Stephen C Schimpff's Blog (101)

Leadership In Medicine – New Expectations, Time to Rethink What Leaders Should Be Doing

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 — No Comments

New Finding May Aid Alzheimer’s Treatment Options

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 — No Comments

The Implications of Chronic Disease

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 — No Comments

Encapsulated Pig Islet Cells For Diabetes Type 1 – A Trial

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 — No Comments

More on Transplanted Pig Organs – Xenotransplantation

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 — No Comments

Transplanted Organs From A Pig?

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 — No Comments

Thought Controlled Artificial Limbs

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 — No Comments

Are Physicians Knights, Knaves or Pawns?

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 — No Comments

Time to Rethink How We Pay for Medical Care and Healthcare

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 — 3 Comments

Today’s Health Insurance Has Perverse Incentives

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality. In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care physician feels underpaid for routine visits but nevertheless we basically… Continue

Added by Stephen C Schimpff on July 1, 2010 at 8:47am — No Comments

A Disease Industry vs. A Healthcare System

Today America does not have a true healthcare system that focuses on wellness and disease prevention. Rather it focuses on disease diagnosis and treatment paid for on a unit basis. Each visit, each procedure, each test, each drug, each hospitalization is charged for. The result is more and more units of care are given rather than a focus on how to give good preventive care and how to coordinate the care of those with complex chronic illnesses. As long as we have a disease industry – driven by… Continue

Added by Stephen C Schimpff on June 24, 2010 at 5:36pm — 3 Comments

Turbulence Ahead in Health Care

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.

But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or diagnostic device in a clinical laboratory – to create any return on the investment before a new or… Continue

Added by Stephen C Schimpff on June 10, 2010 at 4:26pm — No Comments

Cut Health Care Costs With Prevention

On May 12, 2010 the Harvard Business Review ran this post of mine on their web site. The original is at http://tinyurl.com/2vnpato

Prevention is the key to both better health and lower health-care costs over the long haul. This is where the nation — and each of us as individuals — needs to put energy and resources. In the long run, it is more important than addressing the high cost of new technologies and drugs or their inappropriate… Continue

Added by Stephen C Schimpff on May 14, 2010 at 2:20pm — No Comments

Further Disruptive Trends in Medicine

Generally we prefer calm seas but often they don’t get us anywhere. We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change. Here a few more disruptive changes or refinements that are leading to disruptions of the old ways.… Continue

Added by Stephen C Schimpff on May 4, 2010 at 7:39am — No Comments

Disruptive Changes Are Coming to the Delivery of Medical Care

The following was an invited post on Harvard Busines Review web site last Friday.

We have grown accustomed to scientific research producing major medical advances such as those I wrote about in The Future of Medicine — Megatrends in Healthcare. But there are now some very disruptive changes coming in how medical care will be delivered by your doctor or hospital.

Some examples:

Team-based care for chronic illness. The combination of an aging population and… Continue

Added by Stephen C Schimpff on April 25, 2010 at 4:42pm — No Comments

Is Technology a Cost Driver or a Cost Saver in Health Care?

The following was an invited post on the Harvard Business Review at http://blogs.hbr.org/cs/2010/04/is_technology_a_cost_driver_or.html

Pharmaceutical, biotechnology, and medical-device and equipment companies have been extremely effective at producing innovations that have created major benefits for medical care. But the cost of new patented drugs and devices (pacemakers, defibrillators, stents,… Continue

Added by Stephen C Schimpff on April 20, 2010 at 3:47pm — 1 Comment

Teamwork Can Help Avert the Pending Cost Crisis in Health Care

The following was posted by me at Harvard Business Review yesterday. http://blogs.hbr.org/cs/2010/04/teamwork_can_help_avert_the_pe.html

Most health care money in the United States goes largely for the care of people with complex chronic illnesses such as diabetes, heart failure, cancer, lung disease, and the like. We will soon see many more individuals with these illnesses because of two factors: the… Continue

Added by Stephen C Schimpff on April 13, 2010 at 11:08am — No Comments

King Tut and Genomics

I wrote in The Future of Medicine that genomics was a revolutionary new technology in medicine and that it would lead to disruptive new megatrends in medical care. I was thinking about new approaches to disease prediction, developing targeted drugs, directing the approach to drug prescribing to assure efficacy yet few side effects, and rapid diagnosis.

Many of us enjoy genealogy as a hobby and to learn about our ancestors. Genomics can been used to study our own genealogy – where… Continue

Added by Stephen C Schimpff on February 28, 2010 at 5:06pm — 1 Comment

“Front of Package Food Labels – Public Health or Propaganda”

The current issue of the Journal of the American Medical Association [JAMA, February 24, 2010, pages 771-772] has an interesting editorial of the title here by Drs Nestle and Ludwig about food labeling. “At no point in US history have food products displayed so may symbols and statements proclaiming nutrition and health benefits” is the opening sentence. In brief, the authors suggest that processed food companies have been aggressive in putting information on the front of their packages that… Continue

Added by Stephen C Schimpff on February 24, 2010 at 9:50am — No Comments

We Have Become An Obese Nation.

Fifty years ago about 55% of Americans were overweight as measured by body mass index [BMI which is based on the relationship of height to weight]. Broken down this was 32% “pre-obesity” or “overweight” [meaning BMI between 25.0 and 29.9] and 13% obese [BMI 30 or greater.] Today that 55% has increased to 68% with 34% now in the obese range! Obesity affects all ages and genders. Among adults, 72% of men and 64% of women are pre-obese and 32% and 36%, respectively, are obese. And very disturbing… Continue

Added by Stephen C Schimpff on February 21, 2010 at 5:46pm — No Comments