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~ Musings on health, illness & evidence based medicine

@justOncology

Tag Archives: FutureMed

@IBMwatson and the Future of Oncology Care

10 Sunday Feb 2013

Posted by @JustOncology in Uncategorized

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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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Victims No More

27 Wednesday Jul 2011

Posted by @JustOncology in Uncategorized

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cancer, clinical trials, clinicaltrials, Daniel Kraft MD, digital media, Dr Just, elder wisdom, FutureMed, genomics, medicine, oncology, Pacific Oncology, research, San Diego, Singularity University, social media, twitter

It was 1967.  I was an intern in the UCLA-Wadsworth VA Rotating Internship Program when I reported for my physical as part of the Berry Plan deferment.  For the younger set, physicians and dentists could elect to delay military service until completion of their first year of residency training, and we could elect our branch of service we preferred to serve in.  I chose the Air Force.  On the History portion, I stated that I suffered with asthma since childhood.  Within short order, I was notified of disqualification by the Air Force, my Draft Board reclassified my status to IA, and I was drafted into the U.S. Army, losing my deferment!  I sought legal advice, pronto.

After one year of legal maneuvering, during which time an independent physician certified I should be disqualified from military service altogether, my attorney informed me that all appeals had been exhausted.  I had two options:  go in as a captain or be drafted as a private.  I elected the former.  His parting words were:  “At least you won’t go to Viet Nam.  Not with all the documentation”.  My orders read “Saigon”.  Modifying the Sinatra song:  “It Was” NOT “A Very Good Year”.

I resigned myself to serving my time in Viet Nam.  My wife and one year old daughter would live in Hawaii near her father during my tour.  But, my wife admonished me to try one more time to appeal what was obviously unfair.  So, before we left for Ft. Sam Houston, I humored her and called the Pentagon.  I explained the situation to a Major Baker who was new at his post.  He discovered that all of my records had been shredded!  I sent more copies of my documents to a panel of physicians for its review with no guarantee that their decision would change my orders.

On reporting to Ft. Sam, the entire new group was addressed by the commanding officer.  Sighting his rank (a bird colonel), we greeted him with the loudest groan I’ve ever heard.  But I’ll never forget his advice to us:  “Let’s face it, we gotcha.  You can be miserable all this time.  Or you can make the best of it”.  He went on to say that we would have one year (I had two) at a stateside base during which time we should avail ourselves of all the opportunities to do something other than practice medicine 24/7.  Two weeks later, I was called into the same bird colonel’s office and advised Major Baker had called.  I was not going to Viet Nam!  I’ve said a prayer for Major Baker every night since.  And I did everything reasonable to appeal the decision and then let it go.  No longer a victim.

My two years at the Rock island Arsenal were terrific.  One Sunday I was rounding at a local hospital when a general practitioner (that’s what the terminology was in those days) commented about the then recently enacted Medicare legislation:  “Mark my words.  This is the beginning of Socialized Medicine”.  From that point on, any proposal to organize our practices was met with suspicion.  We were victims of external pressures and resisted most changes to the status quo.

Over time, this attitude has shifted to a more proactive position, dealing with the situation at hand (i.e., making the best of it) and trusting in an outcome that can be managed.  I was impressed by an article entitled:  “Oncology patient-centered medical home and accountable cancer care” by John D. Sprandio, M.D. in the December 2010 issue of Community Oncology, Volume 7/Number 12, pp. 565-572.  This medical home model has been adapted to oncology from primary care as both are assuming more responsibilities for patient care and are under severe financial restraints.  For oncologists, the situation is complicated by “by the perverse methodology of paying physician practices for the drugs they administer after discounts from pharmaceutical companies-a model that has eroded over the past several years”.  A detailed description of the model is provided and successes to date listed, giving hope that we can deal with proposed healthcare reform in a positive manner.  Current and future challenges are discussed.  These include:

  1. Assessing and improving value in cancer care.
  2. Enhancing physician accountability.
  3. Standardizing and integrating clinical care.
  4. Encouraging payer collaboration.

The author concludes by stating:  “None of the other efforts that payers are considering provides a sustainable business model for community oncologists”.  It was refreshing to read a well thought out plan addressing present issues rather than the old whining and complaining of the past.  Rather than victims, we become survivors.

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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.

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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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