Healthcare cost, Integrative medicine, Nutrition

Where Is the Money Going in Healthcare?

by Alan R. Gaby, MD

A recent study found that total spending on healthcare in the United States in the year 2016 was $3.1 trillion.¹ Healthcare spending increased from 13.3% of gross domestic product (GDP) in 1996 to 17.9% of GDP in 2016. The average amount of money spent on healthcare in 2016 was $9,655 per person. To give you a perspective on how much $3.1 trillion is, it is more than the GDP of every other country in the world except China, Japan, and Germany. Despite this massive amount of spending, we are not a particularly healthy country. An estimated 40% of Americans suffer from at least one chronic disease and, of those, more than half have multiple chronic illnesses.

When I was in medical school, one of the professors remarked that doctors do not cure disease. Rather, we just help people manage their illnesses. After hearing that remark, I thought to myself, “If that is true, then what am I doing here?” I never accepted the idea that we cannot cure (or at least partially reverse) chronic diseases. In my clinical practice that focused mainly on diet, lifestyle, and nutritional supplements, it was the norm rather than the exception to see people with chronic illnesses return to better health. Some patients who had been seeing several different specialists for several different conditions improved so much that they were essentially able to exit the medical system. If mainstream medicine would place more emphasis on approaches that help the chronically ill to get well, much of the money being spent on healthcare could be diverted to other socially useful endeavors. Below are some of the many examples of low-cost, low-risk interventions that are often beneficial for expensive chronic diseases. The annual cost of treating these conditions in the United States is listed in parentheses. The information below is based partly on published research and partly on clinical experience.

Hypertension ($79 billion): Diet; exercise; weight loss when necessary; and supplementation with nutrients such as magnesium, calcium, and vitamin C can often help control hypertension, thereby reducing the need for medications, decreasing the need for visits to the doctor, and decreasing the risk of developing heart disease or stroke.

Osteoarthritis ($80 billion): Symptoms of osteoarthritis often improve with supplements such as niacinamide, glucosamine sulfate, and chondroitin sulfate. These “natural” remedies may decrease the need for anti-inflammatory drugs, which can cause complications such as gastrointestinal bleeding and kidney disease. Moreover, in contrast to nonsteroidal anti-inflammatory drugs, which appear to accelerate the progression of osteoarthritis, there is evidence that these natural remedies can slow disease progression, and thereby decrease the need for joint-replacement surgery.

Heart failure ($33 billion): As many as 50% of people with chronic heart failure have iron deficiency. Identifying and treating iron deficiency has been reported to decrease the frequency of hospitalizations for worsening heart failure. Supplementation with coenzyme Q10 has also been found to decrease the need for hospitalization. In addition, a series of intravenous injections of magnesium (an inexpensive therapy) has been reported anecdotally to produce long-term improvement in patients with heart failure.

Anxiety disorders ($42 billion): A number of low-cost interventions are effective for some people who suffer from chronic anxiety. These include identifying and treating reactive hypoglycemia; identifying and avoiding hidden food allergens; avoiding caffeine; supplementing with magnesium or niacinamide; and doing aerobic exercise.

Asthma ($36 billion): A large proportion of the annual cost of treating asthma is related to hospitalizations and emergency department visits for acute asthma attacks. Low-cost interventions that can decrease the severity of asthma or reduce the number of acute attacks include identification and avoidance of hidden food allergens and supplementation with magnesium, vitamin B6, and vitamin C.

Rheumatoid arthritis ($34 billion): Some of the drugs used to treat rheumatoid arthritis (e.g., Remicade, Humira, Enbrel) are extremely expensive, with costs ranging from $31,000 to $72,000 per year. In some cases, symptoms of rheumatoid arthritis can be controlled, without medication, by identifying and avoiding allergenic foods. A number of different supplements, including fish oil, borage oil, and ginger root, may improve symptoms in patients with rheumatoid arthritis.

Urinary diseases, including urinary tract infections ($86 billion): Interventions that may decrease the recurrence rate of urinary tract infections include increasing fluid intake and supplementing with a specific probiotic agent (a combination of Lactobacillus rhamnosus GR-1 and L. reuteri RC-14).

Nonmelanoma skin cancer ($22 billion): In patients at risk of developing basal cell or squamous cell carcinoma, supplementation with niacinamide (500 mg once or twice a day) decreased the incidence of these cancers by 23% in one study and by up to 86% in another study.

Migraine ($14 billion): Interventions that can decrease the frequency or severity of migraines include identification and avoidance of allergenic foods and supplementation with magnesium or riboflavin.

Otitis media ($10 billion): Identification and avoidance of allergenic foods can prevent recurrences of otitis media in as many as two-thirds of children who suffer from this condition.

Other “expensive” conditions for which dietary or lifestyle changes, nutritional supplements, or other low-cost interventions may be beneficial include diabetes ($111 billion), ischemic heart disease ($89 billion), depression ($68 billion), inflammatory bowel disease ($25 billion), osteoporosis, fibromyalgia, and irritable bowel syndrome (the annual cost for these last three conditions was not specified in the study).

There are two major obstacles to adopting these money-saving approaches to health and disease. First, many people are unwilling to make the dietary and lifestyle changes that are at the heart of controlling various chronic diseases. However, there are also millions of people who would gladly make the necessary changes if they had a healthcare professional to guide them. I saw countless patients over the years who, after experiencing improvement from nutritional therapies, told me they wished their doctor had told them about this approach long ago. Which brings us to the second obstacle: the mainstream medical community is not trained in and appears to have little interest in learning how to use interventions such as nutritional supplements and elimination diets. Fortunately, this is changing; a growing number of medical doctors are showing interest in integrative medicine. In addition, the number of naturopathic doctors and the number of chiropractors, dietitians, and other healthcare professionals who are learning about nutritional medicine continues to increase. We have great potential to become a healthier people and to free up massive amounts of money to be used for more productive purposes.