May 29, 2014
In what has to be considered a major victory for those concerned about the proliferating use and risks of tanning beds, the Food and Drug Administration this week issued a final rule requiring devices used for indoor tanning to meet very specific requirements before they can be marketed to the public. And in what is probably an even more important part of the rule, they now instruct those who market tanning devices to consumers to warn them clearly about the very real and serious risks of indoor tanning. More...
May 22, 2014
"Don't Fry Day," which we "celebrate" every year on the Friday before Memorial Day is an annual reminder to be good to the skin you're in. It's the only one you get. Wear it out or damage it and you don't get to replace it, like we do with heart valves, knees, hips, and so on.
This year Don't Fry Day is even more personal to me. After hounding all of you to be careful in the sun, I got a very personal reminder this past year of why that's important: two surgeries and two scars from removing skin cancers. One of those scars is pretty visible and a daily reminder of my own past unwise sun behavior. Like many folks, I'm glad the cancer is gone. But I also wish it hadn't been there in the first place.
The reality is that my generation had very little knowledge and very few options when it came to avoiding the dangers of too much sun exposure. We went outdoors, we went to the beach, we didn't have sunscreen, and we just lay there and took it. We thought we looked good. If we worked outdoors--like I did when I was in high school and college--we took our sunburn "lumps" early in the season then "built" a tan over the rest of the summer.
The rewards for our behavior? It certainly wasn't better health. We now have aging skin, with sunspots, wrinkles, and cancers to show for our efforts. And, unfortunately, we have also lost many friends, family, and others to serious skin cancers, such as melanoma. More...
May 16, 2014
This was the dream: we would use technology to create a seamless healthcare system, one where people, computers and machines would work together to improve patient care in many different ways. Health care would be more efficient, it would be safer, it would be less expensive, we would be able to transfer health-related information quickly and accurately.
After spending three days at a meeting this past week with some of the top experts in the field, I am not so certain that the dream is going to come true anytime soon. Perhaps more concerning, the problems--including patient safety issues--that are cropping up in so many areas are very troubling. More...
May 11, 2014
My wife and I did something special this past Friday evening. We attended a Relay for Life in our hometown of Thomasville GA. And the memories of the event will not be soon forgotten, for so many reasons. More...
March 19, 2014
An article published this week in the American Cancer Society journal CA: A Journal for Clinicians received a lot of media attention. The report showed dramatic declines in the rate of people being diagnosed with colorectal cancer, as well as decreases in the rates of colorectal cancer deaths over the past number of years.
But the press didn't say much about the fact that not everyone has benefitted from the progress we have made in the prevention, early detection, and improved treatment for colorectal cancer. It is a sad but very real commentary on how we approach health care in this country that African Americans have not benefitted equally from this progress in treating a cancer that for many people can be prevented or effectively treated when found before it spreads to other parts of the body.
As a nation, I believe it is incumbent that we address this glaring health disparity. To do less is unacceptable. More...
March 06, 2014
News reports covering a prostate cancer study this week in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to "watchful waiting" after they were diagnosed.
But guess what? There's a critical fact that seemed to be missing in much of the coverage I saw. And that fact is this: the men who were given the "watchful waiting" as described in the study never received any curative treatment. Let me repeat: No curative treatment. That is a much different approach to watchful waiting than we currently recommend in the United States, where watchful waiting after a diagnosis of prostate cancer usually means offering curative treatment when the prostate cancer changes its behavior. More...
January 07, 2014
I have made a resolution for 2014: I will never, never, never again call basal and squamous skin cancers "benign" cancers.
Why would I make such a strange commitment? The explanation is simple: I spent 4 hours on New Year's Eve sitting in the surgeon's chair getting a skin cancer taken off my nose. Nothing about the experience fits the "benign" label so many professionals, including yours truly, have used: routine; easy to treat; nothing to worry about. Friends, after this experience, which left me looking like a tall, white-haired Rudolph the Reindeer, I am here to tell you these cancers are not to be trifled with, and are worth every effort you can make at preventing them by reducing exposure to UV radiation. More...
October 18, 2013
I attended a meeting in Washington this past Wednesday that got me to thinking about the fact that as we revolutionize cancer research and treatment, we are also going to have to revolutionize cancer care. And that
may prove to be an even more daunting task than finding new treatments for the disease itself.
The meeting was sponsored by a collaboration called "Turning The Tide Against Cancer". The organizers brought together experts from a variety of disciplines ranging from insurance companies and economists to advocacy groups and highly regarded cancer specialists to discuss policy solutions to support innovation in cancer research and care. Walking in, I anticipated this was going to be another one of those sessions where we talked about funding for research, bringing research into clinical trials, and having patients get access to new drugs. But I was wrong. The discussions quickly steered into a different direction: what do we need to do to make the cancer care system work for patients?
Of course there were the continuing themes of "big data" and the impact of genomics on drug development and patient care, but a surprising amount of the discussion centered around new payment models, quality of care, and fundamental redesign of medical care to become more patient centric. And although we talked a lot about data gathering and analysis, what stuck with me was the redesign piece. I thought the discussion around redesign would focus on personalized medicine, but we spent a lot of time on changing the fundamental structure of cancer care and payment.
How are those two linked? Did we miss our focus?
The answer? If we don't change the way the system is working, we won't realize the promise of personalized medicine. Seems pretty simple and straight forward until you start thinking about the implications. More...
August 21, 2013
A discussion on Twitter caught the eyes of my colleagues yesterday, and raised a very interesting question: should insurance companies be allowed to do PSA testing to detect prostate cancer on men as a condition of getting insurance?
What started the discussion was a blog post by a well-known and respected medical blogger who goes by the name "Skeptical Scalpel." In his blog he detailed the saga of a 56 year old man who had a pre-employment physical in order to be covered by his new company's health insurance plan. He was not informed that he was going to have a PSA test. It was just done as part of the process. No informed consent, no nothing, just stick out your arm, have blood drawn, and register your surprise that the test was done once the results come back.
The United States Preventive Services Task Force recommends against any man having the test to detect prostate cancer. Even among those who say the test is an option, -including the American Cancer Society-recommend that a man have a full, informed understanding of the pros and cons of PSA testing before getting the test, given the uncertainties of whether it really saves lives and the known frequency of side effects associated with treatment for prostate cancer. None of those recommendations were part of the consideration for this man when he was examined for his insurance plan.
You can imagine what happened: his PSA was slightly elevated at 5.9. He was "rated" by the insurer, charged an extra $200 a month for his health insurance, and may well have to have a number of additional studies. Not to mention that he may have prostate cancer, and may undergo more treatments-as a result of a test that is of uncertain value for most men. And, by the way, the odds are overwhelming that the gentleman in question does not have prostate cancer, but will have to go to considerable lengths (and some risk) to find out. Because he had not discussed the test, he did not have the opportunity to prepare for it correctly, so his reading may have been falsely high; we'll never know. And, if he does have prostate cancer, as reflected in the USPSTF recommendations, he has a significant chance of having long term side effects from the treatment, but little proven benefit in terms of saving his life. More...
August 14, 2013
We've all heard the phrase, "When you come to a fork in the road, take it." Well, that saying may hold particular relevance while reviewing a new research report published today in the New England Journal of Medicine.
The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of the drug finasteride could reduce the incidence and deaths from prostate cancer. The study was called the Prostate Cancer Prevention Trial and when it was initially reported in 2003 it showed that the drug could reduce the incidence of prostate cancer by almost 25%. However, there was a catch: there was actually an increase of almost 27% in the number of high grade-or more serious-prostate cancers in the group treated with finasteride compared to those men who did not get the drug. The men in this trial were followed very closely. Since this trial was done in an era when PSA testing to find prostate cancer "early" was part of routine care, these men were screened regularly with the PSA test.
The originally reported results of the trial meant two things to the researchers: first, finasteride was successful in reducing the frequency of prostate cancer, but most of that decrease was in the lower grade, less harmful forms of the disease, and second, it raised the question of whether the drug actually promoted more serious forms of prostate cancer. Some experts argued that in fact there weren't more numerous high grade tumors, only that finasteride made it easier to find them thanks to the fact that it shrinks the prostate.
The debate on the relative merits of using finasteride has continued since. Suffice to say, the use of the drug didn't get much traction. In 2011, the Food and Drug Administration added information to the drug label that finasteride and similar drugs could increase the frequency of more lethal forms of prostate cancer and that the drugs were not approved for prostate cancer prevention.
Meanwhile, organizations such as the American Cancer Society have suggested that men should make an informed decision as to whether or not they really want to be screened for prostate cancer with PSA testing, and the United States Preventive Services Task Force recommends that men should not be screened at all for the disease. But the impact of finasteride on reducing the incidence and deaths from prostate cancer and "the rest of the story" remained unanswered. At least until now. More...