Rebuttal to Times Hypertension Articles 2

Pharmaceuticals one key to longer, healthier living

By J. Patrick Kelly
Special to The Times

Earlier this year, the U.S. government dramatically overhauled its iconic nutrition "pyramid" to emphasize the importance of fresh fruit and fiber over meats and carbohydrates. Cynics could cast a suspicious eye at the fruit industry, but most rational people recognize the change as a result of improved scientific knowledge rather than commercial self-interest.

Yet, when The Seattle Times recently wrote about the rapidly evolving standards in medical care, it drew only the most pessimistic conclusions regarding pharmaceutical companies ("Suddenly Sick," page one, June 26-30). Overlooked were the measurable improvements in the quality and length of lives resulting directly from these refined standards.

The continual reassessment and refinement of human health standards is a positive process that benefits both individuals who might otherwise suffer unnecessarily and society as a whole in terms of longer, healthier and more productive living at lower overall cost to our health-care system.

With medical knowledge deepening and treatment options improving, we are constantly re-examining and refining the definitions of "disease" and "health." These advances offer enormous hope for people who want and expect to live longer and healthier lives than did earlier generations. With continued improvements in diagnosis and treatment — including the expanding role of pharmaceutical medicines — millions more people can realistically entertain this prospect.

Over the past 30 years, improved diagnosis and treatment have reduced the death rate from hypertension by 21 percent, emphysema by 57 percent and rheumatic heart disease by 83 percent. If these rates of improvement continue, we can expect reductions in mortality of as much as 26 percent from lung cancer, 40 percent from coronary heart disease, and 65 percent from breast cancer over the next decade.

All of this brings America to a larger opportunity to provide still better health care still more economically. Today, we are beginning to move to an approach that focuses more on prevention and wellness than on the historic acute-care paradigm, which is both less effective in terms of clinical outcomes and more expensive. This movement is slow, but it is as promising — if not more so — than all of the medical advances of recent years taken together. Not surprisingly, the refinement of medical standards of disease and improvements in the development of pharmaceuticals are central to this approach.

Consider, for example, that advances in the understanding of and the standards for healthy levels of blood pressure and LDL cholesterol have — through early diagnosis and treatment — saved an estimated 150,000 Americans from death by heart attack over a recent 15-year period. And many more averted invasive and hugely expensive surgeries to repair preventable cardiovascular damage.

In 2001, Dr. Rory Collins of Oxford University conducted what was then the world's largest clinical study of cholesterol-lowering statin drugs, the results of which led directly to the redefinition of the current accepted standard for healthy cholesterol levels. According to Collins, if the 10 million people currently at high risk of heart attack sought proper diagnosis and treatment with statins, 50,000 deaths would be prevented annually.

And aggressive treatment yields other direct and measurable returns on investment, as experts have known for some time now. A study by Harvard economist David Cutler and Centers for Medicare and Medicaid Services administrator Dr. Mark McClellan, then of Stanford University, found back in 1998 that progress against certain cardiovascular diseases returns $7 for each dollar spent on increased treatment. Other studies show a similar return on spending.

Yes, a new and healthier approach to health care is beginning to emerge. This new approach — which recognizes the cost of disease as far greater than the price of health — is based on disease awareness, early diagnosis and intervention, and prevention, with the use of pharmaceuticals when appropriate and healthy behavioral change whenever possible.

This approach works. The state of Florida, in partnership with Pfizer and others from both the private and public sectors, is concluding a program to study the effectiveness of re-engineering health-care delivery. This pilot program, named "Florida: A Healthy State," involves 150,000 Medicaid beneficiaries statewide and pairs 19,000 high-risk patients with a group of personal-care managers who help the participants take a greater role in managing their own health. The result? Better health outcomes across the board, including improvements in heart function, blood glucose levels, asthma symptoms ... and more than $41 million in savings to the state in avoided hospital and related costs in the program's first two years.

Businesses are discovering the advantages of this approach, as well. As a member of the Partnership for Prevention, Pfizer is one of a number of companies that have revamped employee prevention and wellness programs. Recent studies have shown that investment in prevention and wellness programs results in an average 28-percent reduction in sick-leave absenteeism and an average 26-percent reduction in health costs, with savings of about $3.50 for every dollar spent.

Are medical-care standards changing? Yes, just as standards have always changed. It wasn't that long ago that depression, epilepsy and HIV/AIDS were considered untreatable. Standards are redefined by new knowledge, and medical knowledge is expanding today like never before.

Projects like the one in Florida and the Partnership for Prevention demonstrate that by using this knowledge to make informed choices, change lifestyles, and employ pre-emptive pharmaceutical intervention when needed, Americans have a better chance of living fuller, more productive lives, suffering less pain and disability than at any time in human history. It is up to us, as a nation, whether we continue to advance our standard of longer, healthier living through this new approach.

J. Patrick Kelly is president of Pfizer U.S. Pharmaceuticals, headquartered in New York City.

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