Posts Tagged ‘Health care’

The National Cancer Research Institute (NCRI) identified top 10 research priorities for people living with cancer to consider to improve treatment and quality of life. 

Reporter: Gail S. Thornton

By 2030 four million people in the UK will be living with the long-term consequences of cancer, but currently there is very little research on the problems they face and how these can be tackled. To help them live better lives, more focused research is needed.

To determine priorities for research that will help people live better with and beyond cancer, NCRI partnered with the James Lind Alliance on a Priority Setting Partnership. The two-year project involved two UK-wide surveys which attracted more than 3500 responses from patients, carers, and health and social care professionals. From these, we identified 26 key questions and distilled these down to 10 top research priorities.

This is the first time that clear research priorities have been identified in this area.

Questions 1 – 10 Questions 11 – 26




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Participatory Healthcare: A New Trend in Research?

 Author: Dr Anayo Unachukwu, MBBS, LLM


When the great innovation appears, it will almost certainly be in muddled, incomplete and confusing form….For any speculation which does not at first glance look crazy, there is no hope”

Freeman Dyson

Healthcare by its very nature is complex. It comprises of not just one single integrated system, but consists of a large number of interrelated systems.[1] Risk[2] is inherent in the system. As a result of its complexity, it is also prone to errors due to concatenation of multiple small failures.[3] Given the fore-goings, it is unsurprising that a patient care pathway can be complex as regards the nature of care delivered and in the number of organisations that contribute to the care.[4] In parallel to this is the mounting cost of healthcare, emergence of post approval hurdle-pricing reimbursement and health technology assessments-that are more stringent.

Risk in general lacks precision both in definition and the impact it presents. There appears to be an inverse relationship between the tolerance of risk in a given society and its level of affluence. However, most affluent society seeks change in the delivery of service. This is to make for faster, efficient and effective delivery of quality services taking advantage of new technologies. The paradox is that change is front-loaded with uncertainty and it is inherently risky. In the National Health Service-as in many public organisations in developed societies that are involved in healthcare-change is influenced by the public choice theory[5] and market theory principles.[6] The government is increasingly relying on effective partnership to deliver on broad outcome measures[7] which is the nature of Public Service Agreement (PSA). Of note, it recognises that good risk management is integral to delivery of successful partnership.[8] Collaboration, co-invention and partnership have now become the buzz words in the pharmaceutical industries as part of to optimise on their research and development efforts, reduce redundant capacity and adoption of Darwinian approach to portfolio management.

The development of risk assessment and management is largely due to trends in the wider society, technological advances in health care, and the paradigm shift from paternalism to autonomy, consumerism, and clinical negligence litigation.[9] Further, in post-Vioxx world, the regulatory environment in the industry has become more challenging resulting in robust risk management and label restrictions. The political and economic trends and impacts on risk assessment and management are now more ubiquitous; and conflate and complicate the perception of risks.

Given this background, wholesale or partial significant changes in healthcare or a significant change in direction must be done circumspectly whilst factoring in inter alia: the complexity of the sector, risk management and resource reallocation among the various competing influences. According to Le Chatelier’s principle[10] which can be roughly stated as:

“Any change in status quo within a closed system will result in an opposing reaction in the responding system”.

At this stage in this discourse, it may be pertinent to look at the practical applications of change particularly with respect to research in healthcare as recently advocated by some healthcare leaders.

In December 2012, Lucien Engelen, director Raboud REshape and Innovation Centre at Raboud University Njimegen Medical Centre communicated his ‘Big Ideas 2013:The ideas include a launch of an initiative where patients together with their family and informal carers will come up with research-ideas and patients will also try to raise the money for chosen research ideas’. According to Mr Engelen, ‘This will start a new movement”.

Mr Engelen’s qualities as a visionary leader (his innovation centre is the second largest Academic Medical Centre in the Netherlands) and indeed enthusiasm are never in doubt. Neither is his honest intention to make healthcare truly participatory with patient at the very heart of service delivery. In principle participatory healthcare is laudable, given that patients come into such partnership/relationship better informed and able to negotiate better and take active part in management of their health.

However, it may be of some concern when ‘Big Ideas’ are bandied around with a complete disconnect between fundamental research and applied research. His idea of research needless to say is informed by the wisdom of the crowd and successes in other fields-art and culture, new technology etc. Healthcare is unique in more ways than one and attempts to extrapolate from other unrelated sector may have the unintended consequences that have far reaching implications.

Bold initiatives and innovation are laudable in all human efforts and endeavours, be it healthcare, other sectors, etc. The problem with the big ideas in research as advanced by Mr Englene is that it is emotive-and I dare say-has a whiff of personal imprimatur in his attempt to vivify research. Further, big ideas by its very nature, generally have at stake self beliefs, ego and personal ambitions, etc; “outcomes”[11] (as it is said torture data long enough it will confess to anything) become everything. The new game will be the end justifies the means and as a result ‘Lance Armstronging’[12] investigative studies will not be off the radar of the “researchers,” given that the vocal minority backing the effort will be banking on immediate positive outcomes. This cannot by any stretch of definition be called a scientific quest for truth. Call it by any other name-by all means-but not research. Research in healthcare is complex and is beset with vicissitudes of life. Serendipity is integral to any serious research effort and certainly it has changed lives. Part of the reasons why pharmaceutical industries have not had as many successes as previously-apart from the fact that previous research efforts have picked the low hanging fruits-is the ‘sanitised’ funding that leaves little room for serendipity. I am pleased to note that The Dean of the University where Mr Englene is based, Paul Smits, although he likes the idea-‘it brings science into the living room’-however cautioned that care ought to be exercised that the big ideas are not pursued at the expense of fundamental research.

We have to accept that certain endeavours are more difficult than others, no matter how much other disciplines may attempt to borrow from science or even language up what they do to imbricate scientific investigations. The output will be at best a pseudoscientific pretender. Einstein’s wise words are instructive: “Everything should be made as simple as possible, but not simpler”.


[1] Ellie Scrivens, Quality, Risk And Control in Health Care. Open University Press 2005. p. 8

[2] HM Treasure. The Orange Book Management of Risk-Principle and Concepts (October 2004).

[3] Ibid.

[4] Sheila Peskett, “The challenges of commissioning healthcare: a discussion paper,” Int J Health Plann Mgmt 2009; 24: 95-112.

[5] This take the view that publicly provided services are prone to be less efficient, less productive and less focused on their customers than privately provided services.

[6] Competition amongst providers will drive up quality, innovation and productivity whilst containing costs.

[7] This applies not only in the  health sector and other public sectors.

[8] HM TREASURY. Managing risks with delivery partners. Office of Government Commerce (OGC).

[9] Department of Health Making Amends: A Consultation Paper Setting out proposals for Reforming the Approach to Clinical Negligence in the NHS (2003); the cost of compensating patients jumped 400 per cent in the course of the 1970s and 750 per cent in the 1990s.

[10] This principle is native to chemistry and  in its original form states that in a closed system-a chemical system-if it experiences a change in concentration, temperature, volume or pressure, the new equilibrium is achieved to counteract the imposed change.

[11] Who is measuring; always bear in mind Hawthorn’s effect

[12] One is not talking about being dishonest to achieve a success, but going to an inordinate extraordinary length to see that success is ensured without counting the cost in the long term.

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Author: Jukka Karjalainen, MD, PhD


Sorry ladies, you will be seduced, pheromones make it impossible for you to resist men, no matter how dreadful the man wearing the pheromones may be.

Wait, please don’t panic. Sadly, the pheromone marketing craze may be causing us to turn a blind eye to an interesting discovery. As far as I see it’s like hearing about vitamins for the first time from a hard core drug dealer. When you get over your encounter with Mr. Dealer, you are not going to think of vitamins in the same way as a person who had heard about vitamins from GNC or Vitamin World. I believe the same thing is happening with marketers and pheromones. With that in mind let’s take a deeper look at pheromones.
Most people still believe pheromones are no different from X-ray glasses sold in the back of comic books. Some have been using them for years. To be sure, they are used heavily by government agencies worldwide. Business uses them daily, you may even use them. Of course I’m talking about insect and animal pheromones.
It was well known by the late 70s that females of the insect and animal kingdom produced chemicals for attracting males of the same species. Several examples were presented in literature. By the late 70s pheromones were already being manufactured for pest control. Indeed, pheromones were being used to attract or repel bugs and animals. Pheromones were already protecting crops from damage. Roaches were checking in and not checking out. At the same time scientist were working hard to find and prove the existence of human pheromones. This evidence was found in the mid 70s but did not reach the public with any power until the mid 80s.

Human pheromones made front page news in 1986 when Researchers at the Monell Chemical Senses Center of Philadelphia released their findings to the scientific journal Hormones and Behavior, as well as to the public by way of:

  • Time Magazine: “Studies find that male pheromones are good for women’s health.”
  • News week: “The Chemistry Between People: Are Our Bodies Affected by Another Person’s Scent?”
  • USA Today: “The Real Chemical Reaction between the Sexes.”
  • The Washington post: “Pheromones Discovered in Humans.”

The human pheromone was big news in the 80s. It was found that women’s health was directly affected by male pheromone. Interestingly, Monell Chemical Senses Center of Philadelphia reported that women who work or live together tend to get their menstrual cycles in sync. That curious phenomenon known for years by scientists and many ordinary folk, has long been suspected as an indication that humans, like insects and some mammals, communicate subtly by sexual aromas known as pheromones. (1)

In 1986 Dr. Winnifred Cutler, a biologist and behavioral endocrinologist, co discovered pheromones in our underarms. She and her team of researchers found that once any overbearing underarm sweat was removed, what remained were the odorless materials containing the pheromones. The approach to test the hypothesis was interesting: women and men emitted pheromones into the atmosphere and the authors showed that extracted pheromones could be collected, frozen for over a year, thawed and then applied topically above the upper lip of recipients to mimic some of the pheromonal effects found in nature. Dr. Cutler’s original studies in the ’70s showed that women who have regular sex with men have more regular menstrual cycles than women who have sporadic sex. Regular sex delayed the decline of estrogen and made women more fertile. This led the research team to look for what the man was providing in the equation. By 1986 they realized it was pheromones. (1, 2, 3).
Male scents play a role in maintaining the health of women, particularly the health of the female reproductive system. Pheromones help to maintain the health of women. To be more exact, they keep a woman’s reproductive system healthy. They found that women who have sex with men at least once a week are more likely to have normal menstrual cycles, fewer infertility problems and a milder menopause than celibate women and women who have sex rarely or sporadically. A healthy testosterone rich male pheromone signature somehow encouraged a woman’s body to keep itself healthy and young.

The scent of a good man may be music to a woman’s nose. Researchers also found that exposure to the male pheromones also prompted a shift in blood levels of a reproductive hormone called luteinizing hormone (LH). Levels of this hormone typically surge before ovulation, but women also experience small surges during other times in the menstrual cycle. It also can stabilize the menstrual cycle and reduce the symptoms of PMS. Pheromones could lift a woman’s mood actually alleviating depression, even postpone and then alleviate menopause health. (1, 2)
How did we get from health benefits to wild seduction products? People can’t resist a fast buck. If it’s about money, maybe we should be using pheromone products to make women’s lives better. Strike that. We should instead be using pheromone products to make people’s lives better. Provide pheromones that do the things mentioned above. Help to enable pheromone research that will gain more knowledge related to health and longevity. I don’t have anything against attracting the opposite sex. I think that’s a good idea. It’s just sad to see a good thing, or potentially good thing, be lost because of a poorly focus on health.

There is always more to the story than meets the eye. The person who does not ask questions has either been beaten down low by the people who know-it-all, or, they are the people who know-it-all. Keep asking questions. You will keep finding better answers.

1. Biology of Reproduction, June 2003. News release, University of Pennsylvania.
2. Cutler WB, Preti G, Krieger A, Huggins GR, Garcia GR, Lawley HJ. Human axillary secretions influence women’s menstrual cycles: the role of donor extract of men. Horm Behav 1986; 20: 463473.
3. McCoy and Pitino. Pheromonal influences on sociosexual behavior in young women. Physiology & Behavior 2002; 75: 367-375.


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 Reporter: Aviva Lev-Ari, PhD, RN

Ernst & Young (“E&Y”) has published their fifth annual report on the state of the medical technology industry.

Below are the link to this report and also a link to an excerpt from the report displaying charts of the industry’s performance.

Definition of the Global Medical Technology Industry

In this report, medical technology (medtech) companies are defined as companies that primarily design and manufacture medical

technology equipment and supplies and are headquartered within the United States or Europe. For the purposes of this report, we have placed Israel’s data and analysis within the European market, and any grouping of the US and Europe has been referred to as “global.”

This wide ranging definition includes medical device, diagnostic, drug delivery and analytical/life science tool companies, but excludes distributors and service providers such as contract research organizations or contract manufacturing organizations.

By any measure, medical technology is an extraordinarily diverse industry. While developing a consistent and meaningful classification system is important, it is anything but straightforward. Existing taxonomies sometimes segregate companies into scores of thinly populated categories, making it difficult to identify and analyze industry trends.

Furthermore, they tend to combine categories based on products (such as imaging or tools) with those based on diseases targeted by those products (such as cardiovascular or oncology), which makes it harder to analyze trends consistently across either dimension. To address some of these challenges, we have categorized medtech companies across both dimensions —products and diseases targeted.

All publicly traded medtech companies were classified as belonging to one of five broad product groups:


companies developing products used to diagnose or monitor conditions via imaging technologies, including products such as MRI machines, computed tomography (CT) and X-ray imaging and optical biopsy systems

Non-imaging diagnostics:

companies developing products used to diagnose or monitor conditions via non-imaging technologies, which can include patient monitoring and in vitro testing equipment

Research and other equipment:

companies developing equipment used for research or other purposes, including analytical and life science tools, specialized laboratory equipment and furniture

Therapeutic devices:

companies developing products used to treat patients, including therapeutic medical devices, tools or drug delivery/infusion technologies


companies developing products that do not fi t in any of the above categories were classifi ed in this segment

In addition to product groups, this report tracks conglomerate companies that derive a significant part of their revenues from medical technologies. While a conglomerate medtech division’s technology could technically fall into one of the product groups listed above (e.g., General Electric into “imaging” and Allergan into “therapeutic devices”), all conglomerate data is kept separate from that of the nonconglomerates.

This is due to the fact that, while conglomerates report revenues for their medtech divisions, they typically do not report other financial results for their medtech divisions, such as research and development or net income.

Conglomerate companies:

United States

3M Health Care

Abbott: Medical Products

Agilent Technologies: Life Sciences and Chemical Analysis

Allergan: Medical Devices

Baxter International: Medical Products

Corning: Life Sciences

Danaher: Life Sciences & Diagnostics

Endo Health Solutions: AMS and HealthTronics

GE Healthcare

Hospira: Devices

IDEX: Health & Science Technologies

Johnson & Johnson: Medical Devices & Diagnostics

Kimberly-Clark: Health Care

Pall: Life Sciences


Agfa HealthCare

Bayer HealthCare: Medical Care

Beiersdorf: Hansaplast

Carl Zeiss Meditec

Dräger: Medical

Eckert & Ziegler: Medizintechnik

Fresenius Kabi

Halma: Health and Analysis

Jenoptik: Medical

Novartis: Alcon

Philips Healthcare

Quantel Medical

Roche Diagnostics

Sanofi : Genzyme Biosurgery

SCA Svenska Cellulosa Aktiebolaget: Personal Care


Siemens Healthcare

Smiths Medical

The big picture

Despite lingering financial and regulatory uncertainties, US and European publicly held medtech companies delivered another strong performance in 2011. For both conglomerates and pure-play companies, revenue growth in 2011 outpaced 2010 growth rates. Net income increased by 14% — the third consecutive year of double digit growth, and certainly impressive in today’s challenging economic climate.

So far, the medical technology industry appears to be weathering a period of slower global economic growth. However, for an industry that was accustomed to double-digit revenue growth, considerable margins and a predictable sales-and regulatory environment, the long-term future may still be turbulent. The industry’s financial performance will likely continue to be challenged by low economic growth in developed markets, the prospect of austerity measures in many countries, a looming Eurozone debt crisis and an imminent 2.3% medical device tax in the US. And while the US Supreme Court’s upholding of the Affordable Care Act has removed some of the uncertainty in the US, the regulatory environment continues to grow ever more complex around the globe.

As payers tackle runaway health care costs, medtech will face rising pricing pressures and expanded use of comparative effectiveness — making organic growth in western markets more challenging. Efforts to heighten disease management and preventive care, and other efforts to drive efficiency within the health care system, may impact both product utilization and profitability. The cost of not adapting the traditional medtech business model to stay ahead of these trends could be disastrous.

Public company data 2011                 2010 % change

Revenues $331.7                                          $313.9 6%

Conglomerates $142.3                                $132.8 7%

Pure-play companies $189.4                     $181.0 5%

R&D expense $12.6                                        $12.1 4%

SG&A expense $60.3                                    $57.4 5%

Net income $19.9                                          $17.4 14%

Cash and cash equivalents and short-term investments $39.2      $39.4 -1%

Market capitalization $436.1                                                              $465.9 -6%

Number of employees 725,900                                                           702,200 3%

Number of public companies 411                                                        423 -3%

Source: Ernst & Young and company financial statement data.

Numbers may appear to be inconsistent due to rounding.

Data shown for US and European public companies.

Market capitalization data is shown for 30 June 2011 and 30 June 2012.

Medical technology at a glance, 2010–2011

(US$b, data for pure-play companies except where indicated)

Medtech companies — long known for innovation, reinvention and risk-taking in product development — will need to apply the same principles to business model development. These trends and implications are discussed more fully in this year’s point of view article.

US and European publicly held medtech companies delivered another strong performance in 2011

Since we first published Pulse of the industry back in 2008 (using 2007 figures), a number of medtech firms have seen their revenues grow significantly. It is notable that 6 of the 10 fastest-growing companies over the period 2007–11 — led by spinal device company NuVasive and Intuitive Surgical (maker of the da Vinci Surgical System) — expanded their top lines mostly through organic growth and without the assistance of sizeable mergers or acquisitions. Corning Life Sciences was the only conglomerate to make the top 10 list.

Selected fast-growing US medtechs by revenue growth, 2007–2011


Companies 2007                          2011 CAGR

NuVasive $154                                 $541 37%

Alere $767                                       $2,387 33%

Life Technologies $1,282             $3,776 31%

Intuitive Surgical $601                 $1,757 31%

Illumina $367                                 $1,056 30%

Hologic $738                                   $1,789 25%

Corning Life Sciences $305            $595 18%

Thoratec $235                                   $423 16%

Greatbatch $319                                $569 16%

ResMed $716                                    $1,243 15%

Source: Ernst & Young and company financial statement data.

Companies in italics have made significant acquisitions between 2007 and 2011.

CAGR= Compounded Annual Growth Rate. 6 of the 10 fastest-growing companies expanded their top lines mostly through organic growth

Selected fast-growing European medtechs by revenue growth, 2007–2011


Source: Ernst & Young and company financial statement data.

Companies in italics have made significant acquisitions between 2007 and 2011.

CAGR= Compounded Annual Growth Rate.

Companies        Location          2007                   2011                CAGR

Fresenius Kabi        Germany        $2,782                $5,515                     19%

Sonova Holding      Switzerland      $926                 $1,827                   19%

ELEKTA                   Sweden              $674                 $1,217                    16%

Qiagen                     Netherlands       $650               $1,170                    16%

Stratec Biomedical Systems Germany $94               $165                     15%

Sempermed             Austria               $300                 $517                      15%

Syneron Medical         Israel               $141                  $228                    13%

Given Imaging             Israel               $113                  $178                     12%

William Demant Holding Denmark $1,010             $1,501                    10%

Essilor International France            $3,986               $5,829                  10%

While the fastest-growing companies in the US were fueled largely by organic growth, the four fastest-growing firms in Europe were aided by significant acquisitions. Germany’s Fresenius Kabi holds the distinction of having the biggest expansion in both real dollar and percentage terms on this list.

The company’s growth was in large part fueled by the addition of APP Pharmaceuticals, which it acquired for US$3.7 billion in 2008. Of the six commercial leaders on this list, five had made sizeable purchases, while the smaller “other” companies grew mostly through organic means.

Future Growth

Fueling future growth Mergers & acquisitions

The big picture

Merger and acquisition (M&A) activity among US and European medical technology companies remained vibrant in the year ended June 30, 2012. While 2011–12’s total of US$35.0 billion was well below the levels seen over the last two years, those two years were driven by megadeals done by Novartis (which paid US$41.2 billion to Nestlé for the remaining 75% of Alcon it didn’t already control) and Johnson & Johnson (which paid US$19.7 billion for Synthes). On a normalized basis (after removing the impact of the aforementioned megadeals), 2011–12’s total deal value was more in line with previous years — 25% below the prior year and 16% above the year before that.

Although no megadeals were consummated in 2011–12, there were eight transactions valued at more than US$1 billion, versus 12 the year before. The year’s largest deal was between private equity firm Apax Partners, two Canadian pension funds and Texas-based wound care company Kinetic Concepts Inc. (KCI). The US$6.3 billion Apax/KCI deal was particularly notable, as the US$6.3 billion represented one of the largest leveraged buyouts — across all industries — since the onset of the financial crisis in 2008. Two other private equity firms were also involved in multibillion-dollar M&As: Cinven sold off Swedish diagnostics company Phadia to Thermo Fisher Scientific for US$3.5 billion, and TPG Capital acquired in vitro diagnostics maker Immucor for nearly US$2 billion.


Pulse of the Industry – Ernst & Young


Pulse of the Industry: Medical Technology Report 2012 – Industry performance


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Today’s fundamental challenge in Prostate cancer screening

Author and Curator: Dror Nir, PhD

The management of men with prostate cancer is becoming one of the most challenging public health issues in the Western world. It is characterized by: over-diagnosis; over-treatment; low treatment efficacy; treatment related toxicity; escalating cost; and unsustainability [Bangma et al, 2007; Esserman et al, 2009]. How come? Well, everyone accepts that most prostate cancers are clinically insignificant. It is well known that all men above 65 harbor some sort of prostate cancer. Due to the current aggressive PSA-based screening, one in six men will be diagnosed with prostate cancer. Yet, the lifetime risk of dying of prostate cancer is only 3%. The problem is that, once diagnosed with prostate cancer, there is no accurate tool to identify those men that will die of the disease (in my previous post I mentioned 1:37). Currently, screening practices for prostate cancer are relying on the very unspecific prostate-specific-antigen (PSA) bio-marker test to determine which men are at higher risk of harboring prostate cancer and therefore need a biopsy. The existing diagnostic test is a transrectal ultrasound (TRUS) guided prostate biopsy aimed at extracting representative tissue from areas where cancer usually resides. This procedure suffers from several obvious faults:

1. Since the imaging tool used (B-mode ultrasound) is poor at detecting malignancies in the prostate, the probability of hitting a clinically significant cancer or missing a clinically insignificant cancer is subject to random error.

2. TRUS biopsy is also subjected to systematic error as it misses large parts of the prostate which might harbor cancer (e.g. apex and anterior zones).
3. TRUS guided biopsies are often unrepresentative of the true burden of cancer as either the volume or grade of cancer can be underestimated.

In the last ten years I was leading the development of an innovative ultrasound-based technology, HistoScanningTM, aimed at improving the aforementioned faults;

Among the other most popular imaging modalities aimed at better prostate cancer detection in routine use are: MRIElastography, Contrast Enhanced Ultrasound etc…

In my future posts I will go into more detail on how these imaging modalities fit into routine workflow, how much they stay within budget constraints and what level of promise they bear for promoting personalized medicine. Stay tuned… Footnote: According to the final report by an advisory panel to the USA government: Doctors should no longer offer the PSA prostate cancer screening test to healthy men because they’re more likely to be harmed by the blood draw, and the chain of medical interventions that often follows than be helped; (http://www.usatoday.com/news/health/story/2012-05-21/prostate-cancer-screening-test-harmful/55118036/1) But then; what should be offered instead?

Other posts on this Scientific Website addressing Prostate Cancer

Prostate Cancers Plunged After USPSTF Guidance, Will It Happen Again?


New Prostate Cancer Screening Guidelines Face a Tough Sell, Study Suggests




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Reporter: Aviva Lev-Ari, PhD, RN


NEJM 200th Anniversary Documentary

Getting Better is a 45-minute documentary video that tells three remarkable stories of medical progress — in surgery, leukemia, and HIV/AIDS. Atul Gawande, Vincent DeVita, Tony Fauci, Paul Farmer, and other prominent experts explore research, clinical practice, and patient care, and how health care has continued to get better over the past 200 years. View the film in its entirety, or in segments, now on the 200th anniversary website




The Comments by the Public are an integral part of the video watching experience

From Rough to Refined: The Rise of Surgery (Part 1 of 3)

Targeting Cancer: The Story of Leukemia (Part 2 of 3)

The Plague of Our Time: HIV/AIDS Epidemic (Part 3 of 3)

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The Relationship Between “Big Data” and Health Care – Value or Rubbish?

Author: Alan Fleischman, MBA      E-mail: a.fleischman@verizon.net

A blog (pathcareblog.com) entitled Why Big Data for Healthcare is Rubbish

http://pathcareblog.com/why-big-data-for-healthcare-is-rubbish/?goback=%2Eanb_1839273_*2_*1_*1_*1_*1_*1 takes direct aim at a recent report by the McKinsey Global Institute (Big Data: The Next Frontier for Innovation, Competition, and Productivity) http://www.mckinsey.com/insights/mgi/research/technology_and_innovation/big_data_the_next_frontier_for_innovation that projects substantial quantitative and qualitative benefits from implementing Big Data initiatives in health care.  Pathcare essentially states that McKinsey and Big Data ignore the two major stakeholders in healthcare – doctors and patients: “The study does not cite a single interview with a primary care physician or even a CEO of a healthcare organization that might support or validate their theories about big data value for healthcare. This is shoddy research, no matter how well packaged.” http://pathcareblog.com/why-big-data-for-healthcare-is-rubbish/?goback=%2Eanb_1839273_*2_*1_*1_*1_*1_*1

An article in Businessweek (The Health-Care Industry Turns to Big Data by Jordan Robertson, May 17, 2012) http://www.businessweek.com/articles/2012-05-17/the-health-care-industry-turns-to-big-data quotes benefits experienced by New York-Presbyterian Hospital from several data initiatives – including reducing “the rate of potentially fatal blood clots by about a third”, according to surgeon Nicholas Morrissey.  Morrisey is also working to develop a big data driven system to assess risk factors on new patients in the emergency room and the admission wards.  Along with hospitals, NSF and NIH have launched an initiative on Big Data to accelerate progress in biomedical research.

This article will not attempt to defend the research methodology utilized by McKinsey or the magnitude of the benefits projected, but it will defend the premise that medicine must improve its processes and procedures. Information systems are essential to this improvement and large amounts of data will need to be exchanged, integrated, and analyzed as a result. Evidence based medicine, effectiveness research, and performance assessments require the analysis of large amounts of data.  Like it or not, medicine is an industry with massive amounts of data, whether it is clinical, administrative, performance, or business.  Medicine can no longer function as a guild where senior craftsmen dispense tricks of the trade to apprentices and society grins and bears the results in terms of lives impacted and national treasure dispensed.  What is truly alarming to this author is the fact that healthcare has been so slow to adopt methods that have been proven effective in other industries – even low-tech methods.  This may explain the positive reception given to the use of simple checklists that have been advocated by the Institute for Healthcare Improvement and A. Gawandi in his book The Checklist Manifesto. http://gawande.com/the-checklist-manifesto  Checklists have been used in the airline industry since its inception.  Other industries have already demonstrated the benefits of Big Data over a substantial time frame – including finance, transportation, manufacturing, and retail. To be sure, I do not believe that Big Data is a cure-all for what ails medicine, nor do I believe that McKinsey advocated that viewpoint in its study.  However, it is one component on the road to improving a chaotic system.

The eye opening report by the Institute of Medicine on Medical Errors (To Err is Human: Building a Safer Health System, November 1999) http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

estimated that as many as 98000 people die in hospitals each year as a result of preventable medical errors.  The costs in addition to loss of life are estimated to range from $17 billion to $29 billion each year.  One of the major conclusions from the Institute’s study was that faulty systems, processes, or conditions lead people to make mistakes or fail to prevent them.  The report clearly stated a need to address medicine from a systems perspective to decrease the alarming rate of medical errors.  A number of prominent physicians and healthcare organizations have advocated other approaches to improve the provision of healthcare – including changes to the basic organization of how primary care is dispensed (ACO, PCMH),  http://www.pcpcc.net/guide/better_to_best how hospitals fit into the provision of care, and how information systems can be utilized to improve both safety/quality and productivity /effectiveness.

Due to the impact of healthcare costs on our society and the slow rate of change in the industry, government policy makers have also been forced to take a more active role.  Thomas Lee and James Mongan of Partners HealthCare System in their book Chaos and Organization in Health Care http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=11875 strongly advocate for this role and the importance of improving the healthcare information infrastructure.    In 2009 Congress passed the HITECH Act http://www.pwwemslaw.com/content.aspx?id=540 providing nearly $30 billion to address barrier to health IT adoption, $14.6 billion of which went to encourage adoption of electronic medical records.  Other funds were focused on developing Health Information Exchanges (HIE)  http://searchhealthit.techtarget.com/definition/Health-information-exchange-HIE toward the goal of making patient information available across all care delivery settings.  Bitton, Flier, and Jha (Health Information Technology in the Era of Care Delivery, To What End? JAMA,June 27,2012 – Vol 307,No. 24, P2593)

http://jama.jamanetwork.com/article.aspx?articleid=1199162 argue that the debate over whether health information and technology will save money and improve care is anachronistic.  They state flatly that information technology will be used in health care.  “Health IT is inevitable.  The question now is how best to do it”.

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