Chronic inflammatory diseases, the major health challenge in modern societies - Part 1
- One of the biggest burden of diseases where we still have not the right answers -
Wolfgang Kissel and Herbert Treutlein, 21 August 2018
Inflammation is a natural reaction to all kind of injuries and is our body’s attempt to self-protection. Inflammation is part of the immune system and starts the healing process. This makes it a crucial immune response for fighting off illness. However, inflammation becomes a problem when this natural reaction does not stop. This “chronic” immune reaction creates many risks that can lead to debilitating and persistent diseases.
In industrial societies, due to our western lifestyle, inflammation is the route cause of many if not all chronic diseases. Especially Western Diet comprised of excessive fat & sugar consumption is triggering the growth in the occurrence of chronic inflammatory diseases. Unfortunately, inflammatory conditions are difficult to detect. Only when people get ill, we learn that the disease most probably originated from inflammation. Especially, the growing age group of >50 is at risk the most in developing these often-debilitating diseases. But make no mistake, chronic inflammation is not age related. Chronic inflammation starts when people are young and can go undetected for decades. With disease establishment at a young age, early intervention and self-care might have its biggest impact.
According to the WHO, by 2020 chronic inflammatory diseases are expected to contribute to 73% of all deaths and 60% of economic burden of disease. This makes chronic inflammatory diseases the major health challenge in “modern” societies. Already in 2004, Chronic Inflammation made it to Time Magazine cover and was named “The Secret Killer” (Time Magazine article, 2004 ).
Chronic inflammation is not the root cause of just one but of many ill health conditions. With our knowledge today, chronic inflammation can be referred to most of our society’s widespread diseases. In addition, chronic inflammation often leads to co-development of other diseases and is especially correlated with chronic pain. Chronic inflammatory diseases take a huge toll on quality of life of hundreds of millions of people. Late detection and therapeutic solutions, dominated by complexity have a significant economic burden that can only be expressed in $trillions. A good overview about the burden of inflammatory diseases is provided by Pfizer (Value of Medicines Burden of Disease: Chronic Inflammation and Inflammatory Disease (NEW 2017) (PDF))
The most common chronic inflammatory diseases are all the arthritic diseases, Atherosclerosis, chronic obstructive pulmonary disease (COPD, best known as smoker’s cough) and NASH (non-alcoholic fatty liver and liver inflammation), let alone Alzheimer's.
There are no sufficient medical solutions in the market for these diseases. Most of inflammatory disease targets are protein-protein interactions and are among the most difficult ones to drug. The medications in the market are mainly antibody drugs, which need to be applied by injection. E.g. the biggest selling drug in the world, Humira (treats Rheumatoid Arthritis) works only for 20-25% of the patient population and can have significant side effects. The same is for other antibody based drugs and for the few approved small molecule drugs (at least they can be taken as a tablet and are significantly cheaper). Still, for the vast majority other new therapies need to be developed. However, the pharma industry, with its declining R&D productivity, is facing a growing challenge to develop quickly and cost efficient new therapies not just for chronic inflammatory diseases but especially for these.
The natural medicine industry has even less to offer. They are stuck in their niches and focus too much on traditional approaches with easily interchangeable products (e.g. there is no difference in the various turmeric or fish oil products other than the packaging). No wonder the industry experiences:
Lack of acceptance in the wider medical community because lack of scientific proof about what really works
An image of obscurity, esoteric and alchemy
End-consumers not well educated and are more believing than knowing
When exploring drug stores for natural remedies it seems that innovation is understood in this industry as marketing gimmick rather than offering well researched products. With no real innovative approaches on the horizon, this is not likely to change in near future. This is a missed opportunity, because in the area of mild and benign health conditions (but still uncomfortable), natural remedies could be an excellent complement to the necessary pharmaceutical medications for severe conditions.
To emphasize the importance to search for innovative solutions in therapy as well as in self-care and disease prevention, we describe 3 different inflammatory diseases that have high unmet medical needs and where no satisfactory medical solutions have been developed.
Joint inflammation incl. Rheumatoid Arthritis affects nearly 1% of adults in the developed world with between 5 and 50 per 100,000 people newly developing such conditions each year. The age at which these diseases most commonly start is in women between 40 and 50 years of age, and for men somewhat later. Inflammatory conditions of the joints are chronic diseases and affect with Rheumatoid Arthritis alone 17.6 million people worldwide, in the USA 1.6 million and in Australia 400,000 people. The healthcare costs for these patients in the USA are ca. $1.9 billion p.a. and in Australia are currently exceeding $400 Million p.a.
There is no cure for any of the arthritic diseases and therapies are complex and amount to huge costs for the individual and society. The R&D efforts of the pharmaceutical industry can be expressed in $billions but the outcomes are still far from satisfactory. Pharmaceutical solutions are also focused on the disease condition rather than on prevention. Because the chronic inflammation leading to the disease starts early and is undetected for a long time there is a significant potential for self-care, education and disease prevention.
Chronic obstructive pulmonary disease (COPD)
COPD is an chronic inflammatory disease affecting the lungs. The two most common types of COPD are emphysema and chronic bronchitis. The two main causes are smoking (the most significant cause, that’s why COPD often is called smoker’s cough) and air pollution (which can be also expressed in cigarettes smoked per day Effective number of cigarettes smoked per day). The prevalence among adults differs from country to country and seem to be dependent on how deep smoking is ingrained in a country’s culture. In France ca. 3.5 million (6%) of adults have COPD, in the UK 3 million and in Australia 600,000 (2.6%). In the USA, COPD is the 3rd most common cause of death.
There is no cure and all efforts by the pharmaceutical are focused on disease management and mitigation. However, the disease is mostly behavioral and therefore preventable. Not starting or quitting smoking could be the best cure in most cases.
Non-alcoholic liver diseases are on the rise and are rapidly growing, vastly undetected, in industrial societies. Ca 30% of the population is at risk of NAFLD (Nonalcoholic Fatty Liver Disease), the precursor of the more severe form of NASH (Nonalcoholic Steatohepatitis), which affects 3-5% of the population. For the USA this means ca 15-20 million people, for Australia this means ca. 1.5 million people are at risk of having NASH. As mentioned, the disease is vastly undetected and actually hardly known in the public. Shockingly, the disease is considered as the biggest untapped area in medical care. The number of people affected is rapidly growing and it is expected that NASH becomes the predominant liver disease in our society. If untreated NASH leads to liver fibrosis and in parts to liver cancer or liver cirrhosis. Currently there is no standard treatment available and there are no medications in the market. The first drugs are expected earliest by 2022-2028. The growing total financial cost of liver disease was estimated as $5.4 billion in Australia (2012).
The underlying causes of NASH are various types of inflammation. The accepted goals of any NASH treatment is to stop the primary inflammation, to stop liver cell degeneration and to stop subsequent inflammatory conditions. Pharma R&D is investing heavily in NASH drug development but it is already clear that even when a therapy gets into the market, the drug(s) will be not sufficient and that a serious therapy has to to be multidisciplinary. Because of this, the nature of the disease and the low degree of awareness, there is a high potential and actually a must for self-care, consumer education, prevention.
In part 2 of this blog, we’ll have a closer look on innovative solutions in health self-care and disease prevention for some of the challenges from chronic inflammatory diseases.