Oh, No Methotrexate!
Methotrexate has been used in cancer wards for over 50 years. And like other beyond-patent meds, it’s become less profitable to manufacture MTX compared to much costlier new agents.
NIH Sponsors New Website to Help Patients Understand Clinical Trials
This week the NIH launched a new website, NIH Clinical Research Trials and You. In a Feb 6 press release, NIH Director Dr. Francis S. Collins said “The ability to recruit the necessary number of volunteers is vital to carrying out clinical research.” The idea behind the website is to help patients understand how clinical research […]
Notes on Wendell Potter, and Why Companies Support the Individual Mandate
The current debate about the individual mandate reminded me to post this – About a year ago, I had the opportunity to hear Wendell Potter, author of Deadly Spin – an insider’s sharp critique of the insurance industry, speak at a meeting of the New York Metropolitan Chapter of Physicians for a National Health Program. Despite […]
NEJM Reports on 2 New Drugs for Hepatitis C
Last week’s NEJM delivered an intriguing, imperfect article on a new approach to treating hepatitis C (HCV). The paper’s careful title, Preliminary Study of Two Antiviral Agents for Hepatitis C Genotype 1, seems right. The analysis, with 17 authors listed, traces the response of 21 people with hepatitis C (HCV) who got two new anti-viral agents, with or […]
The ‘Journal’ Asks, Should Patients Have Identification Numbers?
Today’s Wall Street Journal includes a special Big Issues health care section. A post on their blog caught my attention: Should Patient Have Electronic Identification Numbers? The idea is that people who use health care would each be assigned a universal patient identifier, or UPI. This unique number would link to a person’s health records. […]
Regorafenib, an Experimental Pill Tested in Colon and Rectal Cancer Patients, on Conference Agenda
Tomorrow the American Society of Clinical Oncology* will host its 9th annual GI Cancers Symposium. Bloomberg and the LA Times have already reported findings of a paper, still in abstract form, to be presented on Saturday. The drug of interest is regorafenib, a pill that loosely inhibits quite a few kinases – enzymes critical in […]
Quote of the Day: On Death Panels and the Insurance Industry, From Dr. Donald Berwick
Dr. Donald Berwick left his position last week as head of CMS. He said this, as quoted in the WSJ’s Washington Wire, yesterday: “Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at […]
A Good Personal Health Record is Hard to Find
Over the weekend I developed another bout of diverticulitis. Did the usual: fluids, antibiotics, rest, avoided going to the ER, cancelled travel plans. One of my doctors asked a very simple question: is this happening more frequently? The answer, we both knew, was yes. But I don’t have a Personal Health Record (PHR) that in […]
Final Word on Avastin, and Why We Need Better Physicians
Today’s breaking breast cancer news is on Avastin. The FDA has just announced, formally, that it will rescind approval for the drug’s use in people with metastatic breast cancer. Commissioner Dr. Margaret Hamburg writes this her statement: I know I speak on behalf of the many physicians that have been involved with this issue here […]
Thoughts, on Getting My Photo Taken at a Medical Appointment
A funny thing happened at my doctor’s appointment on Friday. I checked in, and after confirming that my address and insurance hadn’t changed since last year, waited for approximately 10 minutes. A worker of some sort, likely a med-tech, called me to “take my vitals.” She took my blood pressure with a cuff that made […]
HCR Law Requires Insurers to Cover Routine Care for Patients Participating in Clinical Trials
Something I learned at the MBCN conference is that the Patient Protection and Affordable Care Act of 2010 (PPACA, a.k.a. HCR), will require that private insurance companies cover the routine costs of medical care for patients participating in approved clinical trials. Medicare does so already, said Dr. Tatiana Prowell, an oncologist on the Johns Hopkins […]
Brief Report: Annual Meeting of the Metastatic Breast Cancer Network
The Metastatic Breast Cancer Network held its fifth annual meeting in Baltimore over this past weekend. Most of the nearly 300 registrants were women living with MBC. The lively group of women coalesced in the face of unexpected, pre-seasonal wintry weather. At an evening reception they stood, sat, waited for drinks and lined up for […]
Reading About Thinking (on D. Kahneman’s Ideas on Perceptions of Knowledge)
An article appeared in yesterday’s NYT Magazine on the hazards of over-confidence. The Israeli-born psychologist (and epistemologist, I’d dare say), Nobel laureate and author Daniel Kahneman considers how people make decisions based on bits of information that don’t provide an adequate representation of the subject at hand. He recounts how poorly, and firmly, army officers evaluate […]
Note to Government: Please Don’t Pull Back on Patient Safety Regulations
A few days ago I had a colonoscopy to evaluate some gastrointestinal problems. Subjective summary: Yuck. Downing 3 liters of Nu-Litely, a hyper-osmotic colonic cocktail prep, does not make for a pleasant Sunday afternoon, evening or night. As for the procedure itself, I don’t know how Katie Couric did it on TV. But what made the […]
A Medical School Problem Based Learning (PBL) Parody of ‘The Office’
Last week a video came my way via ZDoggMD, a popular blog by doctors who are not me. The Office Med School Edition — The clip is a parody of The Office about Problem Based Learning (PBL). In a typical PBL, the students meet regularly in small groups. On Monday they begin with clinical aspects of a case. The […]
The Immeasurable Value of Continuity of Care
Today I visited my internist for a checkup and flu shot. We talked about how I’m doing, and she examined me, and we discussed what procedures I ought have done and not done. She’s been my doctor since the summer of 1987, when I was an intern at the hospital. We reviewed so much that […]
Reducing Cancer Care Costs by Comparative and Cost-Effectiveness Research (CER)
Well, it’s the day after Labor Day, time to resume our discussion of Bending the Cost Curve in Cancer Care. We’ve reached the end of the list, on ideas to reduce oncology costs put forth by Drs. Smith and Hillner in the May 25 issue of the NEJM. Really this 10th and final point intended for […]
Reducing Costs by Better Integration of Palliative Care in Cancer Treatment
We’re up to point 9 on the list – and nearing the end – on Bending the Cost Curve in Cancer Care from the May 26 NEJM. The suggestion from Drs. Smith and Hillner is that doctors better integrate palliative care into usual oncology care. The authors start this important section well: We can reduce […]
Reducing Cancer Care Costs: The Value of Physicians’ Cognitive Work
We’ve reached what may be my favorite of the proposed ways to reduce cancer care costs, published in the NEJM by Drs. Smith and Hillner. Idea Number 8 is to realign compensation to value cognitive services, rather than chemotherapy, more highly. What the authors are saying is that we’d save money if oncologists were paid more for […]
Breast Cancer Avastin Update
This afternoon Ed Silverman of Pharmalot reports that Roche has proposed a compromise to the FDA over Avastin’s use in women with metastatic breast cancer. The drug would be approved for use only in combination with paclitaxel (Taxol), for which the data are strongest, and with special warnings. He writes: The deal includes revised labeling […]