It is currently popular for government officials to single out the insurance companies for the rising cost of healthcare. Not that the insurers are without fault but the real reasons for cost increases are rarely addressed and therefore not appreciated. We are a country with an aging population (“old parts wear out”) and of many adverse behaviors (e.g., overweight, sedentary lifestyle, stress and 20% still smoke.) Combined, these are driving a rapid increase in chronic diseases such as… Continue
Added by Stephen C Schimpff on March 27, 2011 at 8:45am —
When Clarissa was 13 she entered Johns Hopkins Hospital to be treated for relapsed acute leukemia knowing full well that she had only a 40% chance of survival. Today she is 16 and in excellent health. But it took 2 ½ years of incredibly rigorous treatments to get there. Equally importantly it meant riding an emotional roller coaster for her and her parents.
Clarissa had been treated for leukemia when she was 2 and had been fine for a decade when the relapse occurred. She found there… Continue
Added by Stephen C Schimpff on March 14, 2011 at 3:25pm —
During the healthcare reform debate there was the unfortunate reference to “death panels.” No such thing was ever in the proposals but it meant that an important part of medical care was set aside as too “toxic” to discuss. But end of life counseling is very important. Indeed it is good to have realistic discussions at the beginning of a serious illness; indeed it is only fair to the patient and the patient’s family.
Palliative care (I don’t like the term; it seems to… Continue
Added by Stephen C Schimpff on February 21, 2011 at 4:22pm —
We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.
Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to obtain, chemotherapy drugs, steps to prevent infection, prevent kidney… Continue
Added by Stephen C Schimpff on February 9, 2011 at 3:25pm —
Diabetes mellitus is the most common cause of kidney failure that progresses to end stage renal disease (ESRD,) meaning that the person requires dialysis or kidney transplant. ESRD is chronic and life long, is complicated to treat, has a major negative effect on quality of life and the costs are high.
So it was good news when the Centers of Disease Control reported that the incidence of ESRD among diabetics had declined by… Continue
Added by Stephen C Schimpff on January 18, 2011 at 3:23pm —
Herpes zoster (or shingles) is caused by the same virus that causes chicken pox. Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic pain thereafter. A vaccine was introduced by Merck in 2006; the initial studies of 38,546 patients indicated that it reduced the incidence by about 50% and for those who still got shingles, the severity was lessened substantially. But… Continue
Added by Stephen C Schimpff on January 14, 2011 at 3:51pm —
Lung cancer is the most common cancer other than skin cancer. The survival rate is still dismal so early diagnosis presumably could make an impact. Chest x-rays just do not have the sensitivity to find early lung cancer. Computed tomography (CT Scans) can detect very small lesions in the lung. Another study has now been completed and it was able to find many early cancers.… Continue
Added by Stephen C Schimpff on January 12, 2011 at 3:36pm —
Over the past ten years and since the publication of the Institute of Medicine landmark book “To Err Is Human” there have been many attempts to reduce preventable medical errors which are estimated to take about 100,000 lives per year – perhaps many more. The question is whether all of this effort has had a substantial clinical impact.
The results of a recently published study are therefore concerning. A… Continue
Added by Stephen C Schimpff on December 14, 2010 at 11:54am —
Age-related macular degeneration (AMD) is the leading cause of blindness in the United States. More than 1 million Americans have neovascular or “wet” AMD and a slightly lower number have “dry” AMD which often progresses to the more severe “wet” form. Since this is a disease of aging, we can expect many more cases as the population expands in the coming years.
Neovascular AMD appears to be related, at lease in part, to excess production of vascular endothelial growth factor… Continue
Added by Stephen C Schimpff on December 8, 2010 at 2:25pm —
Aortic stenosis (a narrowing and hardening of the heart’s aortic valve) is not uncommon among older individuals. It begins without symptoms and progresses for years but, about 50% will die within 2 years once the fitst symptoms develop. The standard approach is to surgically replace the aortic valve which will improve both heart function and survival. Unfortunately, about 30% of symptomatic individuals cannot undergo surgery because of older age, other heart problems or other medical conditions… Continue
Added by Stephen C Schimpff on December 1, 2010 at 10:50am —
Like the cockpit, the operating room (OR) is fraught with high intensity, high complexity, high velocity, and high stakes. And as a capital intense location which serves as the financial engine of many or not most hospitals, there is pressure to use the OR efficiently. Like the cockpit, there is hierarchy, and a deep culture which includes strongly held rituals and customs. Unfortunately, there are also errors of omission and commission which lead to adverse outcomes including patient… Continue
Added by Stephen C Schimpff on November 14, 2010 at 9:04am —
What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.
Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added admissions. A dean might be expected to develop new research programs by building new… Continue
Added by Stephen C Schimpff on November 10, 2010 at 4:45pm —
A protein recently found in the brain -- gamma secretase activating protein or GSAP -- increases the production of beta-amyloid, the presumed culprit in Alzheimer’s disease. In a mouse model, reducing GSAP led to reduced beta-amyloid disposition. This prompts in turn the appealing notion that a drug could be found to inhibit GSAP and thereby forestall or prevent the onset of Alzheimer’s disease.
Imatinib (Gleevec, used to treat chronic myelocytic leukemia or CML) does inhibit GSAP… Continue
Added by Stephen C Schimpff on October 26, 2010 at 1:05pm —
I have written frequently about the importance of chronic illnesses. Most of us are just not aware that their incidence is rising - and rapidly. We tend to think instead about acute illnesses and injury but chronic illnesses are now not only common but last a lifetime once developed and are inherently expensive to treat. On top of that there are enormous losses in quality of life, personal productivity and economic impact on the individual and society.
The Milken Institute quantified some… Continue
Added by Stephen C Schimpff on October 19, 2010 at 2:57pm —
Here is a follow-up to the post on islet cell xenotransplantation for type 1 diabetes mellitus. A group in New Zealand has been studying the use of islet cells derived from pigs which have not been genetically modified. The cells are encapsulated to protect them from immune cells. The company reports that they are self regulating (meaning that they will produce insulin as needed based on the body’s blood sugar levels) and efficient at secreting the insulin produced into the patient’s body. The… Continue
Added by Stephen C Schimpff on October 15, 2010 at 5:40pm —
Although xenotransplantation has not progressed far enough to allow transplanting a pig organ to a human, there are other exciting opportunities in the works for xenotransplantation in the not to distant future.
Individuals that develop liver failure often die before a suitable donor can be found or before the damaged liver can heal on its own. There is no artificial liver comparable to the dialysis machine for kidney failure. But using a specially develop pig liver outside the body… Continue
Added by Stephen C Schimpff on September 27, 2010 at 4:52pm —
There are many more individuals with end stage kidney failure, heart failure, chronic lung disease, or liver failure who would benefit from a transplanted kidney, heart, lung or liver than are available. Similarly, there are many people with unstable, difficult to control diabetes that could benefit from a ready source of pancreatic insulin-producing islet cells.
Today the only option for more organs available for transplant is to encourage more individuals to pre-certify their… Continue
Added by Stephen C Schimpff on September 22, 2010 at 11:03am —
I wrote about the possibility of brain-controlled artificial limbs in “The Future of Medicine”
but now there has been real progress. At Johns Hopkins Applied Physics laboratory, scientists have progressed with their design of an artificial limb that will have a brain controlled interface. The model came about through a contract with the Defense Advanced Research Projects Agency (DARPA) which has been looking for a prosthetic arm that would be many leagues… Continue
Added by Stephen C Schimpff on September 14, 2010 at 4:10pm —
An interesting article in JAMA [Sept 1, 2010] by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.” Basically, are we motivated by virtue, by self interest or are we just passive victims? The authors suggest that this is a good question not only for physicians to contemplate but for our politicians and the general public to consider as well along with the implications of the… Continue
Added by Stephen C Schimpff on September 13, 2010 at 10:24am —
Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare. In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, hospitals, drug and device companies, others) get paid for a unit of activity –… Continue
Added by Stephen C Schimpff on July 10, 2010 at 5:22pm —