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Sure, cancer mutates, but it has other ways to resist treatment Print E-mail
Written by Fabian V. Filipp | The Conversation   
Tuesday, 10 April 2018 16:35

Because of advances in drug design and precision medicine, researchers have been able to target certain molecules within a cell at the root of a particular disease and to develop specific therapies to undo their damages. Today, precision targeting combines therapy decisions with molecular insights to offer hope after a life-changing cancer diagnosis.

But there's a dark side to cancer-killing drugs designed to match distinct cancer mutations like a key into a lock. Some cancers that initially respond to targeted chemotherapy become treatment-resistant - and the drug itself may not be the culprit.

New research helps explain how therapy-resistant cancers arise, findings with important implications for the future of cancer therapy. It shows how hidden, subtle layers of regulation - epigenetics - control the activity of genes to produce drug-resistant surviving cells.

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Last Updated on Thursday, 10 May 2018 09:36
Sink the Two Canoe Argument Print E-mail
Written by Gary Kaplan, MD & C. Craig Blackmore, MD | NEJM   
Thursday, 29 March 2018 00:00

Physicians have defended the status quo in healthcare based on the fear of straddling both fee-for-service and value-based payment models. Two executives at Virginia Mason Health Care System believe that strategy is no longer valid.

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Last Updated on Friday, 30 March 2018 16:33
How to incentivize higher quality and lower cost in U.S. medical care Print E-mail
Written by Samuel Falkson | KevinMD   
Thursday, 01 March 2018 00:00

U.S. health care costs are high - over $3 trillion annually and about 18 percent of our GDP. Estimates suggest that our costs are rising. Concomitantly, we are entering an era of extreme biomedical promise, where research breakthroughs are translating into unprecedented clinical benefit. Luxturna from Spark Therapeutics, for example, remarkably restores vision loss in patients with a specific eye disease. With amazing innovations, however, come high price tags. At $850,000 per treatment, Luxturna carries the highest price for any medication in U.S. history. The introduction of expensive miracle treatments raises questions about how to pay for such therapies. Our health care system is already financially burdened, yet it seems unfathomable to restrict a sick person's access to breakthrough cures for fiscal reasons. How do we create a health care system that keeps pace with technological innovations?

Last Updated on Friday, 02 March 2018 16:38
5 things America can do today to reduce gun deaths Print E-mail
Written by Megan L. Ranney, MD, MPH | KevinMD   
Tuesday, 20 February 2018 18:50

Our country has had yet another school shooting. Seventeen more kids are dead, despite multiple warnings that the perpetrator was high risk. No one wanted this to happen. Across the political spectrum, Americans are appropriately asking what they can do to prevent another shooting. Yesterday many asked for a day to mourn. They said, "tomorrow we take action." Today is tomorrow. My liberal friends are calling to "ban all guns." My conservative friends are calling to "arm all teachers." Neither of these proposals is viable, and neither is likely to be effective. There are, however, things that we can all do now to reduce gun deaths... 

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Last Updated on Tuesday, 20 February 2018 18:56
Health equity is the missing value in value-based payments Print E-mail
Written by Christopher J. Frank, MD, PhD | KevinMD   
Thursday, 15 February 2018 00:00

The way doctors and hospitals are paid is undergoing a quick and quiet revolution in an attempt to control costs and improve health outcomes. Federal payers are driving this change from fee-for-service payments to reimbursements based on quality outcomes and measurements of clinical processes. This focus on clinical outcomes does not account for the deep inequities that drive poor health outcomes in the United States. Without measuring and paying for improvements in health equity, attempts to achieve a high-value and lower-cost health care system through changes to our payment system may fail.

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Pay-for-performance: a dangerous health policy fad that won't die Print E-mail
Written by Kip Sullivan, Stephen Soumerai | STAT First Opinion   
Thursday, 01 February 2018 00:00

Pay-for-performance, the catchall term for policies that purport to pay doctors and hospitals based on quality and cost measures, has been taking a bashing. Last November, University of Pittsburgh and Harvard researchers published a major study in Annals of Internal Medicine showing that a Medicare pay-for-performance program did not improve quality or reduce cost and, to make matters worse, it actually penalized doctors for caring for the poorest and sickest patients because their "quality scores" suffered. In December, Ankur Gupta and colleagues reported that a Medicare program that rewards and punishes hospitals based on arbitrary limits on the number of hospital admissions of heart failure patients may have increased death rates. On New Year's Day, the New York Times reported that penalties for "inappropriate care" concocted by Veterans Affairs induced an Oregon hospital to deny acute medical care to its sickest patients, including an 81-year-old "malnourished and dehydrated" vet with skin ulcers and broken ribs.

What do you say to somebody who knows that they are about to die? Print E-mail
Written by Nathaniel Fleming, KevinMD   
Wednesday, 17 January 2018 08:47
I've had lots of practice comforting people. I've had to tell patients that their cancer is back in a busy emergency department. I've updated family members of patients who are being kept alive by machines in the intensive care unit. I've walked alongside patients as they get rolled into an operating room, and crouched down by a patient's bed as they writhe in pain. There have been moments of fear, grief, sadness, and agony. Although the context is always unique, the messages are inevitably similar: I'm sorry that this is happening. We're going to do everything we can to make this better.

Last Updated on Wednesday, 17 January 2018 08:51
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