A. James Moser, M.D.Co- Director, BIDMC Pancreas and Liver Institute

Beth Israel Deaconess Medical CenterAssociate Professor of Surgery

Harvard Medical School

Three Aces In the Hole

• U.S. Mortality Statistics– #1: Heart Disease– #2: Cancer: Moser– #12: Chronic liver disease: Robson

A cure for hepatitis C!• #1: Inpatient GI diagnosis

• Pancreatitis: Freedman• >240,000 patients annually• $2.8 billion

The DDNC Mission: Three AcesMission: “to improve access to and

the quality of life of digestive health care…”

Facts About Pancreatic Cancer

• Fourth leading cause of cancer death in 2014– 46,420 Americans annually

• Disproportionate incidence among African-Americans

– The “silent killer”: symptoms occur too late• No early diagnostic tests

– No meaningful progress

http://www.lshtm.ac.uk/eph/ncde/cancersurvival/http://www.lshtm.ac.uk/eph/ncde/cancersurvival/

No Time to Be Complacent

• Rising incidence• Disproportionate

impact on African-Americans

• Surpassing breast and colon cancer by 2020

Crossroads of Triumph and Tragedy

46,420 Americans beg you to succeed this year

Werner von Braun

John von NeumannSally RideJack KempLuciano PavarottiJack BennyCount BasieWilliam SaffireJoan CrawfordRex HarrisonDonna Reed

Geniuses lost to pancreatic cancer

Perceived Value of Current Treatment:

Panic!

Steve Jobs unveiling iPhone on

June 9, 2008Lost shareholder value=

$15.95B in 3 days=132X Annual Funding!

June 9!

Brief history oftoo little, too late

• 5- FU; 1974• Gemcitabine; 1996 (+ 1 mo)• Erlotinib; 2005 (+13 days)• Nab-paclitaxel; 2013 (+2.8 mo.)

“Surgery is the only potential cure

for pancreatic cancer.”see footnote

Footnote: Except for all patients with metastases and those in whom resection cannot be done or results in a margin of less than one millimeter.

Bilimoria K, National Failure to Operate on Early Stage Pancreatic Cancer, Ann Surg 2007 Aug

Current Perception:Majority Vote with Their Feet

!“Surgery is something you do, not something you have.” Anonymous

“Human beings, left to their own devices, will usually

find solutions to problems, but only if they are allowed to.”

Stephen Davies

We Must Stop Progress!?

“The Kaiser Family Foundation study concluded that the only measures that are likely to control health care inflation over the long term are either the delay or prevention of new medical technology.”

Press release Feb 2010

“Health Care Investment: The Hidden Crisis”

• Milken WSJ Feb 8, 2011• Murphy and Topol, University of Chicago, 2006

– Improvements in health care added $3.2T per year to US GDP since 1970

• 1% reduction in cancer death: $500B per year

Economic Threats to Progress

X=Recent casualties of “reform” and increased US taxation

X

XX

Technology is Not the Problem…Monopoly and Regulation Are

• Dr. Jeff Flier, Wall Street Journal, Nov. 19, 2009• Regulated marketplace

– Absence of price transparency– Cost overruns

• Price controls and rationing– SGR “formulas,”– Access “issues”– Workforce “targets”

• Looming threats– Elective healthcare may soon follow the rest of US

industry offshore

“We would accomplish many more things if we did not think of them

as impossible.” Vince Lombardi