Sunday, February 24, 2013

The Comorbidity Crisis

The Comorbidity Crisis is not exactly a household word (yet), but I'm betting it will catch on. Multiple morbidity (presence of two or more medical conditions in a given patient at a given time) is increasingly common, and it's creating a kind of secondary health-care crisis of its own.

Approximately 75 million people in the U.S. have two or more chronic conditions, defined as "conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living." [source] Some 65% of health care spending is directed at this 24% of the population. That's for the population as a whole. For the elderly, multiple morbidity is even more problematic. About 80% of Medicare spending goes to patients with four or more chronic conditions, with costs increasing exponentially as the number of chronic conditions increases. [source]

Multimorbidity is steadily getting worse over time, not just because the population is aging but because we're all getting sicker (or at least, showing up at the doctor's office with more complaints).
  • A Dutch study found that while the prevalence of chronic diseases doubled between 1985 and 2005, the proportion of patients with four or more chronic diseases increased in this period by approximately 300%.
  • The number of Americans receiving drugs for depression went from under 100,000 in 1955 to 13.3 million in 1996 to 27.0 million in 2005, and we now know that 68% of the mentally ill are comorbid for a physical ailment.
  • From 1995 to 2010, the age-adjusted prevalence of diabetes increased by over 50% in 42 states and by more than 100% in 18 states. The median prevalence rose from 4.5% to 8.2% in the 1995-2010 time period (almost doubling in 15 years). [source]  Most adults with diabetes have at least one comorbid chronic disease, and as many as 40% have three or more. [source]
  • In one study of 1122 diabetes patients, patients used an average of 13 medications to treat or prevent 8 different medical conditions. Typical diabetic comorbidities include obstructive sleep apnia, retinopathy (eye damage), neuropathy (deterioration of small nerves in extremities), nephropathy (kidney damage), cognitive deterioration (diabetic encephalopathy), and a wide variety of cardiovascular comorbidities.

The top and bottom quintiles of diabetes and obesity co-map.
From http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6145a4.htm

Less obvious is that comorbidity is spreading across various disease types that, in times gone by, wouldn't necessarily have been connected. Who knew, until recently, that gum disease had any connection to cardiovacular disease? Likewise, fifty years ago (when only 13% of the U.S. population was obese) there was no obvious link between being overweight and getting cancer. Today we know that there are statistically significant correlations between overweight (BMI greater than 25) and incidence of endometrial cancer, ovarian cancer, post-menopausal breast cancer, colorectal cancer, kidney cancer, and pancreatic cancer. [source] This is in addition to the well-known links between overweight and hypertension, stroke, coronary artery disease, pulmonary embolism, asthma, gallbladder disease, osteoarthritis, and chronic back pain.

Mental and physical morbidities lead from one to the other in subtle and not-so-subtle ways. Chronic physical ailments with a high "symptom burden" (e.g., chronic pain from arthritis) are often accompanied by depression. Depression, in turn, has been linked to altered immune function (including release of cytokines involved in inflammatory response), which opens the way to physical illness. If you're taking antidepressants, odds are high that you'll gain weight, putting you at greater risk of diabetes and the various cancers mentioned earlier. (One in six patients who take Zyprexa will gain more than 33 pounds in the first two years of use. [source] Moreover, all modern antipsychotics, according to Eli Lilly sales training literature, bring increased risk of diabetes.) It's a world of endless ripple effects.

One untoward outcome of multiple morbidities is polypharmacy, which leads to increased metabolic burden (toxic overload), drug compliance issues (forgetting to take pills), and adverse drug reactions (ADRs). One study found that the risk of ADRs was 2.65-fold higher in patients taking more than four drugs. But many patients take far more than four drugs. "If we apply the relevant CPGs to a 79-year-old woman with osteoporosis, osteoarthritis, type 2 diabetes, hypertension and chronic obstructive pulmonary disease, all of moderate severity," one researcher wrote, "the patient should be taking 12 different medications in 19 daily doses at 5 different times of the day" -- not counting any drugs to be taken "as needed."

The Morbidity Crisis is just getting underway. As DSM-V (due in May) expands the guidelines for mental illness, we're sure to see a continued sharp rise in mental/physical comorbidities; and as the population ages, we'll continue to see more people sick with multiple ailments, taking more drugs for more concurrent illnesses. The burden on the health care system will increase exponentially, and at some point, all of us will be poorer, not just in dollar terms but (very likely) in terms of basic health.

The winners in all this? Big pharma. You may want to buy some drug company stocks now. The really big profits are straight ahead.



RevenuesProfits
RankCompanyFortune 500 rank$ millions
$ millions
1Johnson & Johnson3361,897.0
12,266.0
2Pfizer4050,009.0
8,635.0
3Abbott Laboratories7530,764.7
5,745.8
4Merck8527,428.3
12,901.3
5Eli Lilly11221,836.0
4,328.8
6Bristol-Myers Squibb11421,634.0
10,612.0
7Amgen15914,642.0
4,605.0
8Gilead Sciences3247,011.4
2,635.8
9Mylan4125,092.8
232.6
10Genzyme4584,515.5
422.3
11Allergan4594,503.6
621.3
12Biogen Idec4714,377.3
970.1

28 comments:

  1. "Depression, in turn, has been linked to altered immune function (including release of cytokines involved in inflammatory response), which opens the way to physical illness."

    I think you have the correlation wrong. It isn't Depression that leads to physical illness, instead I'm pretty certain that Depression and whatever physical illness follows share common causes - and in my maybe not so humble view, these causes are nutritional.

    In similar spirit, I find it very doubtful that Obesity causes cancer (and all the other things), but instead Obesity share the same set of cause(s) as cancer and so on – and again the causes are nutritional.

    Do you want to know one thing in nutrition (there are certainly more) that is pro-inflammatory? Seed oils. Look into essential fatty metabolism and the chain from linoleic acid to series-2 prostaglandins (as the most prominent example).

    PUFAs (from seed oil) BTW increase insulin sensitivity (until it fails after years of seed oil consumption). This increased insulin sensitivity drives fat into fat cells, drive glucose into cells, lowers the blood sugar level, leads to hunger and makes people stuff themselves. Voila, obesity! And after this "stuck pedal" has failed, when the insulin mechanism breaks down, you get what? "Adult onset" diabetes.

    (If you want to read up on the gory biochemical details, I can highly recommend the blog "Hyperlipid" by a fellow named Peter - he writes much better than myself.)

    ReplyDelete
    Replies
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  21. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS.I was positive to the Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about DR Ebhota online on how he cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drebhotasoltion@gmail.com) You can contact him on WhatsApp +2348089535482 He also have the herb to cure difference cure for any sickness (1) HERPES,
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    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA..

    ReplyDelete
  22. So is possible that HIV Disease can be cured because I have been scammed so many times not until I came across this great man herbalist Dr Akhigbe who helped me at first I never believe all this comment and post about him and I was very sick because I have been infected with HIV/AIDS for the past two year,just last 2 months I keep reading the testimony about this man named Dr Akhigbe they said that the man is so powerful he have cured different type of diseases, I keep monitoring his post of some people about this man and I found out that he was real so I decided to give him a trial I contacted him for help and he said he was going to help me get my cure that all I needed to do was to send him money to prepare the medication after which it will be sent to me via DHL courier delivery services which I did to my greatest surprise the medication was sent to me he gave me instructions to follow on how to drink it that after  three weeks I should go for check up,after taking the medicine and follow his instruction after three weeks I went back to the hospital for another test, at first I was shocked when the doctor told me that I was  negative I ask the doctor to check again and the result was still the same negative that was how I free from  HIV VIRUS at of the shock I decided to come and share my own testimony with you for those who think there is no cure for HIV VIRUS the cure as finally come'  out stop doubting and contact Dr Akhigbe via email drrealakhigbe@gmail.com he will help you out you can also whats App him via +234 901 075 4824 he is also perfect in curing DIABETICS,HERPES,HIV/AIDS, ;ALS,  CANCER , MALARIA , BACTERIA DIARRHEA, MENINGITIS,HEPATITIS A AND B,ASTHMA, HEART DISEASE, CHRONIC DISEASE. NAUSEA VOMITING OR DIARRHEA, KIDNEY DISEASE,, IMMUNE SYSTEM BOOSTING.  SCHIZOPHRENIA, LUPUS,EXTERNAL INFECTION, COMMON COLD, JOINT PAIN, OSTEOPOROSIS, RABIES RHEUMATISM, THYROID, GALLSTONE, TETANUS, COLD & FLU, DENGUE, HUNTINGTON'S DISEASE, PROSTATE, CIRRHOSIS, DENGUE FEVER, SCABIES, EPILEPSY,STROKE,TUBERCULOSIS ,STOMACH DISEASE. ECZEMA, SMALLPOX,  PROGERIA, EATING DISORDER, LOWER RESPIRATORY INFECTION. etc believe me that deadly disease is not longer a deadly sentence because dr akhigbe has the cure.the godfather of herbal root.email: drrealakhigbe@gmail.com         whatsapp number.  +234 901 075 4824 website: https://drrealakhigbe.weebly.com  

    ReplyDelete


  23. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS.I was positive to the Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about DR Ebhota online on how he cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drebhotasoltion@gmail.com) You can contact him on WhatsApp +2348089535482 He also have the herb to cure difference cure for any sickness (1) HERPES,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA..

    ReplyDelete
  24. I have been suffering from (HERPES) disease for the last four years and had constant pain, especially in my mouth. During the first year,I had faith in God that i would be healed someday.This disease started circulate all over my body and i have been taking treatment from my doctor, few weeks ago i came on search on the internet if i could get any information concerning the prevention of this disease, on my search i saw a testimony of someone who has been healed from (HIV and Cancer) by this Man Dr Ogodo and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so i wrote to Dr Ogodo telling him about my (HERPES Virus) he told me not to worry that i was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as Dr Ogodo assured me that i have cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can email Dr Ogodo on ogodoherbalhomesolution@gmail.com) or call him whatsapp +2348124774363
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    ReplyDelete

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