January 29th, 2009 by Dr. Val Jones in Audio, Expert Interviews
Tags: America's Agenda, Avastin, Bill Tauzin, Cancer, Chemo, Donna Shalala, Dr. Val Jones, Duodenal Adenocarcinoma, Health Reform, healthcare, Miami, Obama, Oncology, Phrma, Podcast
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Billy Tauzin has spent most of his life in politics. He has been a member of the House of Representatives as both a democrat and a republican, though his recent experience with a rare and usually terminal cancer (duodenal adenocarcinoma) radically changed his career path and trajectory. I caught up with Mr. Tauzin by phone at the America’s Agenda conference in Miami. You may listen to our podcast conversation or read my summary of our discussion below.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2009/01/billy-tauzin.mp3]
Dr. Val: Tell me a little bit about your intestinal cancer and how that changed the course of your life.
Tauzin: I was in the process of finishing up a 25-year career in Congress when one night I had a sudden, massive bleed. I was taken to the hospital and was diagnosed with a rare cancer with a poor prognosis: duodenal adenocarcinoma. There was a hole in my intestine, right next to my pancreas.
I went to Johns Hopkins to have a Whipple procedure – and as you know a Whipple procedure is one of the most aggressive types of surgery anyone can endure. They kind of split you open like a fish, pull out your innards and restructure you. They had to remove part of my stomach, intestines, and pancreas, and then reconnected it with new ducts and channels. The Whipple was supposed to cure me, but unfortunately I found out (at a follow up visit at MD Anderson) that there was still cancer in my body.
The doctor told me very frankly that I was going to die.
Dr. Val: Tell me about the experimental drug that you were introduced to at that point.
Tauzin: My doctor reviewed my options with me: I could undergo another surgery, but that would probably kill me and would be unlikely to cure the cancer. They had no approved protocol for people in my position, but there was a drug (called Avastin) that had been successful in treating colon cancer – but was not yet approved for duodenal adenocarcinoma. The drug works by cutting off the blood supply to tumors – which meant that the drug could either damage my healing process or kill the cancer. My wife and I decided to take the risk because we had very little to lose. It was really a choice between “going to die” (my current situation) and “might die” (Avastin could cure me).
It’s a good thing we tried Avastin because it worked like a miracle. By the end of my first round of chemotherapy, the radiologist couldn’t even find the tumor on my CT scans. It was gone. I completed several courses of chemo and radiation and I’ve been cancer-free for over 5 years now.
Dr. Val: Did this miraculous recovery influence your decision to become the CEO of Phrma?
Tauzin: After I recovered from cancer, I was fortunate to be offered many different job opportunities. However, my wife looked at me and said, “You know Billy, you really ought to go to work for the people who saved your life.” And I thought, “If there’s a meaning in why I’m alive today – then surely it must be to use my experience to help patients like me across the world.”
Dr. Val: So what are you hoping to achieve at the America’s Agenda conference in Miami?
Tauzin: This conference is unusual in that we’ve gathered together a group of very disparate voices from different perspectives – labor, business, health plans, trade associations, academic medicine, etc. hosted by Donna Shalala (former Secretary of HHS) at the University of Miami. We are trying to define our commonalities so we can influence health reform more effectively.
Washington is all about differences – it’s partisan, it’s mean, and I’ve been on both sides of the aisle. I can tell you that there are good people in both parties, but they’d never know it because they consider each other enemies. What we’re trying to say here is: patients don’t sign in as democrat or republican when they register at a hospital. They sign in as sick people. This is not a partisan issue. We have a sick care system that needs to be a health care system.
Dr. Val: What should the Obama administration choose as their top priorities for health reform?
Tauzin: First of all we need to recognize that we spend 75 cents of every dollar on the damage done by 5 chronic diseases (including diabetes, heart disease, mental health, cancer, and lung disease). We must focus our system on early detection and prevention of these diseases, so that we manage them well and avoid the costly toll they take when untreated. We’re destined to be a poorer, sicker society if we don’t get insurance coverage for every American. We need insurance to provide early detection, prevention, and good management of our chronic diseases. How we do that is debatable. But we need to get there.
January 27th, 2009 by Dr. Val Jones in Announcements, Audio, Expert Interviews
Tags: America's Agenda, Billy Tauzin, Chronic Disease, Congress, Donna Shalala, Gwen Mayes, Health, health care, Health Care Policy Summit Conversation, Health Insurance, Health Policy, Ken Thorpe, Ken Thorpe PhD, Obama, Podcast, Universal Coverage
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Better Health’s policy writer, Gwen Mayes, caught wind of an interesting new conference being held tomorrow in Miami. She interviewed Ken Thorpe, Ph.D., one of the conference organizers, to get the scoop. You may listen to a podcast of their discussion or read the highlights below. I may get the chance to interview Billy Tauzin and Donna Shalala later on this week to get their take on healthcare reform initiatives likely to advance in 2009. Stay tuned…
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2009/01/gwenken2127.mp3]
Mayes: Tell us about the upcoming conference in Miami on January 28th called “America’s Agenda: Health Care Policy Summit Conversation.”
Thorpe: The conference will start a conversation on the different elements of health care reform such as making health care more affordable and less expensive, finding ways to improve the quality of care and ways to expand coverage to the uninsured. The conference is unique in that we’ve brought together a wide range of participants including government, labor, and industry for the discussion, many of whom have been combatants over this issue in the past.
Mayes: Will there be other meetings?
Thorpe: This is the first of several. There will others in other parts of country over next several months. President Obama and HHS Secretary Designee Tom Daschle have talked about engaging the public in the discussion this time around. So part of this is an educational mission and part of it is to reach consensus among different groups that have not always agreed in the past.
Mayes: What encourages you that these groups will be more likely to reach consensus now when they haven’t in the past?
Thorpe: The main difference is that the cost of health care has gotten to the point that many businesses and most workers are finding it unaffordable. In the past, most businesses felt that, left to their own devices, they could do a better job of controlling health costs by focusing on innovated approaches internally. What we’ve found, despite our best efforts, working individually we haven’t done anything to control the growth of health care spending. The problems go beyond the reach of any individual business or payer and we need to work collectively.
Mayes: How will health care reform remain a priority in this economy?
Thorpe: The two go hand in hand. As part of our ability to improve the economy we’re going we have to find a way to get health care costs down. Spiraling costs are a major impediment to doing business and hiring workers. To the extent we can find new ways to afford health care it will be good for business and workers.
Mayes: Health information technology is also an important aspect. What are the common stumbling blocks to moving forward?
Thorpe: There are three issues we have to deal with. First, we have to have a common set of standards for how the information flows between physicians and physicians, and with payers and hospitals. What we call interoperability standards. Second, we have to safeguard the information. Finally, cost is the biggest challenge because most small physician practices of 3 or 4 physicians don’t have electronic record systems in place. To put in a state-of-the-art system can cost $40,000 per physician and most cannot afford this expense. I think the stimulus bill will provide funds to help with these costs.
Mayes: There’s always growing interest in the patient’s role. How will this be addressed?
Thorpe: We have to find a better way to engage patients in doing better job of reducing weight, improving diet and those with chronic disease to follow their care plan they worked out with their physician. We also want to make it more cost effective for patients to comply with the plan. Patients who comply with health plans will have better outcomes at lower costs.
Mayes: Who’s on the agenda in Miami?
Thorpe: It’s at the University of Miami so it will be hosted by President Donna Shalala who was Secretary of HHS under the Clinton administration so she is well versed on health policy. Also attending is the head of PhRMA, Billy Tauzin, a former Congressman and former majority leader of the House, Dick Gephart. There will be some lay people as well for a nice cross section of consumers, labor, providers, business and others.
Mayes: How can people learn more about American’s Agenda and the conference?
Thorpe: The executive director of American’s Agenda is Mark Blum. He can be reached at 202-262-0700 or at America’s Agenda.org.
January 17th, 2009 by Dr. Val Jones in Expert Interviews
Tags: Center For Connected Health, Consumer Directed Healthcare, Consumer Health World, Dr. Joseph Kvedar, Joe Kvedar, Partners Healthcare
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Dr. Joe Kvedar is the Residency Program Director of the Department of Dermatology at Harvard Medical School. He is also the Founder and Director of the Center for Connected Health, an organization whose provocative goal is to help patients “become their own primary care provider.” I caught up with Dr. Kvedar at a recent health conference, and asked him to explain what his company’s approach contributed to the healthcare landscape.
Dr. Val: What is the Center for Connected Health?
Dr. Kvedar: Connected Health’s mission is to empower patients to be maximally in control of their own health destiny. As much as possible, we’d like to see patients become their own primary care provider.
There are three principles that must work together to accomplish this: first you must have accurate information about the health behavior that you want to change. Measurements must rely on quantifiable data (like the step count of a pedometer) rather than more general self-reports of how physically active you are. Second, the report must be in a format that offers specific feedback to the individual. Trending of information is critical, but the trends must be understood in context. For example a patient with diabetes needs to see how their blood glucose levels are behaving over time, but more than that they need to see how their food intake was influencing these levels. And third, data-driven coaching inspires the application of data to real lifestyle improvements.
Giving accurate information about yourself (in a format that is contextually trended over time) to a person that you trust can inspire behavior change. People are more likely to change their unhealthy choices when they know they’re accountable to someone for them. An appropriate coach can be anyone from a friend in a social network to a digital avatar, to a doctor or nurse.
Dr. Val: So what’s the rate limiting step in getting this behavior change model adopted? Is it lack of financial incentives?
Dr. Kvedar: That’s certainly part of it, but it’s even more than that. Healthcare providers gravitate towards human resource-intensive solutions. Providers are simply not used to thinking of technology as a tool. Instead, they often perceive the solution to better patient compliance as an increase in staff to serve them. But this is not feasible given our provider shortage and increasing healthcare burden. It’s just really hard for doctors to imagine that patients could be coached effectively by an avatar, yet there are many examples of it working. Read more »
January 14th, 2009 by Dr. Val Jones in Expert Interviews, News
Tags: Clorox, Dr. Thomas Sandora, Dr. Val Jones, Elementary School Children, Gastroenterology, Infectious Disease, Norovirus, Pediatrics
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Photo Credit: Dr. Crippen
I recently listened in to a Webinar related to infectious disease prevention strategies in elementary schools. The lead speaker (Dr. Thomas Sandora) was the principal investigator of a research study that was sponsored by Clorox and published in the Journal, Pediatrics a few months ago. I thought the results were interesting.
Study Design
This study was a randomized, controlled trial of 285 third to fifth graders in a school in Avon, Ohio. The study took place over a two-month period: from March to May, 2006. Half of the classrooms were randomized to the intervention group (which included having the kids apply hand sanitizer before and after lunch, and the teachers perform a sanitary wipe down of all their desks once/day), the other half were observed during their “business as usual” daily routine without sanitizers. The primary outcome measure was “days of school missed due to illness – either upper respiratory or gastrointestinal.” Swabs of surfaces in both the intervention and control groups were taken.
Results
Interestingly, there was no difference in the groups in terms of days of school missed due to upper respiratory type illnesses. There was a small but significant (9%) reduction in gastrointestinal-related illnesses absenteeism in the intervention group. Surface swabs picked up norovirus with higher frequency in the control group classrooms. No MRSA was detected during the study.
Discussion
Upper respiratory tract infections (URIs) are highly contagious, and are commonly spread by droplets in the air as well as surface contact (some viruses and bacteria can survive for 2 hours or more outside the body). Due to an infected child’s continuous contact with their own nasal secretions (sorry for the graphic photo), it is difficult to reduce the spread of URIs through the occasional hand washing or sanitizing. One would have to wash a child’s hands after each time they touched their mouth or nose.
On the other hand, gastrointestinal infections like norovirus are spread via the fecal-oral route, and are therefore not dripped and sneezed all over the place the way URI-causing viruses tend to be. Instead, GI infections are spread when hands are not washed thoroughly after a trip to the bathroom – and then food is touched and ingested.
So it’s not all that surprising that the transmission of GI-related infections were particularly susceptible to this study’s intervention: hand sanitizing before and after lunch, and a daily desk surface wipe.
An interesting point that Dr. Sandora made was that alcohol-based hand sanitizers don’t contribute to antibiotic resistance, because their killing mechanism is not related to antibiotics. I guess it’s like saying that humans don’t become resistant to knife injuries when exposed to attacks with greater frequency.
Conclusions
Hand sanitizer and surface disinfectant strategies may be more effective in reducing the transmission of gastrointestinal illnesses than respiratory tract illnesses in elementary school children. But since compliance is challenging – the total reduction in GI illness transmission remains modest though probably worth the hygiene effort. One glance at the photo above tells you all you need to know.
January 12th, 2009 by Dr. Val Jones in Audio, Expert Interviews
Tags: Dr. Philippa Kennealy, Dr. Val Jones, Entrepreneurial MD, healthcare, Thinking Outside The Box, Whole-Brained
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Well today was quite a role reversal for me – instead of interviewing someone for my blog, I was interviewed by another blogger. Dr. Philippa Kennealy of the Entrepreneurial MD, asked to speak to me about my new company, Better Health LLC. She summarized the interview here, calling me “The whole-brained physician who won’t ‘stay in the box.'” Quick, someone send for the men in white with butterfly nets!
You may listen to our podcast interview below (just click on the play button):
[Audio: http://blog.getbetterhealth.com/wp-content/uploads/2009/01/entrepreneurialmd.mp3]
Billy Tauzin has spent most of his life in politics. He has been a member of the House of Representatives as both a democrat and a republican, though his recent experience with a rare and usually terminal cancer (duodenal adenocarcinoma) radically changed his career path and trajectory. I caught up with Mr. Tauzin by phone at the America’s Agenda conference in Miami. You may listen to our podcast conversation or read my summary of our discussion below.
