Zeke Emanuel, a former advisor to President Obama andcurrent Chair of Medical Ethics and Health Policy at the University ofPennsylvania, was the lunchtime speaker at my MBA for Executives: Leadershipin Healthcare class this past weekend. He opened with the $2.8 trillion dollar figure—what we, in the U.S., spend on health care. What ensued was apassionate speech about the need for innovation and reform. Earlier that day, in our Managing Healthcare Organizations class, we had discussed the genesis of the woes of our health caresystem, and how the current system of incentives is designed perfectly toproduce the results it does. Thoughts about evidence-based medicine, appropriate use of technology, and the need to lower cost and improve outcomes for entire populations bounced around in my head….
The same day, ASCO put out its new top 5 list—a rational, evidence-based list of guidelines that has the potential to truly move us inthe right direction in terms of those goals. Common sense things like “Appropriate antiemetics for patients on chemotherapy regimens should be based on the regimens' risk of causing nauseaand vomiting,” and “Do not use a targeted therapy unless a patient's tumorcells have a specific biomarker that predicts a favorable response to thattherapy.” To those who argue that they regularly order tests like PET scans in patients with no signs or symptoms of recurrence to avoid being sued, you now have the largest professional oncologyorganization in the world telling you that this is not only unnecessary, butpotentially harmful—a fact that lawyers would have difficulty arguing against….
Darrell Kirch said it well in his presidential address at the AAMC this weekend, “Change is not just possible, it is happening now…. We all have a choice in these moments of truth. We can sit on the sidelines, or we can embrace responsibilityfor transforming our health care system….”But it’s not just the health care system, it’s everything—how we think about prevention and community wellness, how we invest in innovation that achieves the triple aim of better quality at lower cost for entire populations,how we educate the next generation of responsible physicians, who carefullyconsider value rather than ordering tests “just because….” As with many thingsin life, we have two choices: you can wallow in the status quo and complain vehemently about all that is wrong with the world, or you can take up the charge to do something productive to make apositive difference. My challenge to the world is to do your part. We, as asociety, need to think about where we are going and how to get there—simplylamenting the present without concomitant action to alter trajectory is unlikely to result in a better future. It is, as Einstein once said, the definition of insanity to do the same thing over and over and expect a different result.
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