Posts Tagged ‘clinical trials’

Yahoo Released Its Best Hospital List: Do You Care?

Sunday, July 25th, 2010

Yahoo just released its current report: Best Hospitals (in the U.S.) 2010-11: the Honor Roll. There were no surprises although I believe I could find another 14 hospitals equally good. The list includes John Hopkins, Mayo Clinic- Rochester, Mass General, Cleveland Clinic and others; and much as I see the logic in this list I also see the perverse irrationality in its construction.
For instance: why does Yahoo publish this? Is it an interesting item that sells advertising? Is it a public service? Since there are only 3 hospitals in the West (2 in Calfornia and 1 in seattle) and 2 in the Midwest, and the rest are on the east coast, am I to believe that people are going to travel coast to coast to go to a best hospital?
More important, who takes these evaluations seriously? The reality is these hospitals are the site of origin of many of the clinical studies in the United States and cultivate much of the innovative brain power in medical care. Yet only 1 in 4 Americans with cancer will consent to enter a clinical study and less than 20% of women with breast cancer do so. The reality is these university health systems have partnerships with community hospitals that are laced with financial incentives and the university systems would not impugn the reputation of any clinical hospital for fear of economic reprisal. And another reality is that there is economic competition between community based physicians and university based physicians and it is not in the economic interest of community based physicians to promote the services of the university health system.
Then there is the issue of unaffordable health care and a health care bill passed by the Obama administration that ignores the main causes of runaway health care costs and rewards the beneficiaries of the system. I am referring to the health insurance companies and the trial lawyers who lobby through the trial lawyer associations and its many euphemistic marketing organizations. It cannot go unnoticed that both Barack Obama and Hillary Clinton are attorneys and have supported the heavy contributors to their election campaigns (I bring in Clinton since she was Obama’s main competitor for the Democratic nomination).
Ultimately it is my judgment that the awarding of kudos to what are in fact excellent centers of medical care are just so many marketing ploys to promote the interests of marketing companies (i.e. Yahoo) and political interests. I sense that it is unlikely that we will either address the real issues of disparity in the availability of superior health care or address the issues of educating a poorly informed public as to their more rational choices in times of serious illness.

Managing Cancer

Sunday, January 3rd, 2010

On or about August 27, 2002 I awoke in the morning and went to work as usual. I did not know that my world as I knew it was about to change irrevocably. On a subliminal basis I knew that I had cancer of the soul. My marriage was in name only, my family dissipated, my work was my passion. I did not understand that in a few hours, a Kafkaesque moment, I would turn yellow and the cancer in my soul would become the cancer in my pancreas. That was then and now I am a 7 year survivor of a cancer few get to tell about.
Back then, after a rapid work-up, I was presented a chance to become a patient in a phase III clinical trial. I enlisted before I knew what the trial entailed. Dr. Talamonti asked how I could volunteer with so little knowledge. “Look,” I said. “I have a minimal chance of survival regardless and the possibility of remission if I participate. At the least, someone else may benefit from my experience.” I was unaware of statistics which indicated that from 1980-1989 patients in clinical trials had up to a 400% greater chance of remission than patients who did not participate. So who wouldn’t participate?
75% of adults. That’s who. 75% of adults across all spectra of cancer do not participate in clinical trials. Yet the numbers get worse. My friend, Dr. Jane Petrow, showed me that today less than 5% of women with breast cancer participate in clinical trials. There must be an explanation. Antipathy? For God’s sake you are dying! Who the hell has antipathy at that point? Maybe false bravado, but certainly not antipathy. I judge there are 2 explanations.
Patients: Even today adults with cancer believe that clinical trials involve risk to them. They think they may receive a placebo. There are no placebos in a level III clinical trial. Flashback. The year is 1978 and I am asked to see a woman with Hodgkin’s lymphoma who has a skin rash. I enter her room to find that the lady is in a coma and she has disseminated varicella, chicken pox if not herpes zoster. Herpes Zoster. I erupted with anger. This was about me not the patient. Why had I been called in at all? I was helpless before this woman who had disseminated cancer, disseminated varicella, was clearly dying, and would soon leave 3 children and a husband at age 35. In anger I can be irrational so I began calling colleagues who might know of a clinical trial for this woman. I found one at the University of Chicago. Through a series of not so ethical subterfuges I got her transferred to the U of C Hospitals where she recovered and went on to remission from lymphoma. I later spoke with her attending doctor at the U of C Hospital and he told me the miracle of her cure was not in the drugs used in the trial but in the supportive care she received which was not available at most community hospitals. That’s the rub, the misconception. Patients in level III clinical trials receive the latest therapies, the best of old therapies, and very importantly a level of care that is often not available in a community setting.
Doctors: Doctors today are between a rock and a hard place. Their incomes depend on caring for sick people. Their egos are not satiated by referring every sick patient to a university type setting. They are not always privy to the inside advantages of medical institutions and pharmacopeia. And if the therapy they advise worked for Mrs. Jones why not for you.
But that’s not the point. The point is that cancer today gets far less government appropriations for research than bills filled with pork to advance the careers of politicians who are supposed to be serving us. The point is the system is not geared to give the majority of patients the optimal care that may be available. The point is that adult patients are fearful of the unknown and a known treatment that does not work may feel preferable to one that is being studied. The bottom line for me is that I survived, who knows how or why, and that it is painful to see cancer patients limit their chance of success for any of the above reasons.
So today I am free of the cancer in my pancreas, free of the cancer in my soul, and I am forever grateful for the wonderful care I received at Northwestern University Hospital and the opportunities they presented for me.