Otis W. Brawley, MD, FACP

Chief Medical and Scientific Officer American Cancer Society

Professor of Hematology, Medical Oncology, Medicine and Epidemiology

Emory University

The  American  Cancer  Society  

We  are  dedicated  to  helping  People:  •    Get  Well  •    Stay  Well  •    Find  Cures  •    Fight  Back    

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?  

Otis W. Brawley, MD, FACP

Chief Medical and Scientific Officer American Cancer Society

Professor of Hematology, Medical Oncology, Medicine and Epidemiology

Emory University

U.S.  Health  Care  Spending  

In  2009,  the  U.S.  spent  

$2.53  TRILLION    on  Health  Care  

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  

Spending  in  Context  

2009

* Excludes alcoholic beverages ($150 billion) and tobacco products ($92 billion) Source: Bureau of Economic Analysis; National Bureau of Statistics of China, MGI analysis

17.30%  

$2.53 trillion

$1.1 trillion

$1.4 trillion

Gross Domestic Product

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)  

Higher  Per  Capita  Spending  in  the  U.S.  does  not  Translate  into  Longer  Life  Expectancy  The Cost of a Long Life

Life Expectancy – Per Capita Spending

2006 CIA FACTBOOK

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United States

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%  

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.  

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  

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!!!!  

The  American  Healthcare  System  

 •  Overconsump@on  of  Healthcare  

•  The  Greedy  Feeding  the  Gluaonous  

•  A  Subtle  form  of  Corrup@on  

Overuse of Medicine •  Screening (irrational use)

–  Lung Cancer –  Prostate Cancer –  Breast –  Cervix

•  Imaging (CT and MRI)

•  Expensive Drugs (e.g. Nexium vs Omeprazole)

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  

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!  

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.  

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

                 Upton  Sinclair  

Otis W. Brawley, MD, FACP

Chief Medical and Scientific Officer American Cancer Society

Professor of Hematology, Medical Oncology, Medicine and Epidemiology

Emory University

Rudolph Ludwig Karl Virchow

1821- 1902

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  

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.  

The  future  of  Cancer  Medicine  is  Genomic  

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?  

Otis W. Brawley, MD, FACP

Chief Medical and Scientific Officer American Cancer Society

Professor of Hematology, Medical Oncology, Medicine and Epidemiology

Emory University