18 MAY 2012
Showing posts with label Research Policy. Show all posts
Showing posts with label Research Policy. Show all posts
Friday, May 18, 2012
Friday, January 20, 2012
Getting Healthcare Social. Time is ready, doctors are not.
by Gianmarco Contino
Healthcare is a unique kind of "market". Doctors determine demand, doctors deliver offer. Of course they are not totally free: in the best care scenario they have their professional ethics, knowledge, and compassion. However it would be unfair not to acknowledge the role of national budgets, healthcare policies, big and small pharmas, medical device companies, and insurances. Patients are always at the bottom of this complex network, unfortunately not as real players. Drug and healthcare advertisement don't make a patient free to choose about his own health. Considering the relevance of healthcare choices, advertisement is not able to improve patient's awareness, and in a way it distracts patient-doctor relationship from its trustworthy nature. At the same time, entirely delegating choice to the patient by providing tons of information, doesn't help patient's awareness, it just makes him feel alone with his medical condition.
I have no doubt, time has come for a change. Doctors have been bound to the Hippocratic Oath "to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else." Thus, medicine has been immune by a true "democratization" process, and doctors need to help this process go in the right direction.
Shared decision making is what we need. Embracing this change will save and strengthen the value of patient-doctor relationship, and minimize most of the deviated influences I wouldn't have liked to list above. Shared decision making means essentially shared medical knowledge, and shared personal and institutional healthcare information.
Medical knowledge has been increasingly spread by some high quality governative and private channels, although bad quality healthcare is what make the most of internet and other media. We need a quality ranking system to help people choose where to learn.
Shared personal and institutional information is the most complex part of the problem. The first issue is privacy. Once this is solved a new issue, we can hardly see at the moment, will be what to make of those information in order to help patients to choose and doctors to deliver better care. At the moment both patients and doctors do not see the enormous potential of embracing this challenge. As a result, investment and commitment of government and academia is poor.
I want to give you a taste of what is the potential of medicine getting social the right way. Doctors know every patient is unique, but rely on the largest studies possible to deliver evidence based medicine, which is the best care for the average patient. This medicine is not up to date with the potential of personalized medicine, and old school trials are getting obsolete. Shared medical information has potential to retrieve new kind of data on best personalized treatment, taking in account actual compliance to the treatment, past medical history, geographic area and in close future genetic determinants. Doctors working in underserved or poor areas, will be able to compare treatment with similar areas around the world. Medicine try to set up the best standard of care by implementing new therapies or devices, which constantly increase prices. Not all the world lives in Massachusetts. It will be able to create communities able to negotiate the price of specific drugs such Herceptin for breast cancer, whose cost are extremely variable depending on insurances and public health/government institutions, but most of the time not accessible to poor areas of the worlds. Examples can extend to infinite. But one thing should be enough to convince you this effort is worth. Shared decision making will build up a medicine that requires doctors to listen to patients and vice versa, and doctors and patients listening among them. This is more relevant to the Hippocratic Oath than it is restricting access to knowledge.
I found some inspiration in:
Dave deBronkart, known as e-patient Dave http://www.youtube.com/watch?v=2vejkD0Rl3o
and Information needs of cancer patients and their organisations
Healthcare is a unique kind of "market". Doctors determine demand, doctors deliver offer. Of course they are not totally free: in the best care scenario they have their professional ethics, knowledge, and compassion. However it would be unfair not to acknowledge the role of national budgets, healthcare policies, big and small pharmas, medical device companies, and insurances. Patients are always at the bottom of this complex network, unfortunately not as real players. Drug and healthcare advertisement don't make a patient free to choose about his own health. Considering the relevance of healthcare choices, advertisement is not able to improve patient's awareness, and in a way it distracts patient-doctor relationship from its trustworthy nature. At the same time, entirely delegating choice to the patient by providing tons of information, doesn't help patient's awareness, it just makes him feel alone with his medical condition.
I have no doubt, time has come for a change. Doctors have been bound to the Hippocratic Oath "to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else." Thus, medicine has been immune by a true "democratization" process, and doctors need to help this process go in the right direction.
Shared decision making is what we need. Embracing this change will save and strengthen the value of patient-doctor relationship, and minimize most of the deviated influences I wouldn't have liked to list above. Shared decision making means essentially shared medical knowledge, and shared personal and institutional healthcare information.
Medical knowledge has been increasingly spread by some high quality governative and private channels, although bad quality healthcare is what make the most of internet and other media. We need a quality ranking system to help people choose where to learn.
Shared personal and institutional information is the most complex part of the problem. The first issue is privacy. Once this is solved a new issue, we can hardly see at the moment, will be what to make of those information in order to help patients to choose and doctors to deliver better care. At the moment both patients and doctors do not see the enormous potential of embracing this challenge. As a result, investment and commitment of government and academia is poor.
I want to give you a taste of what is the potential of medicine getting social the right way. Doctors know every patient is unique, but rely on the largest studies possible to deliver evidence based medicine, which is the best care for the average patient. This medicine is not up to date with the potential of personalized medicine, and old school trials are getting obsolete. Shared medical information has potential to retrieve new kind of data on best personalized treatment, taking in account actual compliance to the treatment, past medical history, geographic area and in close future genetic determinants. Doctors working in underserved or poor areas, will be able to compare treatment with similar areas around the world. Medicine try to set up the best standard of care by implementing new therapies or devices, which constantly increase prices. Not all the world lives in Massachusetts. It will be able to create communities able to negotiate the price of specific drugs such Herceptin for breast cancer, whose cost are extremely variable depending on insurances and public health/government institutions, but most of the time not accessible to poor areas of the worlds. Examples can extend to infinite. But one thing should be enough to convince you this effort is worth. Shared decision making will build up a medicine that requires doctors to listen to patients and vice versa, and doctors and patients listening among them. This is more relevant to the Hippocratic Oath than it is restricting access to knowledge.
I found some inspiration in:
Dave deBronkart, known as e-patient Dave http://www.youtube.com/watch?v=2vejkD0Rl3o
and Information needs of cancer patients and their organisations
Thursday, January 19, 2012
Doctor and Patient: Why Doctors Can't Predict Life Expectancy - NYTimes.com
why we shouldn't predict prognosis...
January 19, 2012, 12:01 AM
Why Doctors Can’t Predict How Long a Patient Will Live
Wednesday, December 1, 2010
Reconnecting with family
Research Overseas, a Nature Journal editorial
I left my native Australia nearly two years ago in a flurry of paperwork and last-minute packing. I tied up as many of the loose ends of my life as I could, put my finances in order and tried to work out what I could take with me without exceeding my baggage allowance. There seemed to be just enough time for tearful goodbyes at the airport before I was on my way to Germany.
This year, I returned to Sydney for a visit, courtesy of a conference that I was attending. It was an opportunity to present my postdoctoral work — and it was my first visit home.
Only a month before my trip, I had learned that my grandmother was ill. The high price of pursuing science overseas became all too clear: it is difficult to help and look after your family when you're half a world away. Worried, I had considered booking a flight to Sydney immediately, and pushing my trip forward by a month. The decision was not easy; there is no such thing as a quick dash home when the journey involves a 22-hour flight. If I had left then, half-done experiments would have gone to waste and my colleagues and students would have been inconvenienced, because I was in the middle of teaching a course. But after a few desperate calls to my parents, I learned that all was well — my grandmother was recovering.
I was extremely glad to see all my family when I landed in Sydney for the conference. My grandmother seemed to be in much better health. But the experience made me realize: although working overseas has many career benefits and has been a fantastic experience, the distance has significant drawbacks. I must try to put my experiments aside and take that 22-hour plane ride more often.
Monday, November 8, 2010
Saturday, September 5, 2009
A brave new way to fund cancer research
It is time to think different, forty years of cancer funding have produced disappointing results overall. This is a common feeling in the cancer community. Obviously, this is not completely true. Even if we stand far away from winning the war, we can now thinking of cancer as many different genetic diseases, rationally design drugs, and prolong lives for years as for a chronic illness. In some case, we can definitely cure it, but prevention, rather then treatments helped. Anyhow, results we see are the sum of many little steps. The point is that they might be too little to make the difference. Actually, the way grant system works, induces researcher to propose projects reviewer know will be successful. None wants to fund a fishing expedition without results. But if you already know what you expect the yield of your discovery is more likely to be low. Obama Stimuls Package faced this challenge, a once in a lifetime chance to foster groundbreaking research. But it also should be a good opportunity to re-think of the way we fund research. We won't go to the moon with a bus ticket.
find more on:
Grant System Leads Cancer Researchers to Play It Safe
find more on:
Grant System Leads Cancer Researchers to Play It Safe
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