The Friday April 24, 2009 New York Times included a thoroughly depressing article on cancer by long-time science writer Gina Kolata. The general point of the article is to document the lack of real progress on the “war on cancer.” The lack of progress is especially daunting when one considers some data on how much we spend on different wars. According to Ms. Kolata’s her article, the National Cancer Institute has spent $ 105 billion on cancer since Richard Nixon announced the war on cancer in 1971. That’s a paltry expenditure when one considers that 4% of Americans are cancer survivors, and detailed data showing lifetime cancer risks, such as the 1 in 8 women will develop breast cancer, and 1 in 13 men will develop lung cancer. Risks of course translate into deaths. Slightly under 600,000 people in the US will die from cancer during 2008 according to detailed statistics from the American Cancer Society. That means that every two days, more people die of cancer than died on 9/11/01. Incredibly, since 2001, we’ve spent spent trillions of dollars to stop the risk of a few thousand more 9/11 type deaths, but since 1971, NCI could only muster about $ 5 billion per year for diseases that take hundreds of thousands of lives per year. In my book, that’s insane when considered only in terms of the human agony inflicted by cancer. The failure to solve disease problems becomes even more incredible when one looks at the costs inflicted by disease. On that topic, consider data from an an April 27, 2009, Business Insurance article by Joanne Wojcik. Her article reports on a significant recent study on health care costs of employers. Some quotes are below, but note especially two points. In terms of costs for hospitals and drugs, cancer is the leading cause of expense. But, even those costs are exceeded by 2 to 1 by indirect costs. “For every dollar spent on medical costs and pharmaceuticals, there is $2.30 of health-related productivity losses due to absenteeism and presenteeism, according to the study. For certain conditions, such as anxiety, employers lose as much as $20 in productivity for every dollar they spend on medical care and pharmaceuticals. The study, which researchers said is one of the largest to date on the subject, found that when medical and prescription drug costs are considered alone, the top five conditions driving employer health care costs are cancer, back/neck pain, coronary heart disease, chronic pain and high cholesterol. However, when medical and drug costs and productivity losses are factored into the equation, the five costliest conditions for employers are depression, obesity, arthritis, back/neck pain and anxiety, researchers say.” BTW, this is not a lightweight study. Instead, according to Business Insurance: “The study was conducted in two phases: The first phase used data collected between 2005 and 2006 from four employers with 57,000 employees. In the second phase, between 2007 and 2008, researchers increased the number of employers to 10 and employees to 150,000 and investigated more subtle aspects of the relationship between the 25 targeted health problems and productivity. More than 1.1 million paid medical and pharmacy claims were included in the combined analysis.” The article abstract is pasted below and also is available here. The same link may be used to purchase the article. Health and Productivity as a Business Strategy: A Multiemployer Study. Fast Track Article Journal of Occupational & Environmental Medicine. 51(4):411-428, April 2009.Loeppke, Ronald MD, MPH; Taitel, Michael PhD; Haufle, Vince MPH; Parry, Thomas PhD; Kessler, Ronald C. PhD; Jinnett, Kimberly PhD Abstract: Objective: To explore methodological refinements in measuring health-related lost productivity and to assess the business implications of a full-cost approach to managing health. Methods: Health-related lost productivity was measured among 10 employers with a total of 51,648 employee respondents using the Health and Work Performance Questionnaire combined with 1,134,281 medical and pharmacy claims. Regression analyses were used to estimate the associations of health conditions with absenteeism and presenteeism using a range of models. Results: Health-related productivity costs are significantly greater than medical and pharmacy costs alone (on average 2.3 to 1). Chronic conditions such as depression/anxiety, obesity, arthritis, and back/neck pain are especially important causes of productivity loss. Comorbidities have significant non-additive effects on both absenteeism and presenteeism. Executives/Managers experience as much or more monetized productivity loss from depression and back pain as Laborers/Operators. Testimonials are reported from participating companies on how the study helped shape their corporate health strategies. Conclusions: A strong link exists between health and productivity. Integrating productivity data with health data can help employers develop effective workplace health human capital investment strategies. More research is needed to understand the impacts of comorbidity and to evaluate the cost effectiveness of health and productivity interventions from an employer perspective. (C)2009The American College of Occupational and Environmental Medicine