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@justOncology

~ Musings on health, illness & evidence based medicine

@justOncology

Tag Archives: cancer

In Absentia

02 Tuesday Sep 2014

Posted by @JustOncology in health, health innovation, oncology

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Tags

cancer, digital media, integrated medicine, integrative oncology, Just Oncology, oncology, richard just md, social media

By Gregg A. Masters, MPH

When I first approached Dr. Just on his potential interest in the emergence of social media in healthcare in general and medicine in particular, we engaged in conversations that generally tethered to a contribution to a ‘legacy’ theme.Richard Just MD

Reflecting on a now 40 year career in community based medical oncology he was thinking about winding down his participation in a full time practice while passing on the deep wisdom and insights developed over the decades.

Considering the explosion of digital media platforms and capabilities, and the low hurdle rate to participate via this medium this consideration was rather timely.

The first order of business was to brand that voice and craft a social media ‘presence’.

As I reflected on his last name ‘Just’, and saw a double entendre opportunity to conflate ‘just’ with ‘oncology’ – I thought how perfect! Lets brand you as ‘JustOncology.com’. Since in this context ‘just‘ could mean ‘Dr Just’, or solely focused on oncology, or even just in the sense of ‘equity’ or fairness in oncology care. In all cases, the branding expression and focus was clean and consistent with his interest to write, speak and counsel others on the journey.This Week in Oncology

So we created the blog JustOncology and twitter handle @JustOncology (though he principally tweets via @chemosabe1) and shortly thereafter launched the radio show ‘this week in oncology’.

As noted in the masthead above Dr. Just writings would reflect on ‘health, illness & evidence based medicine’. An intentionally broad brush tapestry that included everything from his personal health encounter with heart surgery, the move into value based pricing for oncology services, oncology ACOs, seemingly interminable encounters with EHRs that actually work for the practice, practice mergers, partner relations and the most recent shift into ‘integrative oncology’ which has literally taken him offline for almost a year – at least as a principal contributor to this blog.tumor board

So as his partner, de-facto editor and co-contributor, let this post call attention to two projects that fit squarely into the ‘legacy’ theme and Dr. Just’s valuation of and advocacy for truly ‘patient centered care’.

CANCERCENTER TV

Meet @TumorBoard aka TumorBoard (dot) com and CancerCenter (dot) TV – both projects in the incubator of ideas in search of funding support.

A little history on @TumorBoard includes the following introduction from our concept paper.

Context

A centerpiece of the American College of Surgeons’ Commission on Cancer (COC) standards to accredit hospital based cancer programs is a multidisciplinary conference (aka ‘tumor board’) of doctors and other cancer specialists, who meet on a regular basis to collaborate in the diagnosis and recommend treatment options for cancer patients. An active and vibrant tumor board is an essential consideration in the accreditation process. For further context see the Commission on Cancer’s ‘Cancer Program Standards 2012, Version 1.1: Ensuring Patient-Centered Care.’

As defined by the National Cancer Institute (NCI), a ‘tumor board’ is:

A treatment planning approach in which a number of doctors who are experts in different specialties (disciplines) review and discuss the medical condition and treatment options of a patient. In cancer treatment, a tumor board review may include that of a medical oncologist (who provides cancer treatment with drugs), a surgical oncologist (who provides cancer treatment with surgery), and a radiation oncologist (who provides cancer treatment with radiation). Also called multidisciplinary opinion.

Once a popular collegial if not ‘social’ venue to network and learn from one’s peers, periodically present or consult on cases, possibly earn CME credit, if not grab an occasional meal, tumor board has unfortunately lost some of its attraction and ‘gravitas’.

Increased practice complexity, misaligned financial incentives, declining reimbursement and growing demands on physician time, are some of the obstacles resulting in declining physician participation in traditional hospital based tumor boards. Yet few other comparable multidisciplinary, peer based clinical forums outside of mature integrated delivery systems or academic medical centers have the potential to enable the integrated practice of collaborative, coordinated and evidence based community cancer care.

Realizing the Promise of Multidisciplinary Cancer Care

Many assume multidisciplinary care is better care, since it engages multiple minds in the care process, yet in ‘The Need for Assessment and Reassessment of the Hospital Cancer Conference‘, in the Annals of Surgical Oncology, October 2009, Frederick L. Greene, MD, identifies the traditional weakness of many hospital based tumor boards:

most of these [tumor board] conferences…are based on a “show and tell” mentality rather than serving as treatment-planning conferences utilizing the expertise of the participating multidisciplinary experts….

In other words, traditional hospital based tumor boards have not yet fulfilled the promise of better care or improved outcomes as a result of the assumed value add of multidisciplinary engagement in cancer diagnosis and treatment. Apparently, business as usual ‘silo-ed’ medicine remains embedded in the care process even in the midst of what appears to be multidisciplinary consideration.

Why @TumorBoard?

@TumorBoard intends to uniquely address the convergence of several macro trends:

  • The high cost of cancer treatment and parallel shift of a greater share of the total cost burden on to a resource constrained and often health literacy challenged patient.
  • A heightened awareness of the need for increased clinical integration and care coordination across an otherwise silo-ed and discontinuous portfolio of specialties.
  • Formal recognition that the upside of the multi-disciplinary engagement of cancer specialists (i.e., tumor board), has neither realized nor fulfilled its collaborative promise (see: Tumor Boards (Team Huddles) Aren’t Enough to Reach the Goal).
  • Emergence of an informed and engaged ‘e-patient’ (witness the launch of SmartPatients).
  • A nascent yet growing pool of technology savvy, patient-centric cancer specialists who value peer based collaborative multidisciplinary care with active engagement of the patients under their care (See e-patients and the Society for Participatory Medicine).

For more information, download the TumorBoard concept paper via tumorboard_description_v1.5.

 

 

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Big Data, Government and Cancer Research: A Benefit for Patients?

23 Tuesday Jul 2013

Posted by @JustOncology in health, oncology, research

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big data, cancer, clinicaltrials, dan munro, evidence based medicine, genomics, innovation, medicine, oncology, social media

By Gregg A. Masters, MPH

On the Wednesday, July 24th, 2013 broadcast of This Week in Oncology at 2PM Pacific/5PM Eastern our special guest is entrepreneur, social media thought leader and Forbes Contributor Dan Munro aka @danmunro.This Week in Oncology

Dan recently penned a piece for Forbes titled: ‘Big Government Opens Big Database For Cancer Research‘

This catchy headline caught my attention since part of our mission at This Week In Oncology is to eliminate the esoterica from ‘oncology-speak’ and to present the significance of the discoveries, trends and developments in the cancer care and dignostics in plain english for more general consumption.

Much progress has been realized in medica oncology of late with a fair amount of the promisesd upside of ‘personalized [or individualized] medicine’ often pointing to better outcomes via more targeted treatment of specific tumors based on their unique genetic signature.

So called ‘big data’ is in the news as ubiquitous technology, connectivity, the declining costs of massive data dragnets and disease specific mashups affords insights previously inaccessible to reseachers, clinicians and others interested in the diagnosis and/or treatment of oncology.

We’ll get Dan’s takes on his piece and see how he sees the confluence of these trends coming together for the benefits of patients.

To listen live or via archived replay, click here.

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The Advent of Cancer Immunotherapy: Addressing Unmet Needs Part 1

03 Wednesday Jul 2013

Posted by @JustOncology in health, immunotherapy, oncology

≈ 3 Comments

Tags

cancer, evidence based medicine, health, immunotherapy, innovation, integrative oncology, managed care, medical education, wellness

By Gregg A. Masters, MPH

The following is provided via the video series at the American Journal of Managed Care on ‘The Advent of Cancer Immunotherapy’, part 1 of a 3 part series:

 

In a discussion moderated by Dr. Peter Salgo, Drs. Jeffrey Weber, Michael Kolodziej, and Daniel J. George share their insights and perspectives on the rise of cancer immunotherapy, and its significance during a time in which cancer is recognized as the “new global pandemic” that has killed more than 600,000 US persons in 2012 alone.

 

For original source link, click here.

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Crowds Care for Cancer Challenge: Supporting Survivors the Finalists

25 Tuesday Jun 2013

Posted by @JustOncology in health, health innovation, healthIT, oncology, patient empowerment

≈ Leave a comment

Tags

accountable care, cancer, coordinated care, crowds care for cancer, digital media, health, innovation, integrative oncology, medicine, survivorship

By Gregg A. Masters, MPH

Last month in a continuing commitment to advance the art and science of patient engagement in health the Office of the National Coordinator for Health Information Technology (ONC) teamed up with the National Cancer Institute (NCI) partnering with Health 2.0 Challenge and the Medstartr crowd funding platforms to field an innovative challenge on creating applications for the estimated 14 million cancer survivors in the United States.

Journey Forward: My Care Plan

For complete program details on the the ‘Crowds Care for Cancer: Supporting Survivors‘ challenge click here, and for the finalists now in the crowd funding optimization stage see the Medstartr finalists feature page here.

On This Week in Oncology, we chat with each of the three finalists in the competition, beginning with Journey Forward: My Care Plan, a project by Tiffany Devitt.

On Thursday, June 27th, 2013 at 1:30PM Pacific/4:30PM Eastern to join us live (or for an archived replay) with Patti Ganz, MD of the Journey Forward: My Care Plan team, click here.

PatientsWithPowerTogether AppBoth remaining Crowds Care for Cancer: Supporting Survivors Challenge finalists are scheduled as follows:

PatientWithPower: A project by PatientsWithPower | 11AM Pacific/2PM Eastern Friday, June 28th, 2013. For live or archived replay, click here.

Together: A project by Michelle Longmire | 11AM Pacific/2PM Eastern Tuesday, July 2nd 2013. For live or archived replay, click here. 

Please review each of the candidates in this important challenge and show your support accordingly. The leader board to date is as follows: PatientsWithPower, Journey Forward: My Care Plan followed by Together.

 

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‘You Don’t Know Jack’ by Morgan Spurlock

20 Wednesday Feb 2013

Posted by @JustOncology in Uncategorized

≈ 2 Comments

Tags

cancer, clinical trials, digital media, evidence based medicine, health, innovation, Intel Science Fair, jack andraka, oncology, participatory medicine

By Gregg A. Masters, MPH

But you should! Get to know him here:

Earlier today we just finished chatting with Jack Andraka on This Week In Oncology. One of my favorite lines from the conversation is quoted below, Jack refers to the high school biology class as the:

absolute stifler of innovation

From which he none-the-less associates inspiration for his scientific inquiry. Suffice it to say, Jack was neither encouraged nor challenged by the curriculum, and found other ways to engage his mind and curiousity.

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@IBMwatson and the Future of Oncology Care

10 Sunday Feb 2013

Posted by @JustOncology in Uncategorized

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Tags

cancer, digital health, FutureMed, genomics, health, IBM Watson, Marty Kohn MD, oncology, wellness

By Gregg A. Masters, MPH

Another of the highlights of FutureMed 2013 was the track on ‘the future of oncology’. In addition to the promise of favorably impacting both the early diagnosis and thus treatment outcomes for pancreatic cancer via the discovery of Jack Andraka, Ronald Levy, MD of Stanford wove a beautiful narrative of hope and promise that might best be represented by the following quote:

My dream is to get rid of chemotherapy and do it with the immune system..

Dr. Levy’s concluding slide outlined the visioned future for oncology:

The Future of Oncology Care

Meanwhile one could not be but immensely inspired by the clinical decision support and powerful AI platform demonstration detailed by Marty Cohn, MD. Witness ‘IBM Watson Demo: Oncology Diagnosis and Treatment’ developed in conjunction with Memorial Sloan-Kettering Cancer Center:

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A Conversation with Jeff Hall, PhD, Vice President of GenOptix

23 Wednesday Jan 2013

Posted by @JustOncology in Uncategorized

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Tags

biomarkers, cancer, genomics, GenOptix, medicine, novartis, oncology, pharma, social media

By Gregg A. Masters, MPH

This Week in Oncology on the BlogTalk Radio Network | @justOncology

On Wednesday’s broadcast of This Week in Oncology our guest Dr. Jeff Hall makes his second appearance on the show. The topic was ‘Biomarkers: their emerging clinical significance in the diagnosis and treatment of cancer’.

Dr. Hall has over 20 years of experience in the life sciences industry, and is currently the Vice President of Clinical Education at GenOptix. He holds a BA in Biology and Chemistry from UC Santa Cruz and a PhD in Biochemistry from UC Berkeley. Dr Hall was the first author on the landmark 1990 Science paper describing the location of BRCA I on chromosome 17q.

GenOptix is division of Novartis. For broader context see webcast by Novartis CEO Joseph Jimenez to the JP Morgan Healthcare conference, and for the deck click here.

To listen to archived replay of broadcast, click here.

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Is It Safe?

04 Friday Jan 2013

Posted by @JustOncology in Uncategorized

≈ 1 Comment

Tags

cancer, digital media, ehr, emr, innovation, internet security, mat honan, oncology, social media

By Richard Just, MD

Richard Just, MDWhen I read William Goldman’s book “The Marathon Man” years ago, I recall the evil Nazi dentist with drill in hand (played by Sir Laurence Olivier in the subsequent movie) hovering over the un-anesthetized Dustin Hoffman strapped to a chair asking the question: “Is it safe?” Of course, Hoffman didn’t know. So when Olivier turned on the drill and Hoffman started screaming, everyone in the theater identified with his pain. I still get chills when thinking about it.

In previous blog post here, I’ve described the pain I experienced when we transitioned from paper charts to electronic medical records. Certainly not as intense as having dental work without anesthesia, but agony just the same. Well guess what! Now we’re transitioning to a new EMR. In many ways, our pain level has increased from 6/10 to 9/10.

I interviewed Casey Quinlan, of Might Casey Media, a very astute commentator on healthcare in general and cancer care specifically, on This Week in Oncology last Wednesday. The “Mighty Casey” made several cogent observations on EMR’s, but, we  really didn’t address the question of security. In the December 15-16, 2012 issue of the Wall Street Journal, Ellen E. Schultz  wrote an article entitled: “How Safe Are Your Medical Records?” Two pieces of legislation are cited:

The first is the Health Insurance Portability and Accountability Act (HIPAA) which “allows health-care providers to disclose medical records without a patient’s consent when the information used is for treatment, payment and ‘health-care operations.’ Providers are supposed to exchange only relevant information, but they commonly transfer a patient’s entire file, which is easier than separating the pertinent records.” In the same manner, protection can be lost for psychotherapy records if they are co mingled with other medical records.

Second is the American Recovery and Reinvestment Act of 2009 which “prohibits the unauthorized sale of medical records, requires that data be encrypted and mandates that individuals be notified of security breaches. It is too soon to say how effective these rules will be.”

Drilling down to the core problem is Mat Honan’s original article “How Apple and Amazon Security Flaws Led to My Epic Hacking” and follow-up video entitled “Mat Honan Hacked and Digitally Destroyed” he describes an “epic hack” that destroyed his entire digital life in 1 hour. Having been the victim of a phishing expedition, a minor nuisance compared to his experience, I know how it feels to have your identity stolen.  After researching how and why hacking has become more problematical, Honan concludes: “The age of the password has come to an end; we just haven’t realized it yet. And no one has figured out what will take its place.” He continues: “The ultimate problem with the password is that it’s a single point of failure, open to many avenues of attack. Two factors should be a bare minimum.” This creates the dilemma that if the password is too simple and obvious, it’s a no-brainer to crack; if it’s too complex and obscure, the password is hard to remember. And, we are advised never to write passwords down. Why am I not surprised that the most common password used is, in fact, “password”, and second is “123456”?

Honan provides a helpful Dos and Don’ts list to survive the “password apocalypse”:

“DON’T:

  1. REUSE PASSWORDS. If you do, a hacker who gets just one of your accounts will own them all.
  2. USE A DICTIONARY WORD AS YOUR PASSWORD. If you must, then string several together into a pass phrase.
  3. USE STANDARD NUMBER SUBSTITUTIONS. Think P455wOrd is a good password? NOp3! Cracking tools now have those built in.
  4. USE A SHORT PASSWORD-no matter how weird. Today’s processing speeds mean that even passwords like “h6!r$q” are quickly crackable. Your best defense is the longest possible password.

DO:

  1. ENABLE TWO-FACTOR AUTHENTICATION WHEN OFFERED. When you log in from a strange location, a system like this will send you a text message with a code to confirm. Yes, that can be cracked, but it’s better than nothing.
  2. GIVE BOGUS ANSWERS TO SECURITY QUESTIONS. Think of them as a secondary password. Just keep your answers memorable. My first car? Why, it was a “Camper Van Beethoven Freaking Rules.”
  3. SCRUB YOUR ONLINE PRESENCE: One of the easiest ways to hack into an account is through your e-mail and billing address information. Sites like Spokeo and WhitePages.com offer opt-out mechanisms to get your information removed from their databases.
  4. USE A UNIQUE, SECURE EMAIL ADDRESS FOR PASSWORD RECOVERIES. If a hacker knows where your password reset goes, that’s a line of attack. So create a special account you never use for communications. And make sure to choose a username that isn’t tied to your name-like m****n@wired.com so it can’t be easily guessed.”

So, the answer to the question: “Is it safe?” is an emphatic NO. Honan concludes that online identity verification will not be a password-based system in the future, any more than our system of personal identification will be based on photo-ID’s. But, passwords may still be involved as just one part of a multifaceted process.

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Clinical Cancer Advances 2012 via @ASCO

04 Tuesday Dec 2012

Posted by @JustOncology in Uncategorized

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cancer, evidence based medicine, innovation, medical education, oncology, participatory medicine, physician, social media, twitter

Now in its eighth year, Clinical Cancer Advances 2012 was developed under the guidance of an 21-person editorial board of leading oncologists, overseen by Executive Editors Nicholas J. Vogelzang, MD and Bruce J. Roth, MD.
Each year, the American Society of Clinical Oncology conducts an independent review of advances in clinical cancer research that have the greatest potential impact on patients’ lives.

This year’s report, Clinical Cancer Advances 2012: ASCO’s Annual Report on Progress Against Cancer, features 87 studies, 17 of which were designated as “major” advances by the report’s 21-person editorial board.

The large number of advances featured in this year’s Report affirms the remarkable payoff of national investments in clinical research on cancer prevention, screening, treatment and quality of life for patients with cancer.

For complete report, click here.

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The ‘Oncology ACO’: Does it Have a Future?

26 Monday Nov 2012

Posted by @JustOncology in Uncategorized

≈ 4 Comments

Tags

accountable care, aco, affordable care act, cancer, FloridaBlue, health reform, innovation, obamacare, oncology ACO, US Oncology

By Gregg A. Masters, MPH

The best business model for oncology care is not yet obvious to me. But it is crystal clear that innovative new models are being hatched before our eyes.. via Oncology Times

Since CMS (via HHS) issued the final rule addressing ACO provisions and specifically ‘excluded’ oncologists from participating as ACO organizers, instead relegating their involvement in at least via the Medicare Shared Savings Program to ‘participants’, there has been rumbling underneath the surface of ‘ACO-dom’.

Perhaps as best evidenced by the April announcement of a tripartite venture between FlordiaBlue, Advanced Medical Specialties (a former US Oncology Affiliate now part of the McKesson fold), and Baptist Health System, the competitive positioning in the oncology market is not sitting idly by as other medical specialties, including primary care, carve out their niche and actively experiment with their version and local vision for accountable care aka ‘the triple aim.’

In the broader conversation on ACOs or their derivatives including medical homes or accountable care collaborations, etc, there has been much discussion from very smart and accomplished wonks including periodic banter, i.e., Goldsmith v. De Marco] as to the significance and forward [reasonably expected] benefits from duly organized [or in the latter case – arranged] ACOs. Bottom-line,  there is a fair amount of credible disagreement over whether these entities as variably configured actually make a difference?

Meanwhile, in the oncology domain, much of the action seems relegated to a few forward thinking players who have taken the initiative regardless of CMS’ decision to limit their participation (at least to this point in time) to contracted participant suppliers of specialty services.

For a deeper dive into the question: ‘Who Is Taking the Lead in Incorporating Oncology into ACO Thinking?’ see: The Rapidly Evolving ACO World, we have the following observation and summary data:

There are several examples of organizations that have stepped up and have taken the lead in exploring payment re-design in oncology, some within an ACO shared savings context and some outside the ACO context.

The vanguard includes:

  • Consultants in Medical Oncology & Hematology. Oncology Patient Centered Medical Home®, Drexel Hill, PA
  • United Healthcare (5 episode payment pilot sites)
  • Texas Oncology/Innovent Oncology and Aetna
  • Oncology Physician Resource (OPR) and Michigan Blue Cross
  • Wilshire Oncology and Wellpoint, Southern California
  • CareFirst Blue Cross pathways and medical home initiative, Maryland
  • Priority Health oncology medical home initiative, Michigan
  • Florida Blue, Baptist Health South Florida and Advanced Medical Specialties Oncology ACO, Miami
  • Harvard Pilgrim Health Plan with oncology medical home demonstration pilot, Massachusetts;
  • Innovative Oncology Business Solutions with CMMI Innovation Challenge grant to demonstrate value proposition of community oncology medical home (COME HOME) at 7 community oncology practices nationwide.

And certainly there will be more organizations joining the vanguard in the near future.

We are working on getting Ronald Barkley, CCBD Group, and Linda Bosserman, MD, President and CEO of Wilshire Oncology respectively to share their thoughts on ‘This Week in Oncology’. We’ll keep you posted when we’re able to lock them down.

Meanwhile, with the elections now behind us, the future is rather clear at least for those who want to manifest the spirit and intent of the Affordable Care Act, so ‘warp drive Mr. Zulu’ as the ACO movement shifts into overdrive.

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← Older posts

The ‘incident’

My life was essentially on autopilot. My oncology practice was very successful; in fact, too successful. All my time and energy was devoted to keeping pace with the increasing demands of the profession. Other pursuits, be they personal or professional, always seemed to take a back seat. My main unfulfilled passion was writing.

On January 7, 2011, everything changed. I had a new bovine aortic valve and three new coronary artery grafts. A life altering event, to say the least. Fortunately my recovery has been uneventful, and I had no evidence of muscle injury. So I’m extremely grateful for the pre-emptive surgery, and since I’m back to work on a part time basis, I now can devote some of my attention to writing.

For the past several years, a colleague, trusted advisor and friend of mine, Gregg Masters, had been prodding me to “just do it”, i.e., just start blogging, podcasting and life streaming my experiences in Medicine. He pointed out the value of my 36 years in clinical practice of hematology and medical oncology as 'elder wisdom' currency in relative short supply. In truth, there is certainly a lot to write about as the clinical knowledge base has grown enormously, to the point where management of all this information requires computers. Fortunately, technology has developed at a rapid rate also so that we can not only mine all this data to obtain meaningful information, but better disseminate it to each other, health plans (including government) and especially our patients. With the advent of social media including Twitter, Facebook and You Tube, this flow of information becomes a two way street allowing physicians to listen as well as talk. On a personal note, my wife published daily status updates during my surgery and through the post-operative period on a website called Caringbridge. She posted pictures as well as narrative. Colleagues, relatives, friends and patients had a window opened to them as to how I was doing, and they in turn wrote back notes of encouragement that touched me deeply.

When Gregg and I thought about it, his background not only in 'web 2.0' (social media) but perhaps more significantly his considerable experience in the business aspects of medicine brings value into the conversation as well. In today’s environment, physicians are constantly reminded that we not only are responsible for all aspects of caring for patients, but we are running a business as well. Years ago, I remember reading an excellent book called “The E-Myth Physician” by Michael Gerber. One of the chapters was devoted to the subject of “Money”. So Gregg’s knowledge complements my clinical background resulting in the birth of JustOncology.com.

Certainly there is no shortage of topics to discuss. Utilizing a variety of media: blogging (which addresses my passion for writing), audio and visual interviews with as many of the stakeholders in cancer care as possible, we hope to provide a forum for discussion of problems facing us. From these interactions, the desired outcome is to identify solutions that can only come from a collaborative effort.

Recent Posts

  • In Absentia
  • What Is Cancer?
  • Big Data, Government and Cancer Research: A Benefit for Patients?
  • The Advent of Cancer Immunotherapy: Addressing Unmet Needs Part 1
  • Crowds Care for Cancer Challenge: Supporting Survivors the Finalists
  • Tumor Board: Is There Value in Multidisciplinary Case Consideration?
  • ‘You Don’t Know Jack’ by Morgan Spurlock
  • @IBMwatson and the Future of Oncology Care

About

JustOncology.com is a joint publication of Richard Just, MD, aka @chemosabe1 on Twitter and Gregg Masters, MPH, aka @2healthguru on Twitter.

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