January 30, 2015
This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.
Are we prepared for the genomics revolution?
The President's proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it's probably time to get ready for some changes in our daily routines as health professionals.
I'm not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.
And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.
No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It's not just about cancer, my friends. It will be coming to a primary care practice near you probably sooner than you realize -- but it is coming. More...
October 02, 2014
It's October and that means we are about to see a lot of pink for the next 31 days. And virtually all of the work comes down to one simple -some might say overly simple-message: get a mammogram.
But as National Breast Cancer Awareness Month (NBCAM), begins, I find myself one again asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms? Is there more to the story? The answer is absolutely unequivocal and without a moments hesitation: YES! More...
September 30, 2014
I had an interesting day this past week. Sadly, it left me wondering why the same "hope and hype" directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.
In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren't necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.
Not long after, I was informed of an online discussion on Twitter (called a "tweet chat" at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a "scrum" of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the limitations of our knowledge or potential problems with the treatment. It was all about "we can do it, call us and we will tell you how good we are, and insurers won't pay us." Simply stated, the "conversation" seemed to be glancing by some of the inconvenient facts surrounding what has become another poster story for how we develop and promote new treatments in medicine, let alone cancer care. More...
June 04, 2014
It was the picture (see below) that, to me, said it all: a 96 year old woman -- one of the first patients in the world to receive a brand new cancer drug--, and a large tumor on her neck had melted completely away. But it was the smile on her lips that you couldn't avoid noticing. 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...
August 06, 2013
There was a memorable scene in the movie "The Graduate" from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: "plastics."
Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central ones that our becoming our new "plastics" in medicine: genomics and big data. Words that didn't mean much to most people a year or so ago now occupy front and center discussions at every level, not to mention are the topics of a number of meetings I have attended recently.
This past week I went to one of those meetings (sponsored by e Health Initiative) where over 450 people spent two days hearing from experts about the meaning, uses, and precautions that come along with "big data" in medical care. (Interestingly, there were also several presentations on the intersection of genomics and big data. So the two are definitely not mutually exclusive.)
Not that medicine is unique: big data is transforming much of the way we live and the way we experience life. What is different about medical care is that we are so far behind everyone else when it comes to adopting and effectively using information technology and data analysis to improve healthcare. But that is quickly changing. The power of technology is just beginning to impact health care as hospitals and doctors' offices increasingly adopt (and adapt to) health information technology, but it takes lots of resources and commitment--both human and financial--to make that happen. More...
June 07, 2013
It is a disarmingly simple idea: create a blue button logo with a download moniker on it and let it loose so people can actually download, review, and keep their own medical records. But simple on the surface masks complexity below a revolutionary concept: that patients are not only the subject of the records, but that they own those records, and through that ownership can actually be partners in their care or even improve their own health.
That was the topic of a meeting I attended yesterday at the White House, where representatives of government, health technology vendors, consumer groups, and others interested in advancing the role and usefulness of health information technology came together to give updates on the progress of the "Blue Button" program, review the current state of affairs, and pledge to advance the concept going forward. And I was honored to be invited to join this knowledgeable and committed group on behalf of the American Cancer Society.
When you think about it, patients with cancer and other serious illnesses should be clamoring for this to become the routine and not the exception. As I have written before, it is difficult enough to hear that you have cancer and are going to need complicated treatment. But that is just the beginning of what can be a very tortuous journey for patients and their caregivers through the cancer treatment maze. Complex diagnoses, loads of records, and no way to have the health information communicated easily from one place to another is just one more way that the quality of life of cancer patients is impacted by their illness.
Why do we tolerate this? I don't know, that's for sure. As patients we should be our own advocates. We should be expecting--no, demanding--a more transparent and efficient system of care. And getting our information in our hands is just one way to make that happen. The people in that room yesterday are committed to the concept that you own your medical information and should have access to it,, and that we are obligated to make to find a simple and straight forward way to get your medical information to you and to anyone you choose to share it with, whether that be a doctor, a family member, or a company or organization you want to help you organize and understand that information. More...
September 06, 2012
(Author's note: The following blog was posted today on the "Science Update Blog" hosted by Cancer Research UK, where you can read it in its entirety. My thanks to Cancer Research UK and especially to Oliver Childs who made this opportunity available.)
Expert opinion: a US perspective on beating cancer
Posted on September 6, 2012 by Oliver Childs
Dr Len Lichtenfeld is deputy chief medical officer for the American Cancer Society. We invited Len to share his thoughts about our shared challenge of beating cancer.
As well as giving his unique perspective on the US's "war on cancer", Dr Len writes about the similarities and differences between the US and UK in our approaches to preventing, detecting and treating the disease:
It has been a long slog since we started our war on cancer here in the United States in 1971.
At times I am not certain that this has been so much of a war as opposed to a series of skirmishes that occasionally have produced incredible moments of optimism. But there have been a fair share of frustrations as well along the way. Our science and our care have made significant progress, but sometimes we find ourselves asking, "What have you done for me lately?"
I think it is important to reflect on the progress that we have made on several fronts in detecting cancer earlier, treating it more effectively and providing quality of care for those who find themselves caught in the jaws of illness, especially for those whose journey has not been successful. More...
November 18, 2011
Today the Commissioner of the Food and Drug Administration, Dr. Margaret Hamburg, announced that the FDA is withdrawing approval of Avastin® (bevacizumab) for the treatment of metastatic breast cancer.
This announcement culminates a highly watched process where the FDA determined that although it had granted accelerated approval for the use of this drug in treating breast cancer, subsequent studies did not demonstrate in any group of women that Avastin® actually helped patients in any meaningful way, while causing significant harms-including death.
In the accelerated approval process, the FDA permits a company to market a drug for a specific indication, usually in a life threatening disease, while allowing the company to perform additional trials to confirm the value of the drug. After those trials are done, under this form of approval, the FDA reserves the right to revoke that approval if the original promise of the drug is not confirmed. That is what has happened with Avastin® in breast cancer.
As difficult as this decision has been for the FDA, it is even more difficult for women (and their loved ones and their doctors) who believe that Avastin® has saved their lives. The Commissioner emphasized that she was acutely aware of that concern in making her determination, but she underlined the fact that when the science was carefully reviewed, there was no evidence of meaningful benefit of Avastin® in breast cancer treatment.
The full impact of this decision is difficult to determine at this time. More...
September 18, 2011
Are we the victims of our own success?
That may be an unusual-and some would say offensive-way to open a discussion of cancer survivorship. I mean it only with the best of intentions, for when it comes to cancer survivorship over the past 40 years, there is much to be grateful for. But that doesn't mean the journey has been without difficulty, and it doesn't mean that there isn't much more to do.
Last week, in Washington, DC, LIVESTRONG brought together over 120 experts on the issues surrounding cancer survivorship to do something reasonable and fairly straightforward: define the essential elements of survivorship that every cancer patient, their loved ones and caregivers should expect once the acute treatment part of their journey has been completed. What's amazing is that no one has been able to do this before.
Having those experts in one room at one place at one time brought into focus the enormous task we face in trying to define those elements, let alone how we configure our systems of care to provide those services in a world where care is becoming more diffuse and resources for anything other than the most necessary care are dwindling on an almost daily basis.
It wasn't always this way. More...