keynote presentation: otis w. brawley, md, facp
DESCRIPTION
2012 Summer Medical Editors Meeting: Otis W. Brawley, MD, FACP (Keynote Speaker)TRANSCRIPT
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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
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The American Cancer Society
We are dedicated to helping People: • Get Well • Stay Well • Find Cures • Fight Back
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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?
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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
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U.S. Health Care Spending
In 2009, the U.S. spent
$2.53 TRILLION on Health Care
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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
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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
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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)
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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
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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%
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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.
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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
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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!!!!
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The American Healthcare System
• Overconsump@on of Healthcare
• The Greedy Feeding the Gluaonous
• A Subtle form of Corrup@on
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Overuse of Medicine • Screening (irrational use)
– Lung Cancer – Prostate Cancer – Breast – Cervix
• Imaging (CT and MRI)
• Expensive Drugs (e.g. Nexium vs Omeprazole)
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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
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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!
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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.
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“It is difficult to get a man to understand something, when his salary depends on his not understanding it”
Upton Sinclair
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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
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Rudolph Ludwig Karl Virchow
1821- 1902
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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
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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.
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The future of Cancer Medicine is Genomic
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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?
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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