Stephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO, University of Maryland Medical Center, and senior advisor, Sage Growth Partners. He is the author of Fixing the Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor.
Genomics promises to fundamentally change much of medical care. But the ultimate value of this new understanding of basic human biology will in many cases come with fits and starts. The saga of belimumab (Benlysta) and Human Genome Sciences (HGS) is illustrative.
Systemic lupus erythematosus (SLE) occurs in somewhere between 300,000 and 4 million Americans according to the …
In the previous post I discussed the field of pharmacogenomics.
Today I will focus on:
Nutragenomics or the science of how our genes affect what we eat is a developing field.
Here is one example. Cholesterol is an important part of our physiology although too much in the wrong places is harmful. Cholesterol is carried in the body by …
Little more than a decade ago, most people had never heard of the word genomics; today it is used frequently. It is indeed a revolutionary science that is and will transform medical research and medical care. To better understand how this new science will markedly change medicine, it is convenient to consider it through a few categories:
There are a series of medical megatrends outlined in my book The Future of Medicine – Megatrends in Healthcare that will profoundly affect health care in the coming five to fifteen years and beyond. Some are due to the explosion of basic understandings of cellular and molecular biology. Others are related to advances in engineering and computer science. Here is a very brief overview.
These are the megatrends in medical …
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 1/2 years of incredibly rigorous treatments to get there. Equally importantly it meant riding an emotional roller coaster for her and her parents.
Clarissa had …
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 …
An interesting article in JAMA 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 …
Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease.
These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are not all that difficult to prevent. Unfortunately, our dietary guidelines are of little or no help in this regard but could be.
In 1941, following studies that demonstrated …
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, …
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 …
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 …
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 …
Prevention is the key to both better health and lower healthcare 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 overuse.
Today, the U.S. basically has a medical care system rather than a health care …
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