Wendy Harpham on Healthy Survivorship

Doctors vs Computers

A front-page story in today's Science Times poses a provocative question in the rapidly changing world of medical diagnostics: Can computer software ever replace physicians to ensure timely, correct diagnoses?

Choosing Wisely Campaign - Part II

In my last post, I introduced the Choosing Wisely™ campaign, an effort by clinicians to avoid overuse or inappropriate use of tests and therapies. Obviously, a successful campaign would save lots of money. But the campaign is motivated by a higher goal that reflects the mission of Healthy Survivorship.

Problems with Generics

Did you know that when you take a generic drug, you essentially forfeit the ability to sue the company making the drug for damages if you experience an adverse event?

Revoking FDA Approval: Right or Wrong? - Part IX

In my last post, I asked, "Why not, at least, make Avastin available to breast cancer patients who are doing well on it?"

Revoking FDA Approval: Right or Wrong? - Part V

Now let's look at the players who influenced the FDA's decision to revoke approval of Avastin for breast cancer. The complex process requires a book-length manuscript to fully explain. Rather than abandon my effort, here are the bare bones:

Revoking FDA Approval: Right or Wrong? - Part IV

My last post provided an outline of the FDA's approval process. I cringed while writing it, knowing 250 words couldn't capture the investment of time, people and capital. 

Revoking FDA Approval: Right or Wrong - Part III

In my November 28th and December 3rd posts I introduced the media storm regarding the FDA's recent revocation of approval of Avastin for the treatment of breast cancer. Today I'll provide an overview of the FDA approval process to help us talk about the controversy.

Revoking FDA Approval: Right or Wrong? Part II

To judge the FDA's recent revocation of approval for Avastin for breast cancer, let's go back to basics. What is the job of the FDA?

Revoking FDA Approval: Right or Wrong?

Recently the FDA revoked approval of a best-selling drug, Avastin, for treatment of breast cancer. Ever since, arguments for and against the removal have been voiced in blogs and major media by a wide variety of people with different points of view. Let's look at some of the issues in the context of Healthy Survivorship.

Your Medical Mind

My recent posts have discussed some of the difficulties of modern medical decision-making in the context of PSA testing for prostate cancer. A new book by Harvard oncologist Jerome Groopman and Harvard endocrinologist Pamela Hartzband offers help to Healthy Survivors: Your Medical Mind: How to Decide What is Right for You.

My Bad?

My August 6th post shares a report on a new technology for breast cancer screening. I confess: I did not check out the story.

Talking About Side Effects of Cancer Treatments

Effective communication is an essential element of Healthy Survivorship. So I felt honored when MD Anderson Cancer Center's Dr. Walter Baile invited me to write and narrate an audiovisual module titled TALKING ABOUT SIDE EFFECTS OF CANCER TREATMENTS

Hope or Letting Go - Part II

In my last post, Hope or Letting Go, I shared the story of a physician, Dr. Youn, still troubled by an incident that happened ten years ago. Since reading it, I've been bothered by some of the questions he posed.

For example, Dr. Youn asked if concern for the needs of the patient's loved ones ever take precedence over the patients' needs?

From Promise to Disaster

Patients are not Healthy Survivors if they believe the promises of charlatans. What about patients who receive treatment from of team of professionals at a major university in a clinical trial that turns out to be based on wrong information?

Free Toolbox

We are not born knowing how to become Healthy Survivors. We aren't taught in school how to get good care and live as fully as possible when living with, through and beyond cancer or other serious illness. I wish we were.

Understanding Post-Treatment Survivorship

If a picture is worth a thousand words, this 17-minute video by Eric Slade Productions is worth at least an undecillion (1 followed by 36 zeros). 

The Pro-Diabetes Board

In 2006, leaders in the state of Washington created the Health Technology Assessment (HTA) program to evaluate the cost-effectiveness of various medical therapies. With our country facing a huge budget deficit, what could be better than determining which treatments are worth paying for?

Rare Cancer Initiatives

My recent posts are about the trouble of defining "rare cancers." The attention these cancers are now getting gives Healthy Survivors many reasons for hope.

Compassion in Modern Medicine

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion." So let's take a look at compassion.

The Big Picture

I chose internal medicine as a career because I love having "the big picture."

One of my great concerns about the changes in modern medicine is this: It is becoming increasingly common for none of the clinicians on a patient's healthcare team to have that big picture so vital to expert and compassionate care.

Bringing Back the Physical Exam

I shudder when I hear stories of physicians who order a CT scan to evaluate a patient's pain without examining the painful area. So I was happy to read that Dr. Abraham Verghese is on a mission to save the art of the physical exam.

Abigail's Alliance

On my recent post about clinical trials, commenter Steve Walker wrote, "The Phase III trial is being run primarily to satisfy the rigid, formulaic and in many cases scientifically obsolete requirements imposed by the FDA's Office of Oncology Drug Products for most cancer drugs...." 

Is the randomized clinical/controlled trial (RCT) obsolete?

Testing a Fast Track to Rx

Recently, I've pointed out the clashes between business and ethical considerations and beween clinicians' obligations to their individual patients and to the method that leads to advances. What if researchers can find ways to satisfy both the science and today's patients?

The Problem with Accelerated FDA Approval

In Phase I trials researchers test an experimental treatment in a few patients for the first time. The purpose is NOT to see if the treatment kills cancer cells, but only to:

• evaluate the drug's safety
• determine a safe dosage range
• identify side effects

What if the patients in a Phase I trial experience shrinkage of their tumors? Should this speed up FDA approval of the trial drug?

Anguished Debate on Witholding Rx for the Control Arm

My last post introduced a dilemma regarding modern clinical trials: Is it ethical to randomize some patients to the "control arm" of a trial where they will NOT receive the trial drug?

According a NYTimes article, one particular trial of a therapy (called PLX4032) for malignant melanoma "ignited an anguished debate among oncologists about whether a controlled trial that measures a drug's impact on extending life is still the best method for evaluating hundreds of genetically targeted cancer drugs being developed."

Researching Clinicial Trials

People who hear my story often say, "You had an advantage getting into those clinical trials, because you were a doctor with connections." Given the paucity of patient-centered resources in 1993, this was true. 

Today a plethora of excellent resources can help patients and families learn about clinical trials and find any available trials that might be right for you. Resources include:

The Treatment Option You May Be Missing

As a scientist, I credit clinical trials with advancing our understanding of cancer and ability to treat it effectively. As a patient, I credit clinical trials with playing an essential role in my survival. 

From both perspectives it troubles me greatly that only ~3% of adult cancer patients participate in clinical trials.

Open Notes and Compassionate Care

For me, the crux of the problem is this: Do open notes conflict with the ideal of compassionate care? 

Open Notes: "Our" Chart

My recent posts set the stage for asking: Does the opportunity for patients to read their medical charts help or hurt patients' ability to become Healthy Survivors?

The OpenNotes Project - Why Do We Need It?

In my August 9th post, I introduced you to the OpenNotes project. If you are wondering why we need the study, here is a two-word answer: informational technology.

The OpenNotes Project - Introduction

Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

For the next few posts, we'll explore the OpenNotes project in the context of Healthy Survivorship.

HON

Patients wanting to learn about their illness used to search high and low for a few drops of patient-centered information. The dilemma for modern patients has become how to sort through the flood of information available on the Internet.

HON certification can help.

Mesothelioma

The post entitled "Mesothelioma" was under construction. The final post was published as "Mesothelio-what?"

Caveat Emptor re: Genetic Testing

Great progress has been made in linking disease to mutations in certain genes. So why the sudden brouhaha at the FDA about companies selling gene-testing kits directly to consumers?

A Problem with the Electronic Health Record (EHR)

In the newsletter of the Texas Chapter of the American College of Physicians, Dr. Steve Urban shares an important concern about Electronic Health Records (EHR).

Cancer Survivorship Research: Recovery and Beyond

What a three days I've had here at the 2010 Biennial Conference. While packing my suitcase for the return home, I'm thinking about all I've heard.

Wendy in Washington

Tomorrow begins a conference entitled "Cancer Survivorship Research: Recovery and Beyond." And I have a job to do.

10 Rules for Good Medicine

I've been following a provocative blog, Musings of a Distractable Mind, hosted by primary care physician Dr. Rob Lamberts. His recent post entitled "10 Rules for Good Medicine." offers food for thought about modern healthcare. Here is a sampling, with my commentary added:

Placebos -- The Magic Cure

Your doctors evaluate your pain and conclude it is due to something benign (i.e., you don't have cancer, a broken bone or other health-threatening condition). Then they give you a prescription for a placebo. Should you sue these doctors? Or thank them?

Copying Off Your Privacy

The task sounds innocent enough: You copy your medical records on your personal home copier or an office copier, making sure nobody is looking over your shoulder and making sure to take all your originals and copies with you. Are you safe? Maybe not. 

Do I Need a Specialist?

After being diagnosed with a disease, many Healthy Survivors ask, "Do I need to see a specialist to get good care?"

Calling all Patients!

Will someone please explain this to me: Clinical trials are the modern tool for finding truths about preventing and treating cancer. Yet our system puts obstacles in the path of clinicians who might participate in designing and running trials and in the path of patients who might enroll in trials.

Berk is Back

You were introduced to Dr. Bradford Berk on my Feb 19th post, The Comeback Physician. I'm happy to share the update reported in the current Rochester Review: Berk is Back.

Let me draw your attention to one of Dr. Berk's key messages:

Patient 2.0

Patients obtain medical information not only from their healthcare team but also from the Internet. Time Magazine's Bonnie Rochman discusses one potential benefit of this phenomenon in a fascinating article entitled, "When Patients Share Medical Data Online."

When Doctors Become Patients

The Princeton Alumni Weekly published an essay by Robert Klitzman, M.D., "Double Lives," adapted from his book, When Doctors Become Patients. Naturally, it caught my eye. 

Listening to Patient's Stories

We've been discussing the importance of valuing the time it takes primary care physicians to listen to their patients. 

Valuing PCPs

What does it mean to "value" the time and expertise of primary care clinicians (PCPs)?

Addressing the Primary Care Shortage

In yesterday's post I explained why combining college and med school into six years is not a good antidote to the primary care shortage (in my opinion). Here are other ideas that might help encourage medical students to go into primary care:

Antidote for Primary Care Shortage

The author of a recent post on YJHM (the companion blog for the Yale Journal for Humanities in Medicine) suggested that combining college and med school into six years is a good idea as an antidote to the primary care shortage.

I, too, am concerned about the growing shortage of primary care clinicians. But this idea worries me.

CISCRP

Huh? CISCRP? Is that a word?

No, it is the acronym for a non-profit organization I'd like to highlight. Then you'll have it in the back pocket of your brain in case you ever need it for yourself or someone you love.