If you could choose the method, how would you want to die?
Many people wish for a quick and painless demise, such as passing away peacefully in your sleep after having lived to a ripe old age. What we fear is a slow, lingering death from a painful disease.
Unfortunately, this fear will come true for many of us. The federal Centers for Disease Control and Prevention reports that as of 2007, the top five causes of death in the United States were:
4.Chronic lower respiratory disease (chronic bronchitis, emphysema and asthma).
The top 10 is rounded out by Alzheimer’s disease, diabetes, flu/pneumonia, nephritis (kidney ailment) and related disorders, and septicemia (blood infection).
Interestingly, recent data on what illnesses Americans fear most doesn't line up the most common causes of death. In a survey conducted in 2010 by Harris Interactive for insurer MetLife, Americans said they most feared cancer and Alzheimer’s, followed by heart disease, stroke and diabetes.
Cancer was far and away the most feared disease, with 41 percent of people surveyed naming it, followed by Alzheimer’s at 31 percent. The number of people who feared these two diseases rose compared with a benchmark 2006 survey – cancer fear rose 3 percentage points while Alzheimer’s shot up 11 percentage points. At the same time, the fear of heart disease, stroke and diabetes declined.
The nation’s actual No. 1 killer – heart disease – was named the most feared disease by just 8 percent of those polled, with stroke gaining a similar share of the vote. Only 6 percent of people in the MetLife survey feared diabetes.
Clearly, Americans’ perceptions are out of whack when it comes to worrying about diseases they’re statistically most likely to suffer. But their fears are not entirely irrational.
Alzheimer’s: Where fear is justified
There is some logic concerning why fears of Alzheimer’s outstrip the frequency of the disease. At the Alzheimer’s Association, Ruth Drew, director of family and information services, notes that while medical advances have led to declines in heart disease and some cancers, the ever-graying population means Alzheimer’s is on the rise.
“Not so long ago, Alzheimer’s was the 10th most common cause of death,” Drew says. “Now, it’s sixth.”
Worse yet, there's currently no meaningful treatment, much less a cure, for Alzheimer's, which steadily robs victims of their memories. Those diagnosed early can benefit from medications that lessen initial symptoms, but at the moment, that’s all the treatment available. Unlike cancer and heart disease, where survival rates are improving, no one survives Alzheimer's.
Here’s another reason Alzheimer’s is the object of so much fear: People can reduce their risk of getting cancer, heart disease or diabetes by changing their lifestyle – quit smoking, lose weight, get more exercise – but there's no known cause of Alzheimer’s, so there's nothing you can do to avoid getting it.
Deaths from Alzheimer’s jumped 66 percent between 2000 and 2008, according to the Alzheimer's Association, while the death rates for breast cancer, prostate cancer, heart disease stroke and AIDS all declined during that time.
On top of that, the cost to care for Alzheimer's patient is skyrocketing. The price tag for Alzheimer’s care in the United States will be about $183 billion in 2011, according to the Alzheimer's Association. That would be an increase of $11 billion over 2010.
Drew and others who work with Alzheimer’s patients are concerned that fears about the disease keep those affected from seeking help. That’s unfortunate, she says, because early diagnosis offers more options for patients and their loved ones.
“It gives the person with the disease a voice,” Drew says. “They can make decisions about living situations. If you wait too long, family members say, ‘I don’t know what she would have wanted for this,’ and they can no longer ask their loved one. In the early stages, the person can tell you.”
Cancer: Mixed news
In recent years, treatment breakthroughs have improved the survival rates for people with many types of cancer, says Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. Although there’s a brighter outlook for patients with many forms of cancer, thanks partly to earlier detection, Lichtenfeld says many people’s cancer fears remain rooted in perceptions of how deadly the disease was decades ago.
Decades after urban myths are debunked, Lichtenfeld says, the American Cancer Society continues to educate people about falsehoods surrounding the disease – such as the long-discredited notion that exposing the cancer to air during surgery will make it worse.
“Some people are still worried that cancer is contagious and you could catch it from casual contact,” Lichtenfeld says. “We tend to hold onto our fears for a very long time.”
High costs of chronic diseases
The top causes of death are to be feared not just because of the physical agony they inflict, but because they're all expensive to treat, contributing to rising health insurance costs. The Agency for Healthcare Treatment and Quality reports the five most expensive conditions in 2002 were heart disease, cancer, trauma, mental disorders and lung conditions.
While the most expensive conditions in terms of total health care spending are heart disease and trauma, on a per-person basis cancer is the most expensive, followed by heart disease.
Insurance doesn’t pay the whole tab, either. For instance, in a study published in 2010, the federal Centers for Disease Control and Prevention found patients and their families paid roughly 8 percent of the roughly $48 billion cost of cancer treatment. Private insurance paid half the costs; Medicare and Medicaid, 37 percent; and other public funding sources, 5 percent.
The National Institutes of Health recently forecast the cost of cancer treatment could rise to $207 billion in 2020 if new, less expensive treatments aren’t found.