This piece originally appeared in the Timmerman Report.

I make a lot of lists. It’s not the right approach for everyone, but it works for me, especially when there’s a lot going on in my life. Sometimes the lists are things to do, things to buy, or just ways to organize my thoughts. And yet my life isn’t particularly complicated or hard. When I dig into our healthcare system and how convoluted it can be, I’m thankful that I don’t have a lot of decisions to make or choices to research.

That’s not the case for everyone. For people with chronic diseases like diabetes or complicated conditions like cancer, being sick imposes not just health and financial burdens, but mental ones as well. Disease can force patients to make huge numbers of mentally taxing, difficult decisions every day.

As an example, a type 1 diabetic has to perform a daily balancing act. Every day she needs to estimate how much insulin she’ll need at different times depending upon what she’s doing now and what she’s planning for the near future. She also has to estimate how glycemic her foods are at every meal and whether her last insulin dose was enough. She’ll need to take into account other factors that may affect her metabolism. And the penalty for not getting it right? In mild cases, hypoglycemia, with attendant nausea, fuzzy thinking or blurred vision; or hyperglycemia, which incrementally increases her odds of long-term complications like neuropathy or cardiovascular issues. In severe cases, a patient can slip into a diabetic coma. On top of that, patients experience shame when being judged by their medical practitioners for not keeping their HbA1c levels under control.

That’s a mental burden.

Imagine that’s your life every day. Likely a good fraction of people reading this (about half, according to the CDC) don’t have to imagine it because they have a chronic condition. Now, many of those conditions are low maintenance and not greatly mentally taxing—for example, mild hypertension can be controlled with simple daily medication. But some conditions are more challenging and for people with multiple conditions, the mental gymnastics increase as different, and sometimes conflicting, medical decisions must be made.

It’s tough. It also reminds me of another systemic problem in our society. Having a chronic condition is a lot like living in poverty. Maybe there’s a way for the biopharma industry to catch several fish in one net by finding ways to help people manage their lives to better outcomes. And I think it would end up making real, financial sense to boot. Continue reading →