WHO PAYS?

The Cost of Pre-Existing Conditions Just Keeps Climbing

Chronic illnesses and conditions such as MS and ADHD cost billions, but innovative treatments will go begging unless government funds the research.

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Acne, allergies, anxiety, asthma, depression, ear infections, high cholesterol, hypertension, menstrual irregularities, migraine headaches, being overweight. Sound familiar? These are some of the common pre-existing conditions that private health insurers charged individuals more for before Obamacare put an end to such uneven billing, according to the Kaiser Family Foundation. With Obamacare facing repeal, the costs of these chronic issues could again be passed along to the individuals who have them. Under the House bill, which allowed states to opt out of protections for patients with pre-existing conditions, this would likely be the case, according to the Congressional Budget Office analysis. The Senate’s version doesn’t allow states this option.

Regardless of who’s stuck with paying for chronic diseases, the costs are unsustainable. The National MS Society reports that the newest drugs for the disease can run as much as $92,000 a year per patient. With a staggering 11 percent of U.S. children diagnosed with ADHD, medication to control symptoms is expected to cost $17.5 billion a year by 2020, according to a report by IBISWorld. And in 2013, rheumatoid arthritis drugs brought in more than $15 billion, according to QuintilesIMS research.

Even without an existing drug that can head off an allergy attack, the medical bill for food allergies amounts to $4.3 billion a year in the U.S., according to a recent study in JAMA Pediatrics. The cost of autism alone, including lost income as patients become adults, is expected to reach $1 trillion by 2025, according to the advocacy group Autism Speaks.

With diagnoses of many of these conditions on the rise, they threaten the entire system.

But what if people with some of these persistent pre-existing conditions could recover from them or benefit from treatment that’s much cheaper than drug therapy?

What if people with multiple sclerosis or ADHD or autism could be treated with certain specialized diets? What if we could help people with autism overcome more of their symptoms so that they required less care? What if food allergies could be managed with cognitive behavioral therapy? What if symptoms of irritable bowel syndrome improved after no therapy at all—just a long appointment with a kind, confident doctor?

This may sound like complete fantasy, but it isn’t. While we are a ways off from solid proof, all of these interventions are supported by compelling anecdotal evidence that suggests that some people get better when they try them. In the cases of RA, ADHD, autism, and MS, there is also some evidence from clinical trials suggesting that particular diets can improve symptoms.

One theory about why food might make such a profound difference is that it is one of the primary ways that we can sustain the population of bacteria that lives in our guts—our microbiome—which is such a key player in our bodies that researchers call it an organ. Unhealthy communities of this bacteria are linked to all kinds of diseases, including obesity.

There are promising results for irritable bowel syndrome too. In one study of the placebo effect in The BMJ, 62 percent of patients with IBS reported an improvement in symptoms after getting a sham treatment and spending 45 minutes with a doctor who projected kindness and confidence. That’s an amazing, stop-the-presses outcome. If we could confirm those results with further study, and figure out how to harness the placebo effect, imagine the implications not only for people who suffer from IBS, but for those facing other diseases.

As for severe food allergies, I’ve spoken to the parents of almost 100 children who went from having allergic reactions to then being able to eat everything. The change occurred after they underwent an innovative, and, as of yet, unstudied treatment, based, in part, on ideas from cognitive behavioral therapy. Again, that kind of success in the food allergy world is unheard of.

None of this is enough evidence for doctors to start prescribing these therapies, certainly not in place of medicines that are known to be effective, if they exist. And it’s not meant to suggest that people will be fine without access to affordable healthcare.

But in the wake of recent town halls, where constituents asked their representatives how they were going to take care of their families, this early, unfinished science should offer some hope to individual patients with pre-existing conditions.

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But we need to fund trials. The evidence we already have merits further study. Not to follow up on such tantalizing possibilities is foolish—and makes no economic sense. (A pilot study of the allergy therapy is now underway at Boston Children’s Hospital. If the outcome is positive, still more study will be needed.)

Let’s set aside the incalculable value of alleviated suffering, if that’s even possible. Or the chance to lessen the sometimes terrible side effects drugs can come with. Or the potential (worse) nightmare that medical bills could soon become for some patients. Or the power of the pharmaceutical industry and its lobbyists whose interests lie in maintaining the status quo.

Getting off drugs—or finding real answers for allergies and autism—might save the patients and the healthcare system. Even if only a certain percentage of these non-pharmaceutical interventions panned out under further scrutiny, and a small portion of people with chronic diseases could quit taking their medications or required less care, the economic savings would still be enormous. A fraction of more than a trillion dollars is approximately a lot of money.

Yes, the cost of doing the science is steep. It always is. And the odds of a real breakthrough are very long. They always are. But think of the potential windfall.

Curing diseases can’t be left to private enterprise. No pharmaceutical company is going to invest in expensive clinical trials if there’s no hope of a return for them, however successful the science. You can’t patent and profit from a study, for example, that helps us understand how the majority of those IBS patients got better. You can’t package kindness.

President Trump’s budget, however, slashes support of the National Institutes of Health, which funds biomedical science. Which is too bad because government-funded science allows us to pursue every possible solution even if it can’t be profited from. This is not, by the way, a knock on pharmaceutical companies. I’m all for any biomedical innovation. But it makes no sense to close ourselves off to any answer that isn’t a pharmaceutical, when the one thing we know for sure is that a discovery can come from anywhere.

And with our healthcare system in such a precarious state, we really need one now.

Susannah Meadows is the author of the new book The Other Side of Impossible: Ordinary People Who Faced Daunting Medical Challenges and Refused to Give Up.