Sean Khozin, MD, MPH

President Obama has proposed that widespread adoption of health IT can save us $80 billion a year in healthcare costs. This is a bold statement that has many physicians and experts wondering how the clunky health IT solutions currently on the market can add so much value to our system.

In response to Obama’s projections, Jerome Groopman, Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and staff writer for The New Yorker, had the following to say in a recent Wall Street Journal opinion piece:

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

Groopman goes on to say that “the basis for the president’s proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system.”

The gap between what the administration is thinking and reality can best be explained by considering that most current health IT solutions have been designed to sustain the needs of the status quo. They are by no means disruptive solutions. In “The Innovator’s Prescription: A Disruptive Solution for Health Care”, Clayton M. Christensen, et al. present a compelling definition of truly disruptive technologies:

… “disruption” is an innovation that makes things simpler and more affordable and “technology” is a way of combining inputs of materials, components, information, labor, and energy into outputs of greater value.

Do we really think that the existing health technology options are truly disruptive solutions that can lower costs and lead to better outcomes? If there are any doubts, we should pause and reassess.

The Crisis of Credit Visualized from Jonathan Jarvis on Vimeo.

I have a lot of interest in finding practical applications for data visualization techniques, where specific patterns are revealed by merging and visually depicting large numbers of seemingly discordant data points. Data visualization can be of potential use in analyzing population health outcomes by, for example, scanning large databases of specific medical interventions paired with outcomes and representing the results visually to physicians at the point of care, in order to facilitate making more informed decisions.

My latest favorite data visualization project is by Jonathan Harris and Sep Kamvar. Their project is called “We Feel Fine: An exploration of human emotion in six movements.” In this artfully crafted project, the creators have developed a system that searches “the world’s newly posted blog entries for occurrences of the phrases ‘I feel’ and ‘I am feeling.’ When it finds such a phrase, it records the full sentence, up to the period, and identifies the ‘feeling’ expressed in that sentence (e.g. sad, happy, depressed, etc.)” and organizes it by the author’s gender, age, and geographic location (information that is usually available from blog registries). The data is then visually organized in six different ways or “movements.”

Their website is definitely worth checking out.

Not sure if this is our First Lady’s official twitter page, but the picture posted there is kinda cool and a refreshing representation in the dry world of politics.

I was just introduced to Medi-Share, a non-profit Christian ministry where people share their high cost medical expenses. They even have services to negotiate rates for individuals after they’re thrown an exaggerated medical bill. It seems like they’ve created a viable alternative to the expensive and intrusive third party payment system. On their website they say that since 1993, “more than $345,000,000 in needs have been shared among members.”

Great way to get the middleman out of the way.

It costs drug companies about $800 million to develop a new drug that may not even be approved by the regulators. The rising costs of drug development coupled with a stagnant pipeline has urged Merck to buy Schering-Plough for an impressive $41.1 billion in cash and stock, making them the second largest drug company in the world after Pfizer.

Merck expects to save about $3.5 billion annually beyond 2011 and double the number of potential medicines in late development to a total of 18 drugs.

Large pharmaceutical companies are combing the market and buying up their smaller counterparts, which sometimes have more promising medicines in the pipeline.  A few months ago, Pfizer bought Wyeth for about $62 billion.

We can expect to see more mergers and acquisitions in the pharmaceutical sector in the near future to fulfill the need for more innovative drugs in the face of increasing development costs and a future that may bring declining revenues for drug makers as payers (insurance companies, the government) tighten their belts.

The White House has annouced that President Barack Obama will lift the eight-year ban on embryonic stem cell research today. This is good news for science and medicine.

The previous administration had not completely banned research on stem cells but instead imposed serious restrictions. In 2001, President Bush made it a requirement that federal funding could only be awarded to stem cell research if it met the following criteria:

• The derivation process (which begins with the destruction of the embryo) was initiated prior to 9:00 P.M. EDT on August 9, 2001.
• The stem cells must have been derived from an embryo that was created for reproductive purposes and was no longer needed.
• Informed consent must have been obtained for the donation of the embryo and that donation must not have involved financial inducements.

Nature on Comparative Effectiveness research:

Where the really tough questions arise … is in how [the outcomes of Comparative Effectiveness research] will be used. Sometimes the decision is easy: treatment A is much better than B, so A should become standard practice. But what if treatment A is only a little bit better than B, yet costs ten times as much — is it worth it? Decisions about clinical effectiveness are difficult to divorce from those about cost effectiveness.

On July 31, 2008, Senators Max Baucus (D, Mont) and Kent Conrad (D, ND) introduced the Comparative Effectiveness (CE) Research Act of 2008. The bill authorizes the establishment of a private, nonprofit corporation to be known as the Health Care Comparative Effectiveness Research Institute which will aim “to improve health care in the U.S. by advancing evidence concerning the manner in which diseases, disorders, and other health conditions can best be prevented, diagnosed, treated, and managed through research, evidence synthesis, and dissemination of findings, with respect to relative outcomes, effectiveness, and appropriateness of health care strategies.” (Full text: S 3408)

In the stimulus package, $1.1 billion has been set aside for supporting CE research. Proponents of CE believe that it has the potential to reduce healthcare costs while improving quality of care by discouraging practices that are deemed too expensive or ineffective, especially where cheaper alternative exist. The critics warn that such research may result in a one-treatment-fits-all strategy, making the government an intrusive third party in the medical decision making process. Some also fear that insurance companies will abuse the data to deny appropriate care to patients.

Both sides have valid arguments.

Thomas Sydenham (1624 – 1689), the father of English Medicine, pioneered the concept of separating the disease from the patient. Prior to that, doctors focused mostly on addressing symptoms. Sydenham recognized that the disease process behaves almost the same in most individuals and that the “phenomenon that you would observe in the sickness of a Socrates you would observe in the sickness of a simpleton.”

The separation of the disease from the person made treating it more uniform and rational but it also caused physicians to start speaking a different language from patients. Symptoms of a disease (headache, runny nose) are easy to relate to and  understand. On the other hand, characterizing a disease (subarachnoid hemorrhage, allergic rhinitis) is in the domain of the scientist physician.

The art of medicine is most visible when physicians attempt to bridge the gap between scientific facts and individual human needs. The outcomes of CE research may widen this gap as the focus shifts more towards aggregated evidence and farther from patients’ individual needs and preference.

The scientist-artist duality seems to be an enduring reality for the modern physician.

Yesterday, President Barack Obama nominated Kansas Gov. Kathleen Sebelius to head the Department of Health and Human Services.

Sebelius is fully on board with Obama’s  proposal to raise $634 billion for healthcare reform over 10 years through tax increases on the wealthy and cuts to existing government healthcare spending. These cuts may include reduction of government funding of Medicare Advantage programs (probably a good move), which are Medicare plans that are run by private insurance companies and account for a large proportion of their revenues (e.g.  48% of Humana’s annual revenues) but cost the government more than administering the plans themselves. The cuts may also reduce physician reimbursement (definitely a bad move), who’ve already reached full workload capacity and financially-threatened medical practices.

Unfortunately, there is still not much talk about increasing efficiency at the delivery end, something that if done well can not only reduce costs but also improve quality of care. Paying less for something without trying to find out and correct why it costs too much can not be a viable long-term strategy.