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)

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

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  • 1. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University
  • 2. The  American  Cancer  Society   We  are  dedicated  to  helping  People:   •    Get  Well   •    Stay  Well   •    Find  Cures   •    Fight  Back    
  • 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. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University
  • 5. U.S.  Health  Care  Spending   In  2009,  the  U.S.  spent  $2.53  TRILLION     on  Health  Care  
  • 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. 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. 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. 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. 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. 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. 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. 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. The  American  Healthcare  System    •  Overconsump@on  of  Healthcare  •  The  Greedy  Feeding  the  Gluaonous  •  A  Subtle  form  of  Corrup@on  
  • 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. 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. 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. 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. “It  is  difficult  to  get  a  man  to  understand  something,  when  his  salary  depends  on  his  not  understanding  it”                      Upton  Sinclair  
  • 20. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University
  • 21. Rudolph Ludwig Karl Virchow 1821- 1902
  • 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. 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. The  future  of  Cancer  Medicine  is  Genomic  
  • 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. Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer SocietyProfessor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University