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2012 Summer Medical Editors Meeting: Otis W. Brawley, MD, FACP (Keynote Speaker)
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Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer American Cancer Society
Professor of Hematology, Medical Oncology, Medicine and Epidemiology
Emory University
The American Cancer Society
We are dedicated to helping People: • Get Well • Stay Well • Find Cures • Fight Back
Prostate Cancer and Chemopreven@on • Pretend you are a 55 year old male and a preven@ve pill exists: – If you take the pill it will definitely double your risk of prostate cancer diagnosis from 10% life@me to 20% life@me.
– It you take it, it may decrease your life@me risk of prostate cancer death by 20% from 3% to 2.4%
• Would you take this pill?
Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer American Cancer Society
Professor of Hematology, Medical Oncology, Medicine and Epidemiology
Emory University
U.S. Health Care Spending
In 2009, the U.S. spent
$2.53 TRILLION on Health Care
U.S. Health Care Spending
• How Big is a Trillion? 1 million seconds Last week
1 billion seconds Richard Nixon’s Resigna@on
1 trillion seconds 30,000 BCE
Spending in Context
2009
* Excludes alcoholic beverages ($150 billion) and tobacco products ($92 billion) Source: Bureau of Economic Analysis; National Bureau of Statistics of China, MGI analysis
17.30%
$2.53 trillion
$1.1 trillion
$1.4 trillion
Gross Domestic Product
American Healthcare
• 16.2% of GDP in 2008 • 17.3% of GDP in 2009 • 19.3% of GDP by 2019 (projected) • 25% of GDP by 2025 (projected)
Higher Per Capita Spending in the U.S. does not Translate into Longer Life Expectancy The Cost of a Long Life
Life Expectancy – Per Capita Spending
2006 CIA FACTBOOK
Ave
rage
Life
Exp
ecta
ncy
(yea
rs)
Per C
apita
Spe
ndin
g in
USD
74
75
76
77
78
79
80
81
82
Japa
n
San M
arino
Monac
o
Switzerl
and
Austra
lia
Sweden
Icelan
d
Andorr
a
Canad
aFran
ce Italy
Austria
Spain
Norway
Singap
ore Israe
l
Luxe
mbourg
New Zea
land
Netherl
ands
German
y
Greece
Malta
Belgium
Finlan
d
United
Kingdo
m
Denmark
United
States
Cuba
Cyprus
Irelan
d
Portug
al0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
United States
Healthcare in Three Countries (2009)
• Canada Switzerland U.S. • Infant Mortality 5.04 4.53 6.22 per 1000 live births • White Male Life Exp 78.0 79.7 76.8 Years • Per Capita Costs 3173 4011 6096 US Dollars • ProporXon of GDP 9.6% 11.2% 17.3%
Beyond Healthcare Reform
• Medicare, Medicaid, and Social Security account for all of the projected increase in Federal spending over the next 40 years.
• For the past 30 years, costs per person throughout the health care system have been growing approximately two percentage points faster per year than per-‐capita GDP.
• Most projec@ons assume this paaern will con@nue through 2050. Over @me, the fiscal consequences of this rate of growth in health costs are massive.
In order to advance medical care
– We must objec@vely define the per@nent scien@fic ques@ons that need to be addressed
– We define the per@nent ques@ons by assessing the epidemiology and clinical outcomes
Toward an Efficient Healthcare System
• Some consume too much – (Unnecessary care given)
• Some consume too liale – (Necessary care not given)
• We could decrease the waste and improve overall health!!!!
The American Healthcare System
• Overconsump@on of Healthcare
• The Greedy Feeding the Gluaonous
• A Subtle form of Corrup@on
Overuse of Medicine • Screening (irrational use)
– Lung Cancer – Prostate Cancer – Breast – Cervix
• Imaging (CT and MRI)
• Expensive Drugs (e.g. Nexium vs Omeprazole)
True Healthcare Reform (An Efficient, Value Driven Health System)
• Ra@onal use of healthcare is necessary for the future of the U.S. economy (an issue of U.S. security)
• It is possible to decrease costs and improve healthcare by using science to guide our policies
True Healthcare Reform Requires:
• The use of “Evidence Based Care and Preven@on”
That is: § the ra@onal use of medicine § not the ra@oning of medicine
• We do what we know works, and ogen do not do! • We stop doing what we know does not work and ogen do!
Cancer Care
• An issue that must be approached ethically, logically and ra@onally
• We must realize: – What we know. – What we do not know. – What we believe.
“It is difficult to get a man to understand something, when his salary depends on his not understanding it”
Upton Sinclair
Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer American Cancer Society
Professor of Hematology, Medical Oncology, Medicine and Epidemiology
Emory University
Rudolph Ludwig Karl Virchow
1821- 1902
Virchow’s Accomplishment
• One of the first cellular pathologists • Virchow’s node • Defined condi@ons that cause thrombosis • Defined cancer as a disease involving uncontrolled
cell growth • The ini@al descrip@on of leukemia • Defined cancer using a light microscope on
specimens obtained on autopsy
Virchow’s Accomplishments
The defini@on of cancer used in 2010 is largely that of Virchow with minor modifica@ons
More than 160 years later, we s@ll use his
defini@ons using a light microscope. There is clear evidence that some early detected
cancers do not pose a threat and do not need to be treated.
The future of Cancer Medicine is Genomic
Prostate Cancer and Chemopreven@on • Pretend you are a 55 year old male and a preven@ve pill exists: – If you take the pill it will definitely double your risk of prostate cancer diagnosis from 10% life@me to 20% life@me.
– It you take it, it may decrease your life@me risk of prostate cancer death by 20% from 3% to 2.4%
• Would you take this pill?
Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer American Cancer Society
Professor of Hematology, Medical Oncology, Medicine and Epidemiology
Emory University