. These are the great unknowns of medicine going forward: If medicine gets much better because it comes up with extraordinarily expensive ways to treat illnesses, we're in some real trouble and will face some incredibly hard choices. The word for that world, I think, is "rationing." But if we figure out fairly cheap interventions, we could see costs trend down on their own: Being able to stop diabetes early can save hundreds of thousands of dollars over a patient's lifetime. Policy isn't everything.

Incidentally, here's Ewald presenting at TED:

By Ezra Klein  |  July 8, 2010; 1:25 PM ET
Categories:  Health  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: Research desk is open
Next: Research Desk summarizes: How does the world finance elections?


Or, the PPACA could kill jobs (as the Post reports today, and “may impose significant burdens on businesses, charities, and government agencies” which “out to be disproportionate as compared with any resulting improvement in tax compliance.”

The quote is from -- hold your breath -- an Internal Revenue Service spokesperson and appears in another Post report highlighting the growing burdens related to the PPACA. The report appears at

The IRS also now acknowledges that it lacks the personnel necessary to manage the upsurge in paperwork and enforcement activities. Not surprisingly, the cost of new personnel virtually nullifies the funds raised by the new taxes. We really should have collected unbiased data and argued this topic before passage of the bill -- oh, wait a second, some folks did actually mention the topic...

Posted by: rmgregory | July 8, 2010 1:40 PM | Report abuse

Parts of diabetes research (Juvenile/type 1) have trended this line. There is a belief among researchers that diabetes (an auto-immune disease) is triggered after a virus leaves the body. After attacking the virus, the immune system attacks the pancreas. As we all know diabetes is an incredibly expensive disease to treat, and as treatments have gotten better, well--they've gotten more expensive. If researchers can prevent that virus or something like that, they could maybe prevent diabetes....

Thanks for highlighting this, Ezra!

Posted by: MD-DC-VA | July 8, 2010 2:08 PM | Report abuse

Putting the science of cancer aside, the incentives in medicine are aligned with treatment, not prevention. Thus, intervention has become more costly over time. Moreover, many of the easily preventable causes of morbidity have been addressed through public health programs (chlorination, vaccination, etc.). Future preventative measures are likely to be much more difficult and not easily amenable to a single intervention (think lifestyle modification for obesity and smoking). To address these issues, we have to rebuild the primary care system and realign the incentives towards prevention. The history of medical intervention strongly suggests that we will not be able to treat our selves out of the cost problem.

Posted by: jhop2016 | July 8, 2010 2:09 PM | Report abuse

Everyone eventually dies of something, and the longer you live, it seems the more expensive it is to die. there some data showing that treating preventable diseases actually saves money over the course of someone's life, or does it just delay death until a more expensive problem comes along?

Obviously this ignores the moral imperative we all (should) feel to help everyone live a long, healthy lives. But it's a valid question when you start using dollar arguments. The practice of just saying, "Well diabetes costs X, so preventing diabetes will save X" is wrong because eliminating diabetes just means more people will die of cancer or car accidents or bear maulings etc.

Posted by: claytex | July 8, 2010 2:25 PM | Report abuse

jhop, the incentive in medicine is in treatment, but the incentive in insurance lies in prevention. One of my hopes is that insurance companies will do more to encourage healthy behavior.

Posted by: DDAWD | July 8, 2010 2:28 PM | Report abuse

DDAWD, the incentives are not so clear. Both the payers and the insurance companies (two separate entities) have historically been very poor at investing in a strong preventive health care system. This stems from the fact that the benefits to preventive interventions are often decades down the road (which, incidentally is why it is hard to answer the question posed by claytex) while there is a great deal of job and insurance mobility. This greatly contributes to our treatment focused health care system. In a system where one payer is responsible for all health care costs (Canada, NHS), there is much more emphasis on primary care.

On a another note, the logic in this article stems from the romantic notion that technological innovation will save us from our long term problems(see geoengineering for climate change). The solutions, however, are already known... just too difficult for us to come to terms with.

Posted by: jhop2016 | July 8, 2010 3:38 PM | Report abuse


yes i linked to that article too. The startling thing is that low and behold we now hear that every small employer would have to 1099 down to $600 every single expense in and out.

I doubt that will get much play around here but again ANOTHER reason why job growth is stagnant. This administration CLAIMS to be all about JOBS and the ECONOMY and Republicans are the ones stalling yet this is one of the biggest job killers of small businesses around.

Oh and onto the subject at hand I believe it was Dr Gawande that had the "checklist" for physicians although I may be wrong. 98000 deaths a year from hospital infections is absolutely horrible and needs to be fixed. I read a story once that I believe the Cleveland clinic had implemented these very simplistic procedures and got their infection rate down to near zero. Simple steps that take little time at all. Another reason docs should be paid on a formula based upon their lack of infections.

Posted by: visionbrkr | July 8, 2010 5:47 PM | Report abuse

and to save hundreds of thousands of dollars you actually have to get patients to care about their wellbeing.

How many people were eligible for Medicaid which would have given them the means to treat their diabetes and yet NEVER bothered to go get it?

We could also get into another discussion of poor eating habits if you like too. The answer can't always come from the cost side. At some point the consumer has to consume less. It needs to be a balance.

Posted by: visionbrkr | July 8, 2010 6:01 PM | Report abuse

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