By Clifton Leaf and Sy Mukherjee
May 15, 2017

There’s a common mindset about human health: that there are some illnesses we get because we’re unlucky and some we get because we helped bring them on through our behavior or lifestyle.

We hear that distinction in the “no wonders.” As in: “He was run down. No wonder he got the flu.” “She smoked a pack a day. No wonder she got lung cancer.”

And we heard a variation of that theme late last week from Mick Mulvaney, the former South Carolina Congressman and Freedom Caucuser who now heads the Office of Management and Budget—and who, importantly, has been one of the Trump Administration’s key emissaries in the effort to repeal and replace Obamacare.

Mulvaney was speaking at Stanford University’s Leaders in Global Healthcare and Technology forum and was asked to respond to concerns that late-night host Jimmy Kimmel had raised in a moving monologue about his newborn son’s heart surgery. Kimmel had said that while he could afford the cost of that care—which, among other things, included a 21-day stay in the hospital for his prematurely born son—other parents might not be able to do so under a GOP bill that lets states opt out of rules that now govern the coverage of pre-existing conditions. “No parent should have to decide if they can afford to save their child’s life,” said the TV host—a threshold that one Republican Senator dubbed “the Kimmel Test.”

Mulvaney quickly dismissed that concern: “We have plenty of money to deal with that,” he said. “We have plenty of money to provide that safety net so that if you get cancer you don’t end up broke.” But then he added: “That doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes.”

Now, I don’t believe in socking a person over one misspoken line. I, myself, am a king of misspeaking. But Mulvaney’s comment is reflective of that widespread and entrenched mindset I mentioned up top: the belief that some people, at least to some extent, deserve the diseases they get. And that’s not only a dangerous mindset, it’s also terribly misinformed.

That’s not to say that those who smoke aren’t doing something self-destructive and stupid. They are. (Smoking substantially increases a person’s risk of getting a number of cancers, heart and lung diseases, and other ailments.)

But with the exception (perhaps) of some infections, human disease, including lung cancer, is rarely “caused” by one (and only one) thing. Rather, it is most often the result of a complex and often random interplay of factors—you might even call it a collision of factors—including our genes, our environment, and our dumb luck.

Take Mulvaney’s example of diabetes. We’ll just assume he’s not referring to type 1 diabetes, in which the immune system mistakenly targets and kills pancreatic cells that release insulin, a hormone needed for cells throughout the body to properly absorb glucose from the bloodstream—or gestational diabetes, which can occur during pregnancy. We’ll figure he means type 2 diabetes, in which the body makes too little insulin or can’t use it effectively.

Some 29 million Americans have some form of diabetes—and an additional 86 million of us (over the age of 20) have prediabetes, meaning that we have higher-than-normal levels of blood sugar. Diabetes is a devastating, progressive disease that costs the country, by one estimate, nearly $250 billion in medical costs, lost wages, and productivity each year.

It’s also a complicated pathology—with surprising correlations and no straightforward, true-or-false etiology. No singular molecular glitch seems to lie at its heart. While there is a strong heritable factor in the disease, it’s not yet certain which combination of genetic aberrations trigger the disease—or cause it, in the words of one authority, after being “expressed only under the appropriate environmental insults.”

A slew of studies now link diabetes, in various ways, with tuberculosis, Alzheimer’s (which one Japanese research group now suggests may be a “diabetic disorder of the brain”), neural tube defects, glioma, and more. Part of these linkages may be due to diabetes’ myriad effects on (and damage to) the body as it progresses. But there may be other, more deeply rooted, connections—tracing to an overlooked intersection of gene interactions or to another surprise crossing of molecular pathways.

More and more, researchers are discovering unlikely networks of connections between seemingly far-flung diseases and disorders. Sometimes, they show up as a comorbidity—unearthed, perhaps, after a big-data analysis of insurance claims. One Austrian research group, for instance, found highly significant associations between diabetes and 123 separate diseases.

Genes for deafness, meanwhile, are linked with one or more of the genes associated with at least twenty other ailments. And study after study suggests that poor dental health can lead to heart attacks and to vascular disease generally.

With such little-understood connections between diseases and their origin—and between one pathological breakdown and another—it’s an awfully slippery slope to deny health coverage to someone “who sits at home, eats poorly” and gets sick.

The “no wonder” game, in truth, has no end. With this mindset, it’s all too easy to say: “No wonder he got a heart attack. He never flossed.”

More news below.

Clifton Leaf, Editor in Chief, FORTUNE
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

Massive ransomware attack wreaks havoc on U.K. health system. A gigantic cyber attack over the weekend brought the U.K.’s National Health Service (among other companies and systems) to its knees. The “Wanna Cry” epidemic, which is still far from over, represents a perfect storm of outdated hospital system IT, buggy software, and government surveillance, as my colleague Jeff John Roberts explains. (The NSA exploited vulnerabilities in Microsoft operating systems, and its hacking techniques were then stolen and leaked onto the Internet.) Just who is to blame? Depending on who you ask, it might be Microsoft, the NSA, cybersecurity companies, the hospitals and companies affected, or the cybercriminals themselves—or maybe all five groups combined. (Fortune)

Alphabet backing helps Clover Health become a unicorn. Meet digital health’s newest unicorn: Clover Health, which raised $130 million from Alphabet venture arm GV (and a slew of other investors) at a $1.2 billion valuation. The firm has a pretty unique model and goal. For one, it’s an insurance company servicing Medicare Advantage customers. But the firm is also data- and population health-centric; one of its main aspiration is to collect medical information with the goal of providing preventative health care services and interventions. For instance, Clover’s software can analyze gaps in care, such as a missed prescription, and then alert a representative to call the patient to follow up.


INDICATIONS

Dendreon is looking for a comeback with new cancer vaccine data. Dendreon got a boost over the weekend with real world data for its prostate cancer vaccine Provenge, which has struggled to make a splash in sales. The therapy had an outsized effect in African American men, helping those with metastatic castrate-resistant prostate cancer live a median 37.3 months after treatment. That’s important because prostate cancer disproportionately afflicts black men. And the new data may get physicians to pull out their prescription pads. (FiercePharma)

Drug manufacturing and research companies are in a merger frenzy. The latest clinical trial outsourcing/drug development and manufacturing merger hit on Monday as scientific instrument giant Thermo Fisher announced it would buy drug ingredients maker Patheon for $5.2 billion ($7.2 billion is you count $2 billion in net debt). This is the latest merger involving the pharmaceutical outsourcing market; last week, inVentiv Health and INC Research announced their own marriage, and Quintiles and IMS Health merged last year to birth a clinical research giant. One potential reason these companies are looking to combine? Similar trends in biopharma M&A, which has disrupted business for third-party firms used by drug makers. (Fortune)


THE BIG PICTURE

World Health Organization chief candidate accused of covering up epidemics. Tedros Adhanom Ghebreyesus, a leading candidate to be the next World Health Organization director-general, is facing a stunning allegation: covering up three cholera outbreaks in his home country of Ethiopia while he was its health minister. The accusation was lobbed by an informal adviser to Dr. David Nabarro, who is also vying for the top job at WHO. Nabarro says he didn’t authorize the release of the allegations while Ghebreyesus denies the charges altogether, classifying them as a “smear campaign” against his candidacy. (New York Times)


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