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TECH: Andy Grove ‘s Prescription By John Irvine

Former Intel Chairman and CEO Andy Grove is in the latest issue of WIRED talking about the paradoxical relationship between healthcare and technology. “We have the Human Genome Project, personalized medicine, war on
cancer, CyberKnife, stem cell research on one hand — no doctor to be
found or to take care of your sore throat on the other," Grove says. "That’s a pretty
ugly picture. It’s pretty ugly today but it’s going to get uglier."

WIRED’s Kristen Philipkoski interviewed Grove after a recent talk he gave at Berkeley. (Watch the webcast here.) The Silicon Valley legend, who Harvard Business School biographer Richard Tedlow thinks "could [probably] hold his own against Benjamin Franklin," argues that part of the answer lies in less complicated solutions than the industry is currently pursuing. "Altogether," Grove tells the magazine, "I am obsessed with doability as opposed to desirability."

Like other tech executives who have been drawn to healthcare as both a business and social issue, Grove has been thinking and talking publicly about the problem for years. Philipkoski writes that Grove’s current thinking focuses on three general areas where he thinks quick improvements might be possible:


First: Keep elderly people at home as long as possible (an idea he
calls "shift left"). Use high-tech gadgets to help them remember to
take their medicine and monitor their health. In one year, if a quarter
of the people now living in nursing homes went home, it would save more than $12 billion, Grove says.


Second, Grove advocates addressing the uninsured by building more
"retail clinics" — basic health care centers in drugstores and other
outlets that can take care of problems that are presently, and
expensively, addressed in emergency rooms.


Lastly, unify medical records using the internet. In his vision, every
patient carries a USB drive containing his or her medical records,
which any doctor can download.

Perhaps predictably, Grove is not a big fan of universal healthcare. He prefers market-based solutions and technological innovation to European or Canadian style government single-payer.

WN: Universal health care is such a buzzword these days but you clearly don’t think it’s the answer. Why not?

Grove: I’m not excited about the implementation or our
willingness or capability of implementing that concept until we figure
out … what to do with a third-party industry that all of a sudden
gets blown up, transported to the moon or whatever. (Insurance
companies) would probably be less than enthusiastic about the move.
(Insurance is) a large industry and employment for a lot of people —
like it or not it’s a real problem.


The second part is — nobody talks about it — but deciding what you
provide under this universal health care system and how do you keep the
treatment inflation from making it more and more expensive? How do you
make certain treatments available and not others … as compared to
everyone being entitled to every scientific possibility out there,
which is the current mind-set. Unless we deal with these two problems,
all we do is flagellate ourselves.

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ShelleyhchcechchcecGregory D. Pawelski Recent comment authors
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Shelley
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Dear Andy and other readers of this blog: Here’s how to fix the U.S. health care system and address all of your concerns: A New Wellness Paradigm We Must Do It Ourselves “Problems cannot be solved at the same level of awareness that created them.” –Albert Einstein Identify the Components: Ones That Work and Ones That Don’t The first step to solving any seemingly daunting problems is to break it down into component parts, identify what works about the existing status; and what doesn’t. It’s crucial to learn from the past. As a physician and owner of a solo practice… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

Evidence-based medicine (population-based evidence) has become a euphemism for managed care, masquerading as science (or profit-maximizing in the guise of science). Control over medical decisions are being shifted from doctors to bureaucrats in big offices. Managed care organizations have used it to solidify their control over medical decisions and the practice of medicine. Instead of explaining their decision by saying the service is not necessary or not cost-effective, they can say it is not scientifically sound. Individual patients are not the focus of evidence-based medicine and its standardized practice guidelines. The guidelines are created by accessing private medical record data,… Read more »

hchcec
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hchcec

A blistering response to the “bloviations and pontifications” of the conspiracy-theorist-blogger, who thinks the scientific method does nothing more than line the pockets of the researchers:
http://scienceblogs.com/insolence/2007/05/bloviations_and_pontifications_on_the_st_1.php

Gregory D. Pawelski
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Gregory D. Pawelski

It is entirely inappropriate to regard the randomized clinical trial as being the “gold standard” for judging whether a treatment does more good than harm. In life or death situations, one must make judgements based upon preponderance of available evidence as opposed to proof beyond reasonable doubt. It seems obvious that evidence-based medicine proponents may fail to apply this common sense standard on a consistent basis. Clinical investigators have too often descended into an exhaustive study of hypotheses which are ultimately of limited importance. Many treatments are of such limited effectiveness that they do not deserve to be protected from… Read more »

hchcec
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hchcec

Evidence-based medicine… is the mindset of rewarding academic achievement and publication over all else.” Another unsupported Pawelski “fact.” 1.EBM consistently applied can reduce costs by reducing inappropriate variation. 2.EBM doesn’t benefit payers or academicians most. It benefits patients most. The front-end costs are higher though long-term benefits are significant in terms of morbidity, mortality, and lifestyle. 3. Of course groups have their own agendas, but give this puppy some time to learn. They are coming together in many ways and continue to work on collaboration. Of course, you don’t have an agenda. What “couldn’t be further from the truth” is… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

Evidence based medicine, since the 1970’s, depended upon the randomized, controlled trial. It rests upon the assumption that evidence should be determined and applied as a basis for medical decision-making. Evidence is based upon quantities, similarities, populations, and averages, rather than qualities, idiosyncracies, individualization, and specifics. Evidence-based medicine is a “trial and error” process of a clinical trials to see what might “appear” to be improving cancer survival. It is the mindset of rewarding academic achievement and publication over all else. There is this aurora that organizations, government agencies, scientists, researcher and even practitioners work together, sharing information for the… Read more »

hchcec
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hchcec

“Evidence-based medicine doesn’t rely on clinical insight” In fact, it integrates the best external evidence with individual clinical expertise. It explicitly involves integrating clinical research evidence with reasoning. One needs an understanding of the scientific process, study limitation, internal validity, etc. “encouraging doctors to act in ways to promote THEIR financial interest.” Ah, the conspiracy theorist at work. Your doctor went into medicine for financial reward. A shotgun argumentation from the biggest shooter of weaponry, Pawelski. “nothing has ever been proven to be better than anything else… so patients should never be treated with any empiric chemotherapy.” This is a… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

Evidence-based medicine doesn’t rely on clinical insight, medical training or personal experience. It is based on data from medical journal articles, epidemiology and economics, which relies on randomized clinical trials, which doesn’t even require a medical education. Nonphysicians trained in social science, science or even public policy analysis, have judgement over medicine. Where doctors defined the “standard of care,” now payers and purchasers of medical services redefine the standards for appropriate medical care, encouraging doctors to act in ways to promote their financial interest when they make medical decisions. Prospective, randomized trials of one form of empiric chemotherapy versus another… Read more »

hchcec
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hchcec

“slash, burn and poison.”
Perhaps Pawelski would rather we pay for essiac tea and tai chi. Let’s see how many years that gives the ovarian cancer patient.
We do too many colonoscopies. When Katie Couric had hers there was a major run on them.
“Given the costs of universal screening, if rates of colonoscopy continue to increase without additional benefit in overall diagnosis of early stage disease, policy makers, health care organizations, and physicians may have to devise a feasible rationing plan for broader colon screening.”
http://www.medscape.com/viewarticle/549667

Gregory D. Pawelski
Guest
Gregory D. Pawelski

In one of Charlie Rose’s specials on cancer, Andy Grove (a cancer survivor himself), was correct in saying, “early detection and biomarkers are where cancer research resources need to be funneled. But the money seems to go towards developing expensive, last-ditch treatments for desperate, dying people willing to spend any amount of money to stay alive.” Even if it’s for 2.5 months. It was an interesting panel on the show. The head of Memorial Sloan Kettering and the head of the National Cancer Institute on the side of the cancer treatment establishment. Clifton Leaf, author of the Fortune article “Why… Read more »