# Presentation: 126397

## Steps to a Healthier US, Putting Prevention FirstBaltimore, MDApril 15, 2003

**Leslie D. Michelson****Chief Executive Officer and Vice Chairman Prostate Cancer Foundation**

## The most significant accomplishments of the 20th century

- Increased human life span in developed countries by over 40%.
- That is a greater increase than occurred in the prior 200,000 years that the human species has existed.
- Better public sanitation, individual hygiene, vaccinations, and antibiotics reduced infant mortality rate in the U.S. from 165,000 to 7,000.
- Better diagnostics, drugs and surgical interventions reduced cardiovascular deaths 60% during the past 30 years.

##   1938:	

**President  Roosevelt **
**declares war on polio**

## 1952: 58,000 cases diagnosed; 

**Polio is declared an epidemic; **
**1,200 people die.**

## 1955:  The Salk polio vaccine is introduced  

## 1956:   Elvis gets his shot 

**1956:   Elvis gets his shot **
**to promote immunization**

## Solving Medical Problems

- Childhood leukemia was a death sentence 30 years ago – 5% of victims lived five years.

**Solving Medical Problems**

## Solving Medical Problems

- Today ...
- 80% are cured!

**Solving Medical Problems**

## We are at an inflection point in health care

**Time**

***Inflection Point***
*Changes in technology, society and economics*

**Source:** Andrew S. Grove, *Only the Paranoid Survive*

**Progress**

## The New Challenges

- As we age, the incidence of many diseases will increase dramatically.

## 1999 Age Specific Probability of Diagnosis

**Prostate cancer attacks aggressively beginning at age 60.**

- Source: SEER 9 Registries incidence and mortality (2001 submission).

## The Baby Boomers 1990 - 2040

- Source: SEER 9 Registries incidence and mortality (2001 submission).

## Projected New Cancer Cases

- Source: SEER 9 Registries incidence and mortality (2001 submission). Assumes 1999 age specific incidence rates.

**Prostate cancer is the most common and most rapidly increasing cancer.**

## Historical & Projected Cancer Deaths

## Without Improvements in Diagnosis & Treatment...

- The number of new prostate cancer cases will increase 50% from about 220,000 today to over 300,000 by 2015.
- There will be over 400,000 new prostate cancer cases per year     by 2037.
- The number of prostate cancer deaths per year will increase      60% from about 32,000 today to over 50,000 by 2020, and 80,000 by 2030.

## The New Challenges

- As we age, the incidence of many diseases will increase dramatically
- Lifestyle induced disease is increasing rapidly.

## Lifestyle Makes a Difference

**U.S. Economy****$10 trillion**

**Lifestyle Makes a Difference**

**15% = health care spending**
**$1.5 trillion**

## Lifestyle Makes a Difference

**U.S. Economy****$10 trillion**

**70% of health-care spending****	****– $1 trillion – is spent on**** ****	****lifestyle-related diseases.**

**Lifestyle Makes a Difference**

## “Obesity Affects Health 

**More Than Smoking or Drinking”**

**36%**

**(Percent of population whose**
** ****health is adversely affected)**

**Over-**
**weight**

**Obesity**

**Smoking**

**Drinking**

**23%**

**19%**

**6%**

**Source: British Public Health Journal**

## The costs of our OBESIGENIC Society

- Chronic diseases related to lifestyle account for 70% of total healthcare spending	– Fries, Koop, Beadle, 1998
- Poor eating habits and lack of physical activity result in 300,000 U.S. deaths per year – U.S. Health & Human Services Dept. 2002
- Better diet and exercise could reduce cancer rates 30 to 40%, 300 million cases worldwide – Int’l Obesity Task Force, 2001
- Obesity affects 59 million Americans: 31% of all adults and 15% of children 		– U.S. Health & Human Services Dept. 2002
- Healthcare costs associated with obesity are 36% higher than the norm—more than smoking (21%) or heavy drinking (14%) 			– Rand Corporation Study 2002
- Being overweight, alone, increases risk for heart failure; for every one point increase in BMI, the risk for men increases 5% and for women 7% 	– New England Journal of Medicine, 2002

## The Need for Change: Consequences of Obesity

**The Need for Change: ****Consequences of Obesity**

**Cardiovascular disease**

**Respiratory disease**

**Gallbladder disease**

**Hormonal abnormalities**

**Hyperuricemia**
**Gout**

**Stroke**

**Diabetes**

**Osteoarthritis**

**Cancer**

- National Institutes of Health/World Health Organization

## America’s Weight Problem

## Obesity Crisis for Children

**25% are overweight**
- 100% jump since 1970
**14% are obese**
- 11% jump since 1997

**Obesity Crisis for Children**

- Source: Centers for Disease Control

## Question:

**In the 1960s, an order of McDonald’s french fries contained fewer than 250 calories? How many calories are in a supersize fries?**

**250**
**375**
**525**
**610**
**1,025**

## ‘Supersizing’ of French Fries

**1970s**

**1960s**

**1980s**

**1990s**

**calories**

**750**

**500**

**250**

**2002**

**610 calories**

## Sodas Then and Now

**1950 Classic Coke  8 oz**

## Hamburgers Then and Now

**Hamburger in the old days**

## Fast Food in the Schools 

- 20% of public schools sell fast foods such as Pizza Hut, Little Caesar’s or McDonald’s.
- Vending machines are omnipresent
- 43% of elementary schools
- 74% of middle schools
- Virtually all high schools
- Government hot-lunch program fattens up
- 20% of hot lunches are within USDA fat limits.
- 15% are within saturated-fat limits.

- Source: Centers for Disease Control

## Growth Rate of U.S. Food Consumption % per person, 1990-2000

**Fats**

**Sugars/****Sweetners**

**Vegetables**

**Grain**

**Dairy**

**Fruit**

**Red****Meat**

**18%**

**11%**

**10%**

**10%**

**4%**

**3%**

**1%**

- U.S. Dep’t of Agriculture

**140 lbs of extra food****each year!**

**Notes:**
Growth in vegetable consumption is misleading: 67% of servings are potatoes (fried, instant, potato chips and fresh), iceberg lettuce, tomatoes (mostly canned), carrots and onions)

## 26% of U.S. children ages 8-16 watch TV four or more hours a day.

**26%** of U.S. children ages 8-16 watch TV four or more hours a day.

**29%** of U.S. high school students participate in physical education classes

**Physical Inactivity**

## January2003

**January****2003**

## The New Challenges

- As we age, the incidence of many diseases will increase dramatically
- Lifestyle induced disease is increasing rapidly.
- The cost of treating disease is becoming unaffordable.

## Health care costs too much

- Health care consumes 14% of GDP.
- Health care costs are increasing at about 4%
- At the current rate of increase, given the state of the economy, health care will consume between 19% and 25% of GDP in the next decade.
- That is an unprecedented change.

## Cost containment efforts have worked for short periods of time

**National Health**
**Planning**

**Nixon Wage and**
**Price Controls**

**Halfway competitive markets**
**And ineffective regulation**

**Managed Care**

- Source: Altman, Stuart H, et. al. “Escalating Health Care Spending: Is it desirable or inevitable?”  Health Affairs. Jan. 8, 2003

## The New Challenges

- As we age, the incidence of many diseases will increase dramatically
- Lifestyle induced disease is increasing rapidly.
- The cost of treating disease is becoming unaffordable.
- The cost of finding new treatments is rising rapidly.

## The Cost of Developing a New Drug is now $800 million

**$ in Millions**

- Source: DiMasi, J.A., “New Drug Development in U.S. 1963-1999.” Clinical Pharmacology & Therapeutics 2001. May 69(s).

## The Time to Develop a New Drug is now 14 years

**Years**

**8.1**

**11.6**

**14.2**

**14.2**

- Source: DiMasi, J.A., “New Drug Development in U.S. 1963-1999.” Clinical Pharmacology & Therapeutics 2001. May 69(s).

## New Molecular Entities approved by the FDA

**New**
**Molecular**
**Entities**

- Source: http://www.fda.gov/cder/rdmt/NMEapps93-02.htm

## The New Challenges

- As we age, the incidence of many diseases will increase dramatically
- Lifestyle induced disease is increasing rapidly.
- The cost of treating disease is becoming unaffordable.
- The cost of finding new treatments is rising rapidly.
- The decoding of the Human Genome will result in individualized recommendations.

## “It requires greater intelligence to solve the problem than it took to reach the problem.” 

- Albert Einstein

## We must focus more resources on healthier lifestyles

- Technology Enhanced Education for Children

## Slide 42

## Slide 43

## We must focus more resources on healthier lifestyles

- Technology Enhanced Education for Children
- Efficient Internet Support Programs for Adults

## What is Miavita?

- Miavita is a leader in the delivery of action-oriented programs that help individuals achieve healthier lifestyles
- Prevent disease
- Improve quality of life
- Reduce health care costs
- Increase productivity
- Miavita can save lives!

## The Miavita Healthy Living Programs

- Personalized
- Tailored programs for action
- Meal planner, fitness planner
- Nutrition and fitness coaches
- Comprehensive
- Fitness, nutrition, stress reduction, wellness
- Science-based programming
- Targeted
- Diabetes, hypertension, heart disease, cancer prevention, life events

## We must focus more resources on healthier lifestyles

- Technology Enhanced Education for Children
- Efficient Internet Support Programs for Adults
- Cookbooks that translate our favorite foods into healthy recipes

## Slide 48

## Slide 49

## We must focus more resources on healthier lifestyles

- Technology Enhanced Education for Children
- Efficient Internet Support Programs for Adults
- Cookbooks that translate our favorite foods into healthy recipes
- Intensify research on nutrition
- The Prostate Cancer Foundation has funded nutrition research in many countries
- Initiate research on the interplay between the genome, lifestyle and disease
- Prostate Cancer is the cancer with the strongest familial link.
- Study the economic implications of disease and health promotion
- The Milken Institute continues to study these issues
- Reduce the cost and time to develop new treatments
- The Milken Institute Center for the Acceleration of Medical Research

## Slide 51

## The End.