Personalized Medicine – Fulfilling the Promise of Genetic Research

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It has been 55 years since the discovery of the structure of DNA, and 40 years since James Watson published his account of that discovery in his book, “The Double Helix.”  (A picture of my autographed copy is below.)

Double Helix - James Watson - Signed Copy

Ever since DNA was discovered to code for the structure of most living things, there has been the hope that understanding abnormal genetics would lead to the ability to treat or cure a vast array of illnesses.  Unfortunately, that progress hasn’t been as rapid as originally hoped.  But medical science is now beginning to put genomic research discoveries into actual medical practice, and start customizing medical treatments based upon each individual patient’s genetic makeup – the fundamental concept of “Personalized Medicine.”…

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Managed Care/Health Insurance Direct-to-Consumer Advertising or YouTube Educational-Propaganda Videos?

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I saw a very interesting couple of videos today put on YouTube by Humana – the managed care insurance company.  Apparently they are the first in a series that they are calling “Stay Smart Stay Healthy.”  According to an email I got today promoting the second video, “Stay Smart Stay Healthy is a Humana new-media venture designed to deliver guidance, and to support awareness and understanding of the healthcare industry. Our goal is simple: to educate consumers on the healthcare system by removing the usual complexities and replacing them with an informative and engaging series of videos.”

While that sounds like good corporate citizenship, the actual content of the videos doesn’t seem quite so innocent.…

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Medical Homes, Hammers and Nails

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Medical homes are being promoted as a way to improve health care delivery by increasing the coordination of patient’s primary and specialty medical care.  The goal of medical homes is to ensure that patients’ care is comprehensive, appropriate and patient-focused.

One of the benefits to the patients and the healthcare system is that medical homes can help sort out the confusion that can arise from the phenomenon sometimes described as, “When you’re a hammer, everything looks like a nail.”

In healthcare delivery what this means is that sometimes the diagnoses or treatment recommendations from specialized clinicians will reflect their expertise – and thus their may be inconsistencies or conflicts in the recommendations coming from several  specialists.…

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Spreading the Wealth

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In the Presidential campaign, one of the criticisms of Barack Obama’s positions was that he wanted to, “Spread the wealth.”  This sprung from a comment he made to Joe “the Plumber” Wurzelbacher in Ohio about his tax proposals not increasing taxes for anyone earning under $250,000/year.  This was one of the issues that was pretzelized in the closing weeks of the campaign, which is why I was interested to see a graph showing the income distribution in several developed western countries in a recent issue of the Economist in an article titles “Pain all around, please.”



This chart – using OECD data – shows that while all these countries have wide distributions between the highest and lowest income groups, the spread in the United States is by far the greatest. …
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				Communicating Health Information and this Blog’s Goals			


		
		
			


				
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Noting that I’ve written about a wide variety of health and biomedical research issues, someone recently asked me about the focus of this blog.  My response was that my goals are two-fold:  First, to present synthesized information – created by combining different sources and analyses – in ways that provide new perspectives on important issues so that people have both broader and deeper understanding of these issue.  And second, to reach multiple audiences with this information and perspectives so that the spectrum of healthcare stakeholders can better communicate and understand each other.  Which is just stating in a different way what I wrote in my first posting, that the reason I started this blog was “to provide stakeholders of all types, (such as patients, clinicians, administrators, payers, researchers, regulators, legislators, etc.)…
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				McCain Plan Would Tax 100% of Health Insurance Costs			


		
		
			


				
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I had a revelation tonight at an event about women’s health issues in the Presidential election at the Kennedy School of Government’s Institute of Politics.  One of the speakers was Gail Wilensky – a Senior Health Care Advisor to Senator McCain’s campaign. I asked her a question about how Senator McCain’s proposal to eliminate the tax deduction for employer provided health benefits would effect non-profit organizations since they don’t pay taxes.


Gail Wilensky’s answer really shocked me.  I’ve been doing health policy work for about 20 years, and following the election’s health issues for the last year.  What she said was that it wouldn’t matter whether the person worked for a non-profit or a for-profit company, since the employee would be the one paying tax on the entire cost of their health insurance – whether it was their contribution, or dollars coming from their employer.…
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				Direct to Consumer Advertising: Drugs, Hospitals, Research….			


		
		
			


				
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A very contentious health policy issue is that of advertising.  Usually the specific topic is the advertising of medicines directly to patients – known as “Direct to Consumer Advertising.”  There have been proposals to limit or ban this activity, and some states have, (or have proposed), limiting or requiring disclosure of other marketing activities by pharmaceutical companies – such as marketing directly to doctors and hospitals.


However, I’ve found it intriguing that many other components of the healthcare industry advertise directly to patients.  For example, the Boston area free daily paper, Metro, contains lots of ads recruiting people to participate in medical research trials. …
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				Rx for Excellence Leaders in Quality Award			


		
		
			


				
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I often find it hard to tout my own accomplishments, so I’m happy to report that Dave Dykeman, a colleague and friend, nominated me for the Massachusetts Medical Law Report’s Rx for Excellence Leaders in Quality award.  After what I’m told was careful consideration, I was selected as one of the people to receive this award – in part because of the success and substance of this blog.


I’m very honored to be included with the other distinguished awardees – including Atul Gawande, my old Congressional colleague. (You can see write ups of the awardees here.)   And I hope that their decision is not only in recognition of our past achievements, but a vote of confidence for our accomplishments yet to come.…
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				New Challenges for Life Sciences Companies to Communicate Value			


		
		
			


				
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Life sciences companies have always faced challenges communicating the clinical and economic value of their products and services to different groups of stakeholders.  These challenges arise from the technical nature of research information, the different perspectives of various groups, (e.g. clinicians, payers and patients), and marketing regulations.  However, with costs continuing to rise, political, business and advocacy leaders are all agreeing that health care spending is growing out of control. Therefore, no matter who wins the White House in November, “cost containment” will be the embodiment of “change” for health care in 2009 and beyond – and the current economic downturn and expanding government deficits will only fan those flames.…
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				Patient – Doctor Communications			


		
		
			


				
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In the last couple of weeks there were two interesting articles in the New York Times about patient-physicians communications.


Value of Empathy

In the first  piece, Dr. Pauline Chen discusses an academic article that explored the way physicians communicate empathy to their patients who have serious and life threatening illnesses.  The conclusion of the research, (which looked at the experience of people who had lung cancer), was that physicians miss 90% of the opportunities to connect empathetically with their patients.


The researchers speculated that physicians don’t engage patients empathetically because they are concerned that this would take too much time. However, according to Dr.…
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				Pfizer Exiting Heart Disease Research – What about Heart Failure?			


		
		
			


				
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It was reported yesterday that Pfizer will stop doing research and development in heart disease, anemia and osteoporosis to concentrate in other areas such as cancer, diabetes, and immunology/inflammatory diseases.


This is interesting since Pfizer has (and had) a large number of products in heart disease, including Lipitor, and pharmaceutical companies have typically continued to do research in areas where they have had products because they have established sales people who are knowledgeable about the disease area and have relationships with clinicians in those areas.  The countervailing force is that many effective medicines to treat heart conditions (like high blood pressure and high cholesterol) are available in generic forms and thus the value bar (benefit/cost ratio) that new medicines must reach to be competitive is much higher than when they competing against other non-generic medicines.…
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				3 Months Late – Massachusetts Waiver Extended			


		
		
			


				
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Just a quick FYI – Today’s Boston Globe reports that the Federal Government has approved a new 3 year Medicaid demonstration waiver for Massachusetts – with $10.6 billion to enable the continuation and growth of the state’s health insurance coverage expansion program.  The original 3 year waiver expired at the end of June, and the state and Federal officials had been discussing a new 3 year waiver for many months before that deadline.  Since the end of June, the state’s program has been running on a series of several week extensions to the old waiver granted by the Federal Government.…
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