Obama Care Will Spend Trillions to tell people what they already know: eat right, exercise and don't light up

Mr. Obama has found a woman to peddle: Laura. Obama likes to talk about Laura, a breast cancer survivor he met at a recent Town Hall Meeting; Laura is fighting a recurrence of the disease. Obama encouraged his team, as the debate for health care reform heats up this summer, “Every single day, I want you to remember Laura. Remember that’s who we’re here to serve and that’s who we’re looking out for.”

Now let’s talk about what works in breast cancer treatment; what is helping women to survive, what the future of advanced medicine is going to be about: personalized medicine. Sorry kids but if we are going to beat cancer this is pretty much the way it will be done.

Some background:
From HealthCentral.com:

Breast cancer was one of the earliest cancers to have this personalized touch through the works of pioneers in cell biology, researchers (such as the eminent Sir Craig V Jordan, formerly at Northwestern and now at Fox Chase) and most importantly patients.

Every breast cancer patient has her cancer tested for estrogen receptor, progesterone receptor, and Her2 status - Her2 being the latest addition to the personalized medicine armamentarium and arising in just the past ten years.

We know that medicines such as tamoxifen and the aromatase inhibitors work only in women with estrogen positive breast cancers, and that Herceptin only works in Her2+ breast cancers. We have personalized breast cancer treatment in terms of offering therapy for each woman that will give her the greatest chance of cure - or in the metastatic setting the greatest chance of response and durable remission.

And new work in breast cancer personalized medicine is being unearthed every day:

For example: this week from Reuters:

WASHINGTON (Reuters) – Genetic mutations can show which breast cancer patients will be helped by a certain type of chemotherapy, U.S. researchers reported on Tuesday.
They found patients with two versions of the SOD2 fared worse when taking the chemotherapy drug cyclophosphamide than other patients. It might be useful to test patients for this gene before giving them the drug, the researchers reported in the journal Clinical Cancer Research.
"In the future, such tests may be used to guide the treatment of patients with the SOD2 variation, ensuring that they receive a therapy that is more effective than cyclophosphamide-based therapies," Dr. Stefan Ambs of the National Cancer Institute, who worked on the study, said in a statement.

And its not just breast cancer, from HealthCentral.com

Personalized medicine is about to get more interesting. If one looks at choices of therapy in colon cancer, for example, we now know that one drug will work only in patients who have a "wild type K-ras" meaning that a protein involved in the cell cycle division process (dividing into two new cancer cells) must be preserved in structure for the drug to work. This is the biologic equivalent of stealth bombing.

These targets will arise in breast cancer as well since all cancer cells have similar biologic molecules involved in their unfettered cell division. A recent paper alluded to the higher probability of response with Bevacizumab based treatment, a targeted therapy against a molecule called vascular endothelial growth factor, in patients who have certain receptors for this molecule. Whereas now treatment is often empiric, we are moving towards the more specific.

Gene chip microarray technology - looking at genes expressed - will be utilized more in the future, as will its cousin proteonomics - assaying which proteins are expressed. What will this mean for the patients? It will hopefully mean better targeted therapies, with higher chances of working, and with less toxicity.
Science marches on!

Or, not!

Obama health care will focus on prevention over new and improved treatments.
Laura may have no way of preventing her cancer, but too bad for her.

Don’t eat those 10 bags of potato chips for lunch will be preferentially funded over personalized tumor treatments…the very treatments that are extending the lives of women who, by the un-luck of the draw, get breast cancer. (There has been a link between obesity and breast cancer, but this is not a strong link, and in no way accounts for the majority of breast cancer cases.)
Prevention preferences aside:

Mr. Obama is spending hundreds of billions of dollars to do meat and potato studies of current therapies, say, does physical therapy work better than arthroscopic surgery. The studies Mr. Obama is pushing are moving us away from personalized medicine and high-tech personalized advancements in cancer treatments and towards collective medicine.

Yes, with the Obama plan more people may get care, but that care will not be the care that sets the U.S. apart from the rest of the world. It will be collective care. It WILL be Heavily rationed care; it will weight prevention more heavily than advanced treatments. And when you are trying to stay alive this is important!

The will be much less money to fund the research that allows science to march on, so it will be backwards care rather than forwards care. Gadzillions of dollars will go towards telling people who are not going to change their behaviors to change their behaviors, rather than actually curing disease.

For example: boatloads of money will be go to pay doctors to spend hours lecturing patients not to stuff undue amounts of food into their faces and to get off their duffs and take the stairs.

I hate to break it to all those who talk about the HOLY DAY when doctors are paid well to lecture patients to eat right and exercise—it won’t make a difference.*
The only way to get people to do this is already proven: A good solid education.
College educated folks are far more likely to do the right thing. And btw, almost every community and hospital has wellness lectures, given by well-paid nurses. Do we REALLY want our extremely educated MDs to fritter away their brains telling patients to eat right and exercise? Trust me-- that can be delegated to nutritionists and nurses, as is currently the case! And it is REALLY boring to tell Sue and Derick for the bazillionth time, to stop already with the Fried Chicken.

One sure-fire way to lower health care costs via prevention: get women to earn a college degree before they make babies.
Well -educated mothers have less children and the children they do have will be far far less likely to end up as obese, smokers who are allergic to physical exercise. Over-eating smokers who drink too much and don’t exercise most often fall into lower socio-economic groups. This is a poverty thing that will not be answered by constant well-paid lectures by MDs to recalcitrant patients.
But this is where Mr. Obama is going to force our medical dollars. There are MANY good ways to reform health care, but penalizing those who do get sick is NOT one of them. Prevention sounds just great until... you get sick and then you just want to get better. I wonder if we will pay teams of I Told YOU SO doctors to march into patient sick rooms? Prevention with a Bite!

Prevention is being heavily touted up by the media and Mr. Obama. And this sounds just great to many folks. Currently “More than three-quarters of Americans (76 percent) support increasing funding for prevention programs that provide people with information and resources and creating policies that help people make healthier choices.” Source: Trust for America's Health

But wait until those same people get sick and are told that all the money that would have gone toward a personalized approach to their illness, is being pumped into repeatedly telling Americans what they knew in the first place: eat right and exercise. You will live a lot less longer, so that a lot more people can be told to eat right and exercise...over and over and over again.

Prevention will only save us money if people actually eat right and exercise and stop smoking. And all those prevention tests will cost boatloads of buck, and just about everyone in the medical know, knows that cost savings from preventative medicine will not materialze.

Obama himself can’t kick the smoking habit, most likely b/c of a genetic susceptibility to addiction. But rather than finding gene targets to hit with new compounds or treatments that will enable him to stand a chance at quitting, Obama doctors will be paid handsomely to tell him another 100 times: Hey man, you really should quit smoking!
Prevention has severe limits, both socioeconomically and genetically--neither of which will be fixed by spending all our health care bucks on lectures to recalcitrant patients.

So back to poor Laura: she may be a non-smoking, moderate drinking, vegetarian, who exercises and maintain her ideal body weight, but with Obama Care, Laura will not live as long. Personalized medicine will peter out...
but hey…. thousands of overweight obese folks will get weekly lectures and wrist slaps over their un-ending tendency to deep fry their Oreos.

*it is a no-brainer to advance the pay of primary care MDs. this is a simple act that would do much to reform health care w/o hurting the sick and retarding medical progress.