Posts Tagged ‘Health care reform’

Health Care Reform: What Will It Take?

February 26, 2010

Like you, I’m wondering what Congress will do now with health reform. After months of debate and negotiation culminating in yesterday’s Presidential Health Summit, it is still unclear whether we will be stuck with a broken health care system or if aspects of the current bills will ultimately be implemented.

Even as health reform stalls, science marches on and is telling us how to turn our sick-care system into a system that proactively preserves health and turns a one-size-fits-all model to a more personalized approach.  The science behind medicine has already shown us it is possible to diagnose disabling health issues early, identify the best treatment for specific groups of patients and even reverse the progress of disease.  We can now see the light at the end of the tunnel: health professionals will no longer need to practice medicine by trial and error.

To fully capitalize on the emerging research however, our health delivery system must adapt.  We have a disjointed system that does not allow us to track disease effectively, identify which treatments work best for which patients or deploy the most up-to-date scientific knowledge in a coordinated way.  We can transform our health care system and give patients access to the latest breakthroughs that are right for them.  But only if an infrastructure that can support personalized care is put into place. What will it take?

At the core are incentives which must be adjusted to align with the concept of delivering the right care for the right person at the right time. And that will not be enough without an integrated, electronic information network that can support a “learning” health care system – where patient  outcomes are effectively utilized  to accelerate research and generate better treatment decisions.  Joining the best science with an efficient and knowledge-based delivery system is the only way to achieve the healthier outcomes we deserve.

Are We There Yet? Casting a Vision for the Future of Personalized Medicine

January 15, 2010

As part of their first issue of the new year, Nature ran a series of commentaries entitled 2020 Visions from leaders throughout the industry offering their predictions for what lies ahead in the coming decade. In his commentary on the future of personalized medicine, David Goldstein of Duke University recognized the following challenge, “Over the next decade millions of people could have their genomes sequenced. Many will be given an indication of the risks they face. Serious consideration about how to handle the practical and ethical implications of such predictive power should begin now.”

Dr. Goldstein’s admonition to consider the ramifications of personalized medicine for consumers is well warranted. Consumers have become increasingly informed and engaged in their health care, and the proper implementation of personalized medicine must include recognizing the impact this is already having on clinical care. There are also other significant challenges and opportunities that many are working vigorously to address, and will require additional effort in the coming months and years. To name a few:

  • To what degree will personalized medicine be addressed in the final version of the health reform bill?
  • Is personalized medicine ready to be adopted into clinical practice, or is there need for a greater scientific evidence-base? If so, what does that look like?
  • Will federal incentives for the adoption of electronic medical records enhance the practice of personalized medicine, or impede its progress through implementation that is not aligned with personalized medicine?
  • Are the efforts from biotech and pharmaceutical companies to augment their drug development pipelines with tailored therapeutics (and companion diagnostics) sufficient, or are we still relying too heavily on traditional drug development models?

In the coming weeks, this blog will feature commentaries from those involved in advancing personalized medicine and offer perspectives on what lies ahead. I invite you to share your predictions and expectations for the coming year and beyond. Many have recognized the potential of personalized medicine, but what must take place on the scientific, regulatory, political, or clinical levels to make personalized medicine a reality? I look forward to hearing your thoughts!

A Holiday Reading List from The Age of Personalized Medicine Blog

December 23, 2009

As we head into the final weeks of 2009, I wanted to share some recent articles and reports that you might want to read between glasses of eggnog and gatherings with family and friends. As the year draws to a close, these articles point to the tremendous opportunities that are ahead for personalized medicine, as well as the challenges in policy, business, and health care practice .

1) ObamaCare Threatens Personalized Medicine, Forbes – Dec 21, 2009 

Gregory Conko of the Competitive Enterprise Institute and Henry I. Miller, a physician and a fellow at Stanford University’s Hoover Institution, wrote a compelling op-ed this week on a topic we have discussed prominently at this blog – the need to align priorities for health care reform, particularly comparative effectiveness research, and personalized medicine. Conko and Miller point to the importance of taking into account the effects of a medicine on sub-populations and how the value of medicine (in terms of diversifying treatment indications) can increase over time. An approach to CER that lacks emphasis on such important advances may stunt the growth of personalized medicine. 

As Tony Coelho pointed out at this blog last week, the language in the Senate version of the health care bill does provide for an approach to CER that embraces patient differences and focuses on providing information that will enable patients and providers to make more-informed decisions. We’ll be standing by on Christmas Eve to see if this is what we get! 
 

2) Welcome to the Era of Personalized Medicine, Huffington Post – Dec 22, 2009 

In this article, WIRED Editor Thomas Goetz suggests that the era of personalized medicine is not only about advances in pharmacogenomics, but also about how advances in bioinformatics and consumer-oriented tools are generating huge amounts of data that can inform a more personalized approach to care. Goetz contends, “Personalized medicine isn’t something that happens to us; it’s something that we have to choose to engage in.” With such an engaged patient population emerging, health care providers also need to consider how interactions will change with patients bringing self-generated records and research into discussions about their health care.  

I look forward to seeing Goetz’s book The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine in February. You can also check out the Decision Tree blog to hear more of his thoughts on predictive medicine and the future of health care. 
 

3) Personalized Medicine Market To Grow 11% Annually, Pharmaceutical Executive – Dec 15, 2009 

Earlier this month, PricewaterhouseCoopers released The new science of personalized medicine: Translating the promise into practice, highlighting how the “disruptive innovation” of personalized medicine is creating opportunities and challenges for traditional health care practice. In case you won’t have a chance to read the 50-page report, this article from Pharm Exec gives a great summary of its salient conclusions. Echoing Goetz’s suggestion that personalized medicine encompasses consumer-oriented products and services, the report contends that a growing emphasis on prevention and wellness is paving the way for advances in personalized medicine.

Personalized Medicine and Health Care Reform: Looking Back, Looking Ahead

December 18, 2009

Will health care reform support personalized medicine?  In my mind, that depends on two important factors: 1) the extent to which health care reform is truly patient-centered (does it make room for patient differences, room for patient voices, and time for patient care?) and, 2) the extent to which it is innovation-friendly.

I’m focusing on the first topic in this post.  Earlier posts have rightly focused on comparative effectiveness research as one key provision.  If CER is structured correctly, it can help inform patients about optimal medical and health care options based on our differing needs.  These differences come from a number of factors, including different clinical conditions we may have, differences in our preferences and the way we view risk/benefit trade-offs, cultural differences, and certainly molecular differences.  CER structured to recognize, and respect, these differences can only accelerate the move to personalized care.  Yet it remains unclear if this is the kind of CER we’ll get.  I think only the Senate bill’s CER language gets us close to this goal, by fully including patients and providers in the process, fully embracing patient differences, and focusing the program on results communications and not national policy recommendations. 

CER is one of several aspects of health care reform that will have an impact on patient-centeredness and personalized medicine.  Just as important are provisions that will apply the scientific evidence to policy decisions.  This includes proposals to establish an independent Medicare advisory board, define physician “best practices” and performance standards, and establish standards for use of health information technology.   

These types of policies, when deployed as cost-control levers, could be one of the single biggest factors influencing the future of personalized medicine.  Payment policy measures designed to control costs and expand access—but that fail to encourage continued development and adoption of personalized medicine—could substantially delay or diminish opportunities for meaningful, measurable improvements in health care value and quality.

That’s because cost containment proposals that impose access restrictions based on average, population-wide study results risk ignoring the different needs of individual patients and discouraging adoption of personalized tests and therapies based on these differences.  For example, “pay for performance” programs focused on short-term provider efficiency could discourage physicians from using gene-based tests and targeted therapies to optimize care for the individual.  As a patient with epilepsy myself, I take a very personal interest in how these policies get developed and applied.  

This nexus of CER and policy levers was highlighted earlier this year in an NPR commentary from Anne Brewster, an internist and instructor at Harvard Medical School.  “Physicians may agree with the end goal, but many of us worry about the methods and unintended consequences.  Comparative effectiveness research sounds sensible.  Of course we need more studies to define best practices.  But I find myself afraid that the results will be used by policy makers, hospital administrators, and lawyers to further limit my autonomy by setting hard and fast rules about what is “right”.  Clinical situations are always nuanced, never black and white.  Perhaps it is semantic, but I want to feel that CER will empower rather than constrain me.” 

Enacting, and implementing, health care policies that support patient-centered care and the science of personalized medicine won’t be easy; but it is absolutely essential.  Let’s work together to make it happen.

By Tony Coelho, Chairperson, Partnership for Improved Patient Care


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