Engage With Grace

November 26, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Public Health, Quality of Care & Safety / 1 Comment

Many bloggers are posting information today about a initiative to encourage conversation about a very difficult topic: How we want to die. This collective effort to prompt discussions about this topic at the beginning of the holiday season is very timely, and it is a good complement to my post last week about empathy and compassion in healthcare.

What follows is essentially the same text that appears on many other blogs along with a picture of the “One Slide” listing the 5 conversation promoting questions that are at the core of the Project:

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Engage with Grace: The One Slide Project is an astonishingly simple idea that literally touches everyone.…

Humana Does Drugs

November 20, 2008 / Michael D. Miller MD / Economics & Financing, Information & Communications, Innovation, Miscellaneous, Patents & IP / No Comments

Humana has put another couple of videos on YouTube in their ongoing series to explain – from their perspective – how the healthcare system works.

The first new video is “Insurance Companies and Prescription Drugs.” Like their other videos, this one paints the insurance industry’s as rosy and altruistic, while stating that “Prescription drug manufacturers are allowed to set their own prices, and they often build large profit margins into name brand drugs to recoup the costs of researching, marketing and advertising.”

This statement strikes me as very curious. First, how do companies “build large profit margins into name brand drugs?”…

Proposals for Expanding the Full Range of Compassionate Care

November 20, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Quality of Care & Safety / 3 Comments

Two recent events made me think about how traditional medical care and medical education address the issue of compassion.

The first was at the annual dinner for the Kenneth B. Schwartz Center when they gave out their annual Compassionate Caregiver Award, and reviewed the accomplishments of previous awardees. These individuals have all made remarkable differences in the lives of patients and families through their empathy and personal connections.

The second event was reading about the passing of Florence Wald, the former Dean of Nursing at Yale who organized the first hospice in the United States in 1974 because of her interest in compassionate care at the end of life.…

Personalized Medicine – Fulfilling the Promise of Genetic Research

November 17, 2008 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Delivery of Healthcare, FDA, Information & Communications, Innovation, Quality of Care & Safety / No Comments

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.)

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.”…

Medical Homes, Hammers and Nails

November 10, 2008 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Comparative Effectiveness, Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 2 Comments

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.…

Communicating Health Information and this Blog’s Goals

October 30, 2008 / Michael D. Miller MD / FDA, Health Policy and Communications Blog, Information & Communications, Quality of Care & Safety / No Comments

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.)…

Rx for Excellence Leaders in Quality Award

October 17, 2008 / Michael D. Miller MD / Miscellaneous, Quality of Care & Safety / No Comments

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.…

New Challenges for Life Sciences Companies to Communicate Value

October 16, 2008 / Michael D. Miller MD / Comparative Effectiveness, Delivery of Healthcare, Economics & Financing, Health System Reform, Information & Communications, Therapeutic Substitution & Interchange / No Comments

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.…

Patient – Doctor Communications

October 7, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Information & Communications, Quality of Care & Safety / 1 Comment

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.…

Pfizer Exiting Heart Disease Research – What about Heart Failure?

October 1, 2008 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Innovation, Quality of Care & Safety, Therapeutic Substitution & Interchange / 1 Comment

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.…

Stem Cells, Cancer, and Politics

September 15, 2008 / Michael D. Miller MD / Access to Healthcare, FDA, Information & Communications, Innovation, Politics / No Comments

The cover of this week’s Economist magazine caught my eye because this weekend I was talking with people about stem cell issues in the context of the Presidential election.

Part of our discussion was how the selection of Sarah Palin as John McCain’s Vice Presidential nominee will effect the Republican ticket’s position on stem cell research.

Doing a quick search on the internet, it appears that John McCain is refining in his position to support research on adult stem cells, while maintaining a foundation that doesn’t alienate the conservative base of his party. Specifically, the only reference to stem cell research that I could find on the campaign’s web-site is:

Addressing the Moral Concerns of Advanced Technology

Stem cell research offers tremendous hope for those suffering from a variety of deadly diseases – hope for both cures and life-extending treatments.

…

Incentives for Everything But Primary Care

September 10, 2008 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Innovation, Medicare, Politics, Public Health / No Comments

Two interesting and related items recently dropped into my inbox concerning the future availability of primary care clinicians. As most people are aware, primary care services are becoming increasingly scarce – and has been seen here in Massachusetts expanding insurance coverage may only increase this strain. In addition, there is some good evidence that a major reason for our higher health care spending is having too many specialists and not enough primary care clinicians. So increasing the number of primary care clinicians might be part of the solution to controlling health care spending.

Incentives to Become a Specialist
The first article in my inbox was a Washington Post story stating that only 2% of graduating medical students were contemplating going into primary care. …

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