Otis W. Brawley, MD, FACP    Chief Medical and Scientific Officer          American Cancer SocietyProfessor of Hematology,...
The	  American	  Cancer	  Society	   We	  are	  dedicated	  to	  helping	  People:	   • 	   Get	  Well	   • 	   Stay	  Wel...
Prostate	  Cancer	  and	  Chemopreven@on	  	  •  Pretend	  you	  are	  a	  55	  year	  old	  male	  and	  a	     preven@ve...
Otis W. Brawley, MD, FACP    Chief Medical and Scientific Officer          American Cancer SocietyProfessor of Hematology,...
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	  we...
Spending	  in	  Context	       2009                                                        $2.53 trillion                 ...
American	  Healthcare	  •    16.2%	  of	  GDP	  in	  2008	  •    17.3%	  of	  GDP	  in	  2009	  •    19.3%	  of	  GDP	  by...
Average Life Expectancy (years)                                                                     S       J             ...
Healthcare	  in	  Three	  Countries	  (2009)                                                          	                   ...
Beyond	  Healthcare	  Reform	  •  Medicare,	  Medicaid,	  and	  Social	  Security	  account	     for	  all	  of	  the	  pr...
In	  order	  to	  advance	  medical	  care	  	         –  We	  must	  objec@vely	  define	  the	            per@nent	  scie...
Toward	  an	  Efficient	  Healthcare	  System	   •  Some	  consume	  too	  much	  	       – (Unnecessary	  care	  given)	   ...
The	  American	  Healthcare	  System	  	  •  Overconsump@on	  of	  Healthcare	  •  The	  Greedy	  Feeding	  the	  Gluaonou...
Overuse of Medicine•  Screening (irrational use)   –  Lung Cancer   –  Prostate Cancer   –  Breast   –  Cervix•  Imaging (...
True	  Healthcare	  Reform    	     (An	  Efficient,	  Value	  Driven	  Health	  System)                                    ...
True	  Healthcare	  Reform	  Requires:	  •  The	  use	  of	  	   Evidence	  Based	  Care	  and	     Preven@on 	  	    	  T...
Cancer	  Care	   •  An	  issue	  that	  must	  be	  approached	      ethically,	  logically	  and	  ra@onally	  	   •  We	...
“It	  is	  difficult	  to	  get	  a	  man	  to	  understand	  something,	  when	  his	  salary	  depends	  on	  his	  not	 ...
Otis W. Brawley, MD, FACP    Chief Medical and Scientific Officer          American Cancer SocietyProfessor of Hematology,...
Rudolph Ludwig Karl Virchow        1821- 1902
Virchow s	  Accomplishment	  •  One	  of	  the	  first	  cellular	  pathologists	  •  Virchow s	  node	  •  Defined	  condi@...
Virchow s	  Accomplishments	  	  	  	  The	  defini@on	  of	  cancer	  used	  in	  2010	  is	  largely	  that	       of	  V...
The	  future	  of	  Cancer	  Medicine	  is	  Genomic	  
Prostate	  Cancer	  and	  Chemopreven@on	  	  •  Pretend	  you	  are	  a	  55	  year	  old	  male	  and	  a	     preven@ve...
Otis W. Brawley, MD, FACP    Chief Medical and Scientific Officer          American Cancer SocietyProfessor of Hematology,...
Keynote Presentation: Otis W. Brawley, MD, FACP
Keynote Presentation: Otis W. Brawley, MD, FACP
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Keynote Presentation: Otis W. Brawley, MD, FACP

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2012 Summer Medical Editors Meeting: Otis W. Brawley, MD, FACP (Keynote Speaker)

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Keynote Presentation: Otis W. Brawley, MD, FACP

  1. 1. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University
  2. 2. The  American  Cancer  Society   We  are  dedicated  to  helping  People:   •    Get  Well   •    Stay  Well   •    Find  Cures   •    Fight  Back    
  3. 3. 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?  
  4. 4. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University
  5. 5. U.S.  Health  Care  Spending   In  2009,  the  U.S.  spent  $2.53  TRILLION     on  Health  Care  
  6. 6. 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  
  7. 7. Spending  in  Context   2009 $2.53 trillion $1.4 trillion 17.30%   $1.1 trillion Gross Domestic Product * Excludes alcoholic beverages ($150 billion) and tobacco products ($92 billion) Source: Bureau of Economic Analysis; National Bureau of Statistics of China, MGI analysis
  8. 8. 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)  
  9. 9. Average Life Expectancy (years) S J 74 75 76 77 78 79 80 81 82 a n ap a M n a M rin S on o w a itz co er A l an us d tr S alia w ed The Cost of a Long Life2006 CIA FACTBOOK Ic en el A and nd o C rra an a F r da an ce Ita A ly us tri S a pa N in S orw in a ga y po Lu I re x sr N em a e l ew bo Z u N ea rg et la he n rl d G and er s m Life Expectancy – Per Capita Spending a G ny re ec Translate  into  Longer  Life  Expectancy   e M B alta el U gi u ni te Fin m d la Ki n ng d U e m D do ni nm te d ar St k United States at e C s ub C a Higher  Per  Capita  Spending  in  the  U.S.  does  not   yp r Ire us P nd la or tu ga l 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 Per Capita Spending in USD
  10. 10. 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%  
  11. 11. 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.  
  12. 12. 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  
  13. 13. 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!!!!  
  14. 14. The  American  Healthcare  System    •  Overconsump@on  of  Healthcare  •  The  Greedy  Feeding  the  Gluaonous  •  A  Subtle  form  of  Corrup@on  
  15. 15. Overuse of Medicine•  Screening (irrational use) –  Lung Cancer –  Prostate Cancer –  Breast –  Cervix•  Imaging (CT and MRI)•  Expensive Drugs (e.g. Nexium vs Omeprazole)
  16. 16. 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  
  17. 17. 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!  
  18. 18. 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.  
  19. 19. “It  is  difficult  to  get  a  man  to  understand  something,  when  his  salary  depends  on  his  not  understanding  it”                      Upton  Sinclair  
  20. 20. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University
  21. 21. Rudolph Ludwig Karl Virchow 1821- 1902
  22. 22. 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  
  23. 23. 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.  
  24. 24. The  future  of  Cancer  Medicine  is  Genomic  
  25. 25. 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?  
  26. 26. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University
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