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Tag: George Lundberg

How to Save American Football

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American football is a great sport. It offers, requires, nurtures, and rewards speed, skill, strength, cunning, offensive and defensive strategic thinking, courage, judgment under pressure, competitive spirit, reliance on teamwork, a requirement for exquisite timing, and resolve. Football teaches a participant how to get up and get back at it after being knocked down again and again, a great life lesson. And football has the capacity to engender huge dedicated fan bases.

Unfortunately, as the supreme contact sport, it is also a collision sport and thrives on a degree of inherent violence. Thus, injuries are expected and common. Most heal, usually without any disability. Some do not.

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How to Replace the AMA

There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, it came apart and now has the least representation of actual members of a widely diverse base than ever and shows few signs of recuperation. Recently, I advocated that ALL American physicians should become members of the AMA for their entire time in medicine.

Responses, both published and unpublished, were vigorous.

The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012.

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All American Physicians Should Be Members of the AMA

All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies.

Why? Because they are the only games in town, and both security and safety are top Maslow imperatives.

The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a group.

American physicians, if united, would have huge clout, speaking with one voice. American physicians, divided as now, speak with hundreds of thousands of individual voices, a cacophony of futility.

As The Bard saith in Macbeth “… tales told by idiots, full of sound and fury, signifying nothing.”

If you are an American physician and you don’t like what the AMA has done and is doing, if you are not a member, shut your mouth, you have no right to complain.

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Using An App to Confront Your Metastatic Melanoma

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If you or anyone else you know has had a malignant melanoma, you and that other person, and your respective physicians, should click http://therapy.collabrx.com to access the Targeted Therapy Finder–Melanoma (ttf-melanoma). It is free and does not require registration.

Collabrx of Palo Alto has developed this first of its kind application (app) under the leadership of noted internet entrepreneur and melanoma survivor Marty Tenenbaum.

The app is based upon the science of the original Melanoma Molecular Disease Model (MMDM) in Cancer Commons built by David Fisher and Keith Flaherty of Harvard Medical School and Smruti Vidwans and colleagues on our staff.

Over decades, medicine has developed a comprehensive approach to diagnosing, grading, and staging malignant melanoma and many physicians follow that knowledge to deliver treatment at the “standard of care”. Thus, of the 70 000 melanomas diagnosed in the USA each year, approximately 90% are cured, mostly by surgery. The problem comes with those 7000 per year that progress “beyond standard of care”. Most of these patients have metastases to organs far from the site of the primary melanoma and its related lymph nodes. This clinical circumstance has long been considered hopeless for most patients, since no therapy has been consistently successful.

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How to Rein in Medical Costs, RIGHT NOW

George Lundberg

I believe that there are still many ethical and professional American physicians and many intelligent American patients who are capable of, in an alliance of patients and physicians, doing “the right things”. Their combined clout is being underestimated in the current healthcare reform debate.

Efforts to control American medical costs date from at least 1932. With few exceptions, they have failed. Health care reform, 2009 politics-style, is again in trouble over cost control. It would be such a shame if we once again fail to cover the uninsured because of hang-ups over costs.

Physician decisions drive the majority of expenditures in the US health care system. American health care costs will never be controlled until most physicians are no longer paid fees for specific services. The lure of economic incentives to provide unnecessary or unproven care, or even that known to be ineffective, drives many physicians to make the lucrative choice. Hospitals and especially academic medical centers are also motivated to profit from many expensive procedures. Alternative payment forms used in integrated multispecialty delivery systems such as those at Geisinger, Mayo, and Kaiser Permanente are far more efficient and effective.

Fee-for-service incentives are a key reason why at least 30% of the $2.5 trillion expended annually for American health care is unnecessary. Eliminating that waste could save $750 billion annually with no harm to patient outcomes.

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Currently several House and Senate bills include various proposals to lower costs. But they are tepid at best, in danger of being bought out by special interests at worst.

So, what can we in the USA do RIGHT NOW to begin to cut health care costs?

An alliance of informed patients and physicians can widely apply recently learned comparative effectiveness science to big ticket items, saving vast sums while improving quality of care.

  1. Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.
  2. The same for invasive angioplasty and stenting (currently around 1,000,000 procedures per year) saving tens of billions of dollars annually.
  3. Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions saved here.
  4. Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions saved.
  5. CAT scans and MRIs are impressive art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by some capitated or packaged method that is use-neutral. More billions saved.
  6. We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.
  7. Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.

Why might many physicians, their patients and their institutions suddenly now change these established behaviors? Patriotism, recognition of new science, stewardship, and the economic survival of the America we love. No legislation is necessary to effect these huge savings. Physicians, patients, and their institutions need only take a good hard look in the mirror and then follow the medical science that most benefits patients and the public health at lowest cost. Academic medical centers should take the lead, rather than continuing to teach new doctors to “take the money and run”.

Physicians can re-affirm their professionalism and patients their rights, with sound ethical behavior without undue concern for meeting revenue needs. The interests of the patients and the public must again supersede the self interest of the learned professional.

George D. Lundberg MD, is former Editor in Chief of Medscape, eMedicine, and the Journal of the American Medical Association. He’s now President and Chair of the Board of The Lundberg Institute

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