Why Not a Behavior Change Moonshot?

For forty years Americans have been convinced that cancer can be fixed. It fits with our quite impossible dream of living forever. We have constantly been told that all that we need is more of each of the following

• highly specialized and costly research, 
• highly specialized and costly tests, 
• highly specialized and costly scans, 
• highly specialized and costly physicians/staff/systems...

Can this be done without collapsing health care or the national economy? Is this a good expenditure of dollars? Can our bodies endure the treatments?

In more recent times we have a call for a cancer moonshot. Is this a fit with what can be done, what science dictates, and at reasonable value?

What is highest probability - is that we will not be able to afford it. President Kennedy understood this with his original moonshot claim and indicated that we could not do this, unless we focused on keeping costs reasonable. Science, innovation, and discovery costs in health care have no such restraints and have gone way out of control since the 1960s.

It is quite interesting that we hear talk of value in health care every day, but no one raises the question of value in the many areas where we are pouring billions into care with little return on investment.

The science required is daunting.

Spending more for fewer Americans is indeed the American way - but this is not value.

Not mentioned are areas with substantial impact upon Americans.

Behavior Change Is Where Complex Disease, Best Outcomes, and Value Coincide

Whatever happened to behavior change? The science studies have long demonstrated that the major impacts upon cancer are about behavior changes such as stopping smoking. This one behavior change was worth forty years of drug, scanning, and technical advances from 1960 to 2000 (NCI researchers). It has taken a massive infusion of dollars to finally tip the scales in favor of a technological solution. 

Patients who present with chest pain with mental health problems are more likely to die in the next year compared to those with cardiac reasons. 

Behavior Change Advantages

• Behavior change is scientific. Patient factors are most important in health outcomes and behavior change is perhaps the most important
• Preventing complex disease is the best approach for least cost and best outcomes
• Completing a full course of treatment for best outcomes requires behavior change as many do not understand how to maximize benefit/minimize consequences

Since 1999 and To Err is Human we have been even more focused on the clinical area - the area least likely to influence outcomes with highest costs. The massive buildup due to technology and subspecialty focus has only been dwarfed by the administrative cost acceleration. 

We are even cutting and compromising the mental health, primary care, and community sources to address changes in behaviors, determinants, situations, and other patient factors that shape most of health and health outcomes.

Cancer Is Not the Only Moonshot Area

Cancer is just one area and a late comer at that. What about sanitation - failing fast? What about clean water, immunization, public health, primary care? What about community interventions, nutrition, housing, security, child development, early education, and other human infrastructure and physical infrastructure to make our society more efficient and more effective.

And then we wonder at all of the different destructive behaviors that dominate the headlines... And we cannot even get cab fare to address them.

And by the way, the Mental Health Reform Bill, is no design to replicate for a moonshot. More funding for best practices, administration, demonstration, and distribution (dollars to agencies) is everything but rubber meets the road one on one behavioral impact.

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