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Comment by JacobJans | Hacker News Reader

Bowel disease is becoming a widespread problem in the United States, and is a big factor behind the increasing popularity of specialized diets such as The Whole 30 Diet, Keto, Paleo, gluten free, etc.

Many people's bowels are not happy, and they're looking for answers by modifying their diets.

The increase is colon cancer among younger people is likely a result of the increased bowel disease among younger people.

The medical establishment is not really equipped for handle this rise in disease; much of the focus is on the development of expensive drugs that are basically cash-cows for pharmaceutical companies. For example, Remicade costs up to $20,000 a month -- and the market of potential users of it is many millions of people.

The financial math for researching non-drug treatments simply pales in comparison to the potential payoff for successfully developing a drug, even if the results are far-inferior to alternative approaches.

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> For example, Remicade costs up to $20,000 a month -- and the market of potential users of it is many millions of people.

That is the annual cost: https://en.m.wikipedia.org/wiki/Infliximab

Those numbers are from 2007.

The prices have increased dramatically. (Because, why not? They can get away with it.) Of course, it varies, depending on "a number of factors"

> Drug cost was $19,727.34. Total for 1 infusion is $22,278.02.

https://www.howmuchisit.org/remicade-infusion-cost/

I have a friend that requires this shot. He has to stay unemployed so that the government will pay for it.

Well, teach/guide him to do open source development? That way he can even do good, and, possibly there might be a charity of some sort that loans the necessary equipment for him to do the work, and as long as he doesn't own it/can't use it for his own good (might be considered as taxable income then), he could probably get away with it. Don't feel bad. UBI is there, just with a shitload of bureaucracy around it.

He rebuilds cars. He has no interest in learning how to code. That said, he does really good work rebuilding and restoring old cars for people. I have seen him contribute to society in other ways, including standing up for a small business owner that was being bullied by a local thug that is the son of a Sheriff.

That is a self-respect that I am highly suspicious of. Per the dosing guidelines[1] one vial should be enough for one infusion for just about anyone. Per GoodRX linked from the page you linked[2], the inflated cash price is $3500/vial. This, I don't see how $19,000 for one infusion is remotely accurate.

Regardless, since the treatment course is one vial per 8 weeks even if it were it is still not $19,000/month, it would be half that.

Edit: I fail at math. One vial per infusion was based on 1mg per kg. The usage is 5, so a typical infusion would need 4 - 5 vials. Still less than $19,000/month using the cash price, and far less using the GoodRX discount.

[1] https://www.drugs.com/dosage/remicade.html

[2] https://m.goodrx.com/remicade

There is an incentive that people often forget when it comes to drugs vs. lifestyle interventions, which is patient compliance. If a drug is < $50/mo out of pocket, patient compliance is very high. However, prescribed lifestyle and diet changes have very low compliance. If a doctor wants their patients to get better or at least feel better, they'll end up prescribing drugs to a lot of them because most of them aren't going to stick to a dietary change.

I know that more than most, from very personal experience.

However, think about it this way:

Imagine investing $20,000 a month in supporting compliance, instead of Remicade. For dietary interventions, this could mean a nutritionist with weekly meetings, occasional meal-prep provided by a personal chef, and even weekly therapy sessions. This would still likely be cheaper than $20,00 a month.

We're willing to make this kind of investment with drugs, often without batting an eye.

Why not with other interventions?

This. Someone just needs to know how to wrap it in a package that still makes some central big business a ton of money and it will take right off by itself !). Some large health club chain needs to work on getting certified as a medical care provider and developing package products. Would probably need to partner with a supplement manufacturer with deep pockets to have any chance of success.

Plenty of gyms offer PT and have registered dietitians, you have to convince insurance companies to pay for it.

Yes, that was my point. You need a behemoth of a special interest to convince anyone with power to make it happen.

It's not just wrapping it in a package. There should be a level of investment in research proving the effectiveness of such alternative treatments, including large studies similar to the types of studies that drugs are required to have. However, this is yet another huge barrier, and our cost incentives simply do not align.

> This would still likely be cheaper than $20,00 a month.

I'm not sure about that. Non drug interventions that are effective, and not generally cheap. Consider that providers of those services are incentivized to capture as much profit as possible. If the alternative to there service is set to let's say arbitrarily $20k, they can probably charge in that neighborhood as well, or higher if the insurance companies can be convinced to pay more.

Removal of polyps during a colonoscopy dramatically lowers the chances of developing cancer. That's part of why they increase the frequency of screening when they find some.

Of course it is an existing procedure and doesn't especially need to be researched (but it also costs a fair amount).

> but it also costs a fair amount

It doesn't cost anything more than the colonoscopy. It's required by the ACA to be included in a colonoscopy.

Yes, and paying $4,000 for people to get screenings is an actual cost that shows up in premiums.

(I was talking about colonscopies themselves costing a fair bit; of course all told they are preferable to catching and treating cancer later).

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