Stephen C. Schimpff, MD

May 25, 2011May 25, 201116

Herpes zoster (or shingles) is caused by the same virus that causes chicken pox. Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic…

Herpes zoster (or shingles) is caused by the same virus that causes chicken pox.

Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic pain thereafter. A vaccine was introduced by Merck in 2006; the initial studies of 38,546 patients indicated …

Drugs and prescribing

Belimumab (Benlysta) to treat systemic lupus erythematosus (SLE)

May 19, 2011May 19, 20112

Genomics promises to fundamentally change much of medical care. But the ultimate value of this new understanding of basic human biology will in many cases come with fits and starts. The saga of belimumab (Benlysta) and Human Genome Sciences (HGS)…

Systemic lupus erythematosus (SLE) occurs in somewhere between 300,000 and 4 million Americans according to the …

Conditions and diseases

Using genomics in cancer, and for early diagnosis in infectious disease

May 11, 2011May 11, 2011

In the previous post I discussed the field of pharmacogenomics. Today I will focus on: Nutragenomics Disease classification Disease prognostication Early and rapid diagnosis Prediction of diseases to develop later in life Nutragenomics or the science of how our genes…

In the previous post I discussed the field of pharmacogenomics.

Today I will focus on:

Nutragenomics
Disease classification
Disease prognostication
Early and rapid diagnosis
Prediction of diseases to develop later in life

Nutragenomics or the science of how our genes affect what we eat is a developing field.

Here is one example. Cholesterol is an important part of our physiology although too much in the wrong places is harmful. Cholesterol is carried in the body …

Drugs and prescribing

How genomics can help doctors target drug therapy

May 5, 2011May 5, 20112

Little more than a decade ago, most people had never heard of the word genomics; today it is used frequently. It is indeed a revolutionary science that is and will transform medical research and medical care. To better understand how this new science will markedly change medicine, it is convenient to consider it through a few categories:

Pharmacogenomics
Nutragenomics
Disease classification
Disease

…

Advances coming in medical science that will have a high impact

April 27, 2011Apr 27, 2011

There are a series of medical megatrends outlined in my book The Future of Medicine – Megatrends in Healthcare that will profoundly affect health care in the coming five to fifteen years and beyond. Some are due to the explosion…

There are a series of medical megatrends outlined in my book The Future of Medicine – Megatrends in Healthcare that will profoundly affect health care in the coming five to fifteen years and beyond. Some are due to the explosion of basic understandings of cellular and molecular biology. Others are related to advances in engineering and computer science. Here is a very brief overview.

These are the megatrends in medical care …

Patient voices

Emotional issues that come with cancer during the teenage years

March 18, 2011Mar 18, 2011

When Clarissa was 13 she entered Johns Hopkins Hospital to be treated for relapsed acute leukemia knowing full well that she had only a 40% chance of survival. Today she is 16 and in excellent health. But it took 2 1/2 years of incredibly rigorous treatments to get there. Equally importantly it meant riding an emotional roller coaster for her and her parents.

Clarissa had …

What should we expect of a physician leader today?

March 11, 2011Mar 11, 2011

What should we expect of a physician leader today? I believe it should be something much different than what leaders do now. Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by…

What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.

Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added …

Are physicians motivated by virtue or are they passive victims?

January 9, 2011Jan 9, 20112

An interesting article in JAMA by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.” Basically, are we motivated by…

An interesting article in JAMA by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.”

Basically, are we motivated by virtue, by self interest or are we just passive victims? The authors suggest that this is a good question not only for physicians to contemplate but …

How dietary guidelines can help prevent disease

November 13, 2010Nov 13, 20106

Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease. These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are…

Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease.

These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are not all that difficult to prevent. Unfortunately, our dietary guidelines are of little or no help in this regard but could be.

In 1941, following studies that demonstrated …

A system based on units of activity encourages more units of care

September 27, 2010Sep 27, 20104

Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare. In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance…

Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare.

In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, …

Insurance does not have incentives to lower costs or improve quality

August 23, 2010Aug 23, 20106

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality. In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to…

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality.

In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care …

America has a disease industry, not a health care system

July 22, 2010Jul 22, 20108

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess. But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is…

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.

But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or …

7 disruptive changes that will affect medicine

June 24, 2010Jun 24, 20104

Generally we prefer calm seas but often they don’t get us anywhere. We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement…

Generally we prefer calm seas but often they don’t get us anywhere.

We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change.

Here a few more disruptive changes or refinements …

Prevention improves health and lowers healthcare costs