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Comment by ch4s3 | Hacker News Reader

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.

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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.

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