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

1. Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer
American Cancer Society
Professor 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

4. 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?

5. Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer
American Cancer Society
Professor of Hematology, Medical Oncology,
Medicine and Epidemiology
Emory University

6. U.S.
Health
Care
Spending
In
2009,
the
U.S.
spent
$2.53
TRILLION
on
Health
Care

7. 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

8. 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

9. 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)

10. 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 Life
2006 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

11. 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%

12. 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.

13. 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

14. 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!!!!

15. The
American
Healthcare
System
• Overconsump@on
of
Healthcare
• The
Greedy
Feeding
the
Gluaonous
• A
Subtle
form
of
Corrup@on

16. Overuse of Medicine
• Screening (irrational use)
– Lung Cancer
– Prostate Cancer
– Breast
– Cervix
• Imaging (CT and MRI)
• Expensive Drugs (e.g. Nexium vs
Omeprazole)

17. 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

18. 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!

19. 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.

20. “It
is
difficult
to
get
a
man
to
understand
something,
when
his
salary
depends
on
his
not
understanding
it”
Upton
Sinclair

21. Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer
American Cancer Society
Professor of Hematology, Medical Oncology,
Medicine and Epidemiology
Emory University

22. Rudolph Ludwig Karl Virchow
1821- 1902

23. 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

24. 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.

26. The
future
of
Cancer
Medicine
is
Genomic

27. 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?

28. Otis W. Brawley, MD, FACP
Chief Medical and Scientific Officer
American Cancer Society
Professor of Hematology, Medical Oncology,
Medicine and Epidemiology
Emory University