January 2019 – Page 3 – The Health Care Blog

Month: January 2019

Google Is Quietly Infiltrating Medicine — But What Rules Will It Play By?

Jan 7, 2019• 2

By MICHAEL L. MILLENSON

With nearly 80 percent of internet users searching online for health-related information, it’s no wonder the catchphrase “Dr. Google” has caught on, to the delight of many searchers and the dismay of many real doctors.

What’s received little attention from physicians or the public is the company’s quiet metamorphosis into a powerhouse focused on the actual practice of medicine.

If “data is the new oil,” as the internet meme has it, Google and its Big Tech brethren could become the new OPEC. Search is only the start for Google and its parent company, Alphabet. Their involvement in health care can continue through a doctor’s diagnosis and even into monitoring a patient’s chronic condition for, essentially, forever. (From here on, I’ll use the term Google to include the confusing intertwining of Google and Alphabet units.)

Last Month in Oncology with Dr. Bishal Gyawali

Jan 4, 2019• 1

By BISHAL GYAWALI MD

Long list of news in lung cancer

September was an important month in oncology—especially for lung cancer. The World Conference in Lung Cancer (WCLC) 2018 gave us some important practice-changing results, also leading to four NEJM publications. The trial with most public health impact is unfortunately not published yet. It’s the NELSON trial that randomised more than 15000 asymptomatic people at high risk of lung cancer to either CT-based screening for lung cancer or to no screening and found a significant reduction in lung cancer mortality rates among the screened cohort compared with the control cohort. This reduction was more pronounced among women, although they constituted only 16% of the trial population. I am looking forward to reading the full publication and am particularly interested in knowing if there were any differences in all-cause mortality rates and the rates of overdiagnoses.

A new ALK-inhibitor on the block—brigatinib—has significantly improved PFS versus crizotinib when used as first-line therapy in ALK-positive non-small cell lung cancer (NSCLC) patients. However, I assume that it will be difficult for brigatinib to replace alectinib in this setting, since the latter has already been tested in two different RCTs and has more mature data.

With Keynote 407, pembrolizumab has entered into the treatment arsenal for squamous NSCLC by improving overall survival in combination with chemotherapy versus chemotherapy alone as a first-line regimen. However, when A B is compared with A, it is important to know whether A B is better than A followed by B. In this trial, 32% of patients who were in the control arm received a PD-1 inhibitor upon progression. Nivolumab is already approved as a second-line option in this setting after first-line chemo; so how much benefit in Keynote 407 is due to more than half of control arm patients not getting PD-1 inhibitor at all versus the benefit of combining pembrolizumab with chemo upfront is an important question.

Into America: The Odds Against a Foreign Trained Doctor

Jan 3, 2019• 1

By SAURABH JHA MD

In this episode of Firing Line, Saurabh Jha (aka @RogueRad), has a conversation with Chadi Nabhan, MD MBA FACP, who is a preeminent oncologist, speaker and the Chief Medical Officer of Cardinal Health Specialty Solutions.

At the great heights of his career, and a secure American citizen, Chadi recalls the struggle and effort it took to get from Syria to Boston. He credits his journey to good luck and a tenacious drive and uncompromising desire to work in the U.S. Chadi speaks for thousands of international medical graduates to fight odds to get here.

Listen to our conversation at Radiology Firing Line Podcast.

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner.

The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers

Jan 2, 2019• 6

BY HANS DUVEFELT MD

Too many specific theories about physician burnout can cloud the real issue and allow healthcare leaders to circle around the “elephant in the room”.

The cause of physician burnout isn’t just the EMRs, Meaningful Use, CMS regulations, the chronic disease epidemic or any other single item.

Instead, it is simply this: Healthcare today has no clear definition of what a physician is. We are more or less suddenly finding ourselves on a playing field, tackled and hollered at, without knowing what sport we are playing and what the rules are.

Historically, physicians have been viewed as professionals and also, more lately, as skilled workers. But we are more and more viewed and treated as neither. Therein lies the problem.

The Death of Cancer: Book Review and Reflections

Jan 1, 2019• 6

By CHADI NABHAN MD, MBA, FACP

Some books draw you in based on a catchy title, a provocative book jacket, or familiarity with the author. For me, recollections of medical school primers written by the renowned lymphoma pioneer Vincent DeVita Jr. and my own path as an oncologist immediately attracted me to “The Death of Cancer.” I felt a connection to this book before even reading it and prepped myself for an optimistic message about how the cancer field is moving forward. Did I get what I bargained for?

Co-authored with his daughter, Elizabeth DeVita-Raeburn, DeVita brings us back decades ago to when he had just started at the National Cancer Institute (NCI) under the wings of Jay Freireich and Tom Frei. At the time, he was a clinical associate and a “chemotherapist”; the field was ultimately renamed and defined as medical oncology. (Note to self: I am ecstatic the field was renamed; I would prefer to be called a medical oncologist anytime than a chemotherapist, but that’s just me). He recounts how chemotherapy was frowned upon in favor of the two preferable ways to treat cancer at the time: surgery and radiotherapy. DeVita eloquently describes how his mentors were ridiculed when they announced their pursuit to cure childhood leukemia using combination chemotherapy; their approach and determination provided him with inspiration to push his research further. He goes on to describe in a fascinating manner the way he designed the MOPP regimen, which cured many patients with Hodgkin lymphoma. He recounts events when he presented his own MOPP data, and how he was verbally attacked by radiotherapists who claimed his data were insufficient and attempts to drive them “out of business”. Even in 2018, my radiation oncology colleagues protest when medical oncologists challenge the role of radiation therapy in Hodgkin lymphoma. I have actually grown tired of attending debates between any two prominent lymphoma figures discussing whether to use radiation or not in such setting; there are better topics to argue about, like who might win the Super Bowl.