The Burrill Report

The following are edited remarks I presented to the Russian Duma’s committee on non-communicable diseases. That committee is preparing, at President Putin’s direction, a series of recommendations to address the many significant health issues that NCDs pose to the Russian Federation. Smoking tops the list.

Non-communicable diseases are the leading causes of death and disease worldwide, killing more than 36 million people in 2008. The incidence of these diseases, which include cancer, diabetes, Alzheimer’s disease, and chronic lung and heart disease, are projected to increase by 15 percent globally between 2010 and 2020, due in large part to progress made in combating infectious diseases through economic growth, development, and better treatment options.

But this frightening increase is also largely linked to lifestyle choices.

For most infectious diseases, rapid access to diagnosis and treatment is an imperative for patient survival. But for non-communicable diseases the lifecycle is different, and there may be many actions that can take place, such as prevention, before medicines or other treatments need to be prescribed. A major epidemiological shift is underway.

The bad news is that these diseases sit at the center of a complex series of social and economic factors that are hard to influence from the top down. The good news is that there are many inexpensive and proven preventative medical interventions that can significantly reduce their burden.

A neglected area of discussion within the debate over these diseases is medical research and development, which has the very real promise of introducing cures for currently incurable chronic conditions, as well as treatments for diseases where there is currently a lack of pharmaceutical options.

Just as innovation in treatment has turned HIV/AIDS from a terminal disease into a manageable chronic condition, it is not unfeasible that future innovation will throw up a cure or prophylactic vaccine for many diseases considered chronic today.

The current trend of increase in Alzheimer’s, for example, threatens to overwhelm health systems in OECD countries because not much can be done beyond labor-intensive care. If a cure were invented, this huge economic burden would be significantly reduced as would much pain and suffering. Remember that tuberculosis used to be an incurable major chronic disease until the invention of treatments. Innovation is crucial, but it is not the only tool available to us in the war against non-communicable diseases.

Fortunately, there are plenty of off-patent and widely available preventative medicines, such as statins and medicines for diabetes and hypertension, which can reduce the overall disease burden.

The good news is that half of deaths caused each year by non-communicable diseases are preventable and lifestyle choices, such as unhealthy diet and tobacco use, are part of the explanation. Reducing disability and death through increased investment in prevention programs will contribute to higher economic growth and allow limited resources to be focused efficiently on patients most in need.

Money is tight everywhere. Before governments agree to increased spending on top-down schemes, it is worth taking a look back at the last major global effort to fight disease: HIV/AIDS.

Some lessons are clear, like the need to focus on prevention. The United Nation’s big mistake with HIV/AIDS was to prioritize treatment. This neglect of prevention led to new infections piling up more quickly than they could be treated, creating unnecessary suffering and costs. Actions on access and affordability of non-communicable disease treatments include promoting the right policy, along with smart regulatory and supply chain environments that secure optimal quality of care for patients.

But in order to accomplish this, there must be a confluence of interests. And there is.

There is no substitute for the power of partnership. It’s not about having pharmaceutical companies write checks, but rather combining the resources of private industry with the expertise of leading global health organizations, to identify new models of patient care that increases access and speed to treatment—and not just medicines.

Part of the role of government is to facilitate partnerships that propel progress.

In the United States we’re learning that, in the battle against non communicable diseases our health systems needs to get smarter, specifically:

• Our reimbursement systems need to be less focused on outputs and more on individual patient outcomes;
• Health professional education should be more holistic addressing all issues concerning both acute and chronic conditions;
• Our view of drug safety relative to what is Rx vs. OTC is going to have to change (such as OTC statins and HIV/AIDS preventative medicines);
• Our delivery systems will have to dramatically reform to take advantage of new e-health technologies;
• The partnership between social services and health services will have to become closer (including smoking cessation and weight reduction strategies), and
• Many aspects of our healthcare system need to be decentralized as far as possible to the local level – thus making it easier to deal with complexity of multi-chronic conditions.

Most importantly, we must place personal responsibility at the center of the non-communicable disease debate, because it is the most effective way to ensure that early detection and prevention is maximized whenever and wherever possible.

Peter J. Pitts is President of the Center for Medicine in the Public Interest and a former FDA Associate Commissioner

Peter J. Pitts is President of the Center for Medicine in the Public Interest and a former FDA Associate Commissioner

June 07, 2012
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