What’s wrong?

This doesn't come cheap, you know

How many diseases are there? An expert would probably look for the answer in ICD-10, the WHO’s catalogue of over 12,000 calamities that could hit you.

The eponymous hero of Jules Romains’ play Knock, or the Triumph of Medicine would probably have replied that there as many as you can convince people to have. According to him, a healthy person is merely a sick one who doesn’t know it yet.

The ICD can give you that impression too. Some of the characteristics of F60.5 (anankastic personality disorder if you must know) sound more like my job description, and in fact few of my colleagues would escape intact from even a superficial check against sections F60-69, Disorders of Adult Personality and Behaviour. Who hasn’t worked with/for “There may be excessive self-importance, and there is often excessive self-reference”?

According to a special issue of PLoS Medicine, the expansion in the number of diseases these past years is not due to the population becoming sicker or diagnostics getting better. The real reason is “disease mongering” – interested parties creating an all-in-one package of a new treatment and a new condition it can treat, or a new use for an old treatment whose patent is about to expire.

This may play a role in increasing health costs, but the main reasons are that patients expect more from health care systems and that the type of conditions the systems have to treat are changing.

Scanners and other modern imaging techniques are expensive, but are now commonplace, as are sophisticated testing techniques. Many diseases that would once have killed the sufferer can now be treated, but the treatment may last for years. The population is ageing, and more people are living to an age when costly care is needed on a daily basis.

These are postive developments, and investment in health pays dividends. For example, up to 40% of the increase in life expectancy since the early 1990s could be due to increased health spending.

That doesn’t mean that the 9% of GDP an average OECD country devotes to health is all money well spent. Health ministers meeting at the OECD this week will be looking at how to get the best value for money, and ensure that the progress we’ve seen in treating those 12,000 diseases continues. They’ll also be looking at prevention, how to stop us getting them in the first place.

Useful links

OECD work on health

The MRI brain scan is courtesy of Dwayne Reed

Patrick Love

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