Against the odds - A band of rebels fights to save health care - Stanford Medicine Magazine

<base href="data:"><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="introParagraph" style="margin: 0px 0px 10px; padding: 0px; border: 0px; outline: 0px; font-size: 12px; vertical-align: baseline; background-color: transparent; color: rgb(132, 158, 173); text-align: left; letter-spacing: 1px; text-transform: none; line-height: 19px; font-family: Georgia, 'Times New Roman', Times, serif; font-weight: bold; background-position: initial initial; background-repeat: initial initial; ">Manali Patel, MD, had dark circles under her eyes after a rough week battling tumors at the Stanford Cancer Institute. Patel, 33, doe-eyed and 99 pounds soaking wet, looked more like a college freshman than an oncology fellow six years out of medical school. </span>Lately, she had seen a lot of bad endings. Several patients who wanted to die at home said their last goodbyes from a hospital bed, tethered to machines with tubes and wires. Another patient was referred to the hospital without knowing why. It was Patel's job to deliver the grim news: He had incurable lung cancer and only a few months to live.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Then, as she hung up her white coat for the day, she received the worst call of her life – her mother had breast cancer.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">This began Patel's journey down the patient side of cancer treatment, away from the traditional career path of a working doctor. She joined a small, idealistic band of physicians, engineers and management scientists with an ambitious goal – to battle the waste and perverse financial incentives in America's increasingly unaffordable medical system.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Her mother's call also brought a personal urgency to a nagging problem that is easy to ignore while working 80-hour weeks and managing the treatments of 100 or so cancer patients a month: Few oncologists have the time to talk to cancer patients anymore.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Less than a third of oncologists have end-of-life discussions with terminal cancer patients. As a result, cancer patients are left out of the decisions that determine how and where they spend their last days. Recent studies show that when cancer patients understand the big picture — treatment side effects, survival odds and pain-relief options – they live longer and enjoy a better quality of life.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Listening to her mother's voice over a bad cell phone connection 3,000 miles away, Patel realized that her mother was about to be rushed off to chemotherapy.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"Wait. We need to talk first," said Patel, as she started to formulate her plans to try to bring compassion and affordability back into cancer care, for mother and country.</div><p class="sectionbreak" style="margin: 20px 0px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 0px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; "><span class="introParagraph" style="margin: 0px 0px 10px; padding: 0px; border: 0px; outline: 0px; font-size: 12px; vertical-align: baseline; background-color: transparent; color: rgb(132, 158, 173); text-align: left; letter-spacing: 1px; text-transform: none; line-height: 19px; font-family: Georgia, 'Times New Roman', Times, serif; font-weight: bold; background-position: initial initial; background-repeat: initial initial; "><span class="Apple-tab-span" style="white-space:pre"> </span>Patel grew up with her parents and two siblings in Shelby, N.C., the rural Appalachian town where The Hunger Games was filmed. </span>Her parents, who emigrated from India in 1973, worked hard to give their three children a good education in a community of primarily cotton farmers and textile workers. Patel's mother held two jobs and her father ran his own textile design company. They bought only books, never toys, for the children. And ultimately, all three were accepted into a competitive science high school near Duke University and the University of North Carolina's medical school.</p><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Around town, Patel's mother is known as "Mrs. Patel with the long hair," because of the long, dark braid that comes down to her knees. Though Patel and her mother look very much alike – petite with caramel-colored skin ‐ their cultural backgrounds are very different.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"My daughter is the protector of the family, aggressive and outspoken," says Mrs. Patel, who asked that her first name not be used.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Patel's mother, whose marriage was arranged by aunts and uncles in Gujarat, India, was raised to follow elders' and doctors' orders without question.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">When Mrs. Patel's local physician first diagnosed her with cancer, he immediately sent her to a local oncologist for chemotherapy. "Once my doctor said the word 'cancer' I started crying and heard nothing," says Mrs. Patel. "I thought it was the end of the world."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Patel, the daughter-oncologist, was upset that her mother hadn't gotten a second opinion. She told her mother to put everything on hold until she could talk to a breast cancer specialist at Stanford. And, for the first time, she experienced "the cancer talk" from the other side of a physician's desk.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"This Stanford breast cancer specialist, who had never met me, called me back at 10 p.m. that same day," says Patel. "He spent an hour on the phone with me, reassuring me, telling me what I needed to know about my mother's cancer and teaching me how to be her caregiver."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Patel flew her mother out to meet with the Stanford specialist, who then spent two hours with her mother discussing her condition and wishes. The deciding factor in her mother's treatment plan came at the very end of the meeting: "My mother said she didn't want chemotherapy because she didn't want her hair to fall out," says Patel. "Back in India, her family had a tradition of never cutting hair. None of her American children had realized that this was so important to her."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Instead of chemotherapy, Patel's mother was given six weeks of daily radiation, followed by a five-year course of a non-chemo drug that doesn't cause hair loss.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"Going through this with my mother made me a better doctor. And it made me realize that these cancer discussions take time," says Patel.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Though she worried about whether her mother had made the right choice, she realized the importance of letting this be her mother's well-informed decision, not hers.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">As she finished her oncology training, she decided to take action on what she had learned. So she hit "pause" on that $380,000 median oncologist's salary, buying a house and starting a family. Instead, she joined the Clinical Excellence Research Center at the Stanford School of Medicine.</div><h3 style="margin: 20px 0px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 11px; vertical-align: baseline; background-color: transparent; text-transform: uppercase; color: rgb(76, 136, 170); letter-spacing: 1px; line-height: 19px; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; font-style: normal; font-variant: normal; orphans: 2; text-align: left; text-indent: 0px; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">LEAP OF FAITH</h3><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="introParagraph" style="margin: 0px 0px 10px; padding: 0px; border: 0px; outline: 0px; font-size: 12px; vertical-align: baseline; background-color: transparent; color: rgb(132, 158, 173); text-align: left; letter-spacing: 1px; text-transform: none; line-height: 19px; font-family: Georgia, 'Times New Roman', Times, serif; font-weight: bold; background-position: initial initial; background-repeat: initial initial; ">The CERC is led by Arnold Milstein, MD, the center's director and a professor of medicine. </span>The 2-year-old center's mission is to find more affordable ways to deliver better medical care to the sickest of our population who consume the bulk of the country's health-care spending.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">The CERC team takes aim at the unintentional wastefulness of the U.S. medical system, which is by far the most expensive in the world, yet is ranked 37th in quality of care. In Milstein's opinion – forged after 25 years as a health-care advisor to Fortune 100 companies, three White House administrations and Congress – there is no quick fix. Our country needs to safely improve the value of its health-care system by at least 2.5 percent per year, every year, in order to align health spending with national income growth. Anything less means more uninsured people, higher taxes and, eventually, fiscal Armageddon.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Milstein, a soft-spoken Midwesterner with a fondness for corduroy jackets, is building a pipeline for creating and testing innovative health-care delivery methods.</div><blockquote style="margin: 0px; padding: 40px 15px 30px 35px; border: 0px; outline: 0px; font-size: 14px; vertical-align: baseline; background-color: transparent; quotes: '', ''; width: 160px; text-transform: uppercase; line-height: 2em; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; float: right; display: inline; letter-spacing: 1px; color: rgb(153, 184, 201); font-style: normal; font-variant: normal; font-weight: normal; orphans: 2; text-align: left; text-indent: 0px; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">AS SHE FINISHED HER ONCOLOGY TRAINING, SHE DECIDED TO TAKE ACTION ON WHAT SHE HAD LEARNED. SO SHE HIT 'PAUSE' ON THAT $380,000 MEDIAN ONCOLOGIST'S SALARY, BUYING A HOUSE AND STARTING A FAMILY.</blockquote><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"To anchor our process, we recruit very smart postdoctoral and master's-level research fellows with a history of fresh thinking and successful doing," says Milstein. "We expose them to successful health-care innovators, pair them with Stanford faculty and Silicon Valley mentors to formulate better health-care models, then recruit health-care organizations and insurers to test the effectiveness of their concepts."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Over the years, Milstein has won a number of epic battles in health-care redesign. He co-founded the Leapfrog Group, which defined hospital patient safety goals that became the de facto standard across the nation. He was the force behind Congress' decision to stop paying hospitals for the cost of treating preventable patient complications. He launched an outpatient care delivery model for medically frail patients, called the "ambulatory-care ICU," which improved health and lowered annual per-patient spending by more than 15 percent. And he's the founding medical director of the Pacific Business Group on Health, the nation's largest regional health-care improvement coalition of large employers, whose members include Chevron, Safeway, Walmart, Boeing, HP, Cisco, Facebook, CalPERS and Stanford University.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">For the fellows' first year, Milstein targeted four of the most debilitating and expensive medical conditions in the U.S. system – chronic kidney disease, morbid obesity, colon cancer and poor-prognosis cancer, which was Patel's area of focus.</div><div style="margin-top: 0px; margin-right: -30px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 10px; padding-left: 20px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; float: right; display: inline; text-indent: 0px; width: 300px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="credit" style="margin: 0px; padding: 0px; border: 0px; outline: 0px; font-size: 8px; vertical-align: baseline; background-color: transparent; font-weight: bold; text-transform: uppercase; color: rgb(99, 99, 99); letter-spacing: 1px; line-height: 14px; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; text-indent: 0px; background-position: initial initial; background-repeat: initial initial; ">PHOTO BY JAMIE KRIPKE</span> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEMNg-UIvHCUpYXQfAMyXOTp4bf-v6vxCCguc1AiniP2dfIPnVG3O0hAKs8pH7KwgF2j2bJNsrAwwYuQnL9qvymRlYJd4O1M3oO0ZP99_pXb57QTCmnJfEyq4nF2n4MHAxpr3Y1l5c3cQ/s1600/article3a-724416.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5814547014878005474" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEMNg-UIvHCUpYXQfAMyXOTp4bf-v6vxCCguc1AiniP2dfIPnVG3O0hAKs8pH7KwgF2j2bJNsrAwwYuQnL9qvymRlYJd4O1M3oO0ZP99_pXb57QTCmnJfEyq4nF2n4MHAxpr3Y1l5c3cQ/s320/article3a-724416.jpg" /></a><br><span class="caption" style="margin: 0px; padding: 10px 0px; border: 0px; outline: 0px; font-size: 10px; vertical-align: baseline; background-color: transparent; float: left; display: inline; width: 250px; color: rgb(49, 49, 49); font-family: Georgia, 'Times New Roman', Times, serif; line-height: 15px; text-align: left; font-style: italic; background-position: initial initial; background-repeat: initial initial; ">The Clinical Excellence Research Center's fellows and Terry Platchek, fellowship director. From left: Sarah Adler, Graham Abra, Manali Patel, Platchek, David Moore and Sundeep Singh.</span></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Though the fellows have diverse backgrounds, all have had personal experiences that have motivated them to join this small group of reformers.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">For example, Graham Abra, MD, a nephrology fellow, was curious about why some medical institutions provide better patient care than others, and whether innovative approaches could make health care more affordable. Psychologist Sarah Adler, PsyD, became interested in obesity after researching the mental health underpinnings that may contribute to overeating. Sundeep Singh, MD, a gastroenterology fellow with a bachelor's degree in industrial and systems engineering, sought to develop systems-based solutions to health-care delivery. Kimberly Stone, MD, a surgery resident, wanted to see if making low-cost bariatric surgery more widely available might extend life for morbidly obese patients. And David Moore, PhD, an industrial engineer and consultant, became interested in the redesign of health services after working on a system to improve efficiency in surgical suites.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Abra, who worked on the chronic kidney disease and cancer care models, spoke about his first impressions: "It was pretty risky signing up for a new type of fellowship program. There's this professor with the crazy idea that better health care can cost much less. But he was giving us a chance to fix the medical system at a higher level. So I joined." And he adds with a smile, "It was a leap of faith."</div><h3 style="margin: 20px 0px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 11px; vertical-align: baseline; background-color: transparent; text-transform: uppercase; color: rgb(76, 136, 170); letter-spacing: 1px; line-height: 19px; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; font-style: normal; font-variant: normal; orphans: 2; text-align: left; text-indent: 0px; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">VALLEY OF DESPAIR</h3><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="introParagraph" style="margin: 0px 0px 10px; padding: 0px; border: 0px; outline: 0px; font-size: 12px; vertical-align: baseline; background-color: transparent; color: rgb(132, 158, 173); text-align: left; letter-spacing: 1px; text-transform: none; line-height: 19px; font-family: Georgia, 'Times New Roman', Times, serif; font-weight: bold; background-position: initial initial; background-repeat: initial initial; ">The team got to work in August 2011 with a month-long "Innovation Bootcamp." </span>It started with almost 50 briefings by eminent health-care economists, biostatisticians, futurists, clinical specialists, faculty, information technology experts, human factors gurus and behavioral scientists. They also met with leaders from efficient health systems, such as the Permanente Medical Group in California, ThedaCare in Wisconsin, Intermountain Healthcare in Utah, and government-run health systems in British Columbia and Sweden.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"I was star-struck, and I even felt a little guilty about how many top national experts met with the six of us," says Patel.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Optimism was high among the fellows as they began their clinical research and observations. To help structure their search for solutions, the center adapted the Stanford Biodesign Program innovation methodology, which has spawned more than 300 patents and 26 medical technology companies. This training teaches inventors to identify the most pressing unmet needs within a medical system, so that the resulting solutions improve clinical outcomes and save money. The team spent two months immersed in clinical settings, observing patients, families and physicians. They interviewed care delivery innovators in the United States, Canada, Sweden and other countries. And they gathered new ideas from scientific literature and medical experts.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Fast forward two months: It was almost 11 p.m., and the fellows were in a conference room cluttered with marker-scratched white boards, fast food carnage and stacks of studies. The fellows had fallen into the "valley of despair," the ugly, chaotic middle of the innovation design process.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"We were all so exhausted and suffering from information overload," says Patel. "That was the low point. We couldn't imagine how we were going to make sense of everything we'd learned."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">That was where the Biodesign process helped – as well as its credo: "Given enough time, sugar and caffeine, you will invent something."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">At this stage of the project, the fellows had a list of about 200 unmet needs (a.k.a. problems to fix) for each target condition. The needs were entered into a database and ranked by characteristics such as importance to patients and clinicians, and potential cost savings. This helped the team narrow the best ideas to those that addressed the most critical "needs clusters." Then, during the late winter and spring, Patel and the other fellows began assembling their care models, folding in feedback from faculty and mentors.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">When Milstein reviewed the first round of care models, he was worried. He felt that some of the fellows had fallen prey to "anchoring bias," the human tendency to fixate too early on one piece of information when making decisions.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"That's where David Moore, our operations researcher, really helped the team," says Milstein. "He created the economic and analytical framework for each of the care models, and in the case of Patel's plan, the biggest cost-benefit in cancer care came from an unexpected line item – rapid symptom relief."</div><h3 style="margin: 20px 0px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 11px; vertical-align: baseline; background-color: transparent; text-transform: uppercase; color: rgb(76, 136, 170); letter-spacing: 1px; line-height: 19px; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; font-style: normal; font-variant: normal; orphans: 2; text-align: left; text-indent: 0px; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">TALK IS CHEAP</h3><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="introParagraph" style="margin: 0px 0px 10px; padding: 0px; border: 0px; outline: 0px; font-size: 12px; vertical-align: baseline; background-color: transparent; color: rgb(132, 158, 173); text-align: left; letter-spacing: 1px; text-transform: none; line-height: 19px; font-family: Georgia, 'Times New Roman', Times, serif; font-weight: bold; background-position: initial initial; background-repeat: initial initial; ">The side effects of cancer treatments – pain, seizures, debilitating headaches and nausea – can easily overwhelm patients at night or during weekends, when oncologists are difficult to reach.</span> Suffering patients often end up in crowded emergency rooms, waiting hours for relief. Sometimes they're hospitalized overnight, waiting until the oncologists arrive the next morning, accruing thousands of dollars in unnecessary medical bills.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Patel's model provides patients with 24-hour telephone access to nurses trained in cancer care. They guide patients' use of symptom-control medications, pre-positioned at home or delivered within hours.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"Quick symptom relief is not only more humane, but it literally saves thousands of dollars per year for these cancer patients," says Patel.</div><blockquote style="margin: 0px; padding: 40px 15px 30px 35px; border: 0px; outline: 0px; font-size: 14px; vertical-align: baseline; background-color: transparent; quotes: '', ''; width: 160px; text-transform: uppercase; line-height: 2em; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; float: right; display: inline; letter-spacing: 1px; color: rgb(153, 184, 201); font-style: normal; font-variant: normal; font-weight: normal; orphans: 2; text-align: left; text-indent: 0px; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">'WE WERE ALL SO EXHAUSTED AND SUFFERING FROM INFORMATION OVERLOAD. THAT WAS THE LOW POINT. WE COULDN'T IMAGINE HOW WE WERE GOING TO MAKE SENSE OF EVERYTHING WE'D LEARNED.'</blockquote><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Another component of her care model is providing patients with more convenient local access to chemotherapy infusions, giving patients with low-risk treatments the option of receiving the drugs at home, via home health nurses, or at nearby infusion centers, such as those operated by Walgreens across the country. These treatments would be monitored by experienced nurses and pharmacists, and remotely guided by expert oncologists. Patel discovered that this approach is already working well for the Nebraska Veterans Administration hospital.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Perhaps the most important aspect of her model is earlier cancer patient counseling, institutionalizing shared decision-making well before a patient is on the brink of death and emotions overwhelm the decision-making skills of patients, their families and clinicians.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">According to a recent study, end-of-life discussions typically take place only 33 days before death. With Patel's new cancer care model, patients would be thoroughly briefed on the survival odds and side effects before being rushed off to surgery or chemotherapy. Many months before the family is gathered around a loved one's deathbed, a person's final wishes – resuscitation, feeding tubes, assisted breathing and whether a person wants to die at home – would be well-informed and documented.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"Eighty percent of all cancer patients express a desire to die at home, yet only 10 percent do," says Patel. "These conversations, which typically take two hours in the beginning and require many follow-on conversations, are too hard, time-consuming and draining for a busy oncologist to do well."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">These conversations would automatically occur whenever the probability of death is 30 percent or more within three years, based on oncology survival tables.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">After months of scenario building and faculty critiques, the team's care models crystallized for each of the four conditions, and three-year health spending reductions were projected.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Based on a conservative financial model, Patel estimated that her team's new care model would lower the $123,000 annual per-capita health spending of poor prognosis cancer patients by 30 percent – even after paying for its new services.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">The problem? Clinics, hospitals and insurers have to be convinced that paying for these additional services on the front end will pay off on the back end. And this was Patel's challenge as the academic year came to a close – to find partners willing to test her plan, so she could gather and publish evidence on effectiveness.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Finally, after 10 months Milstein and the other faculty decided that the fellows' care models were ready for their first public airing.</div><h3 style="margin: 20px 0px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 11px; vertical-align: baseline; background-color: transparent; text-transform: uppercase; color: rgb(76, 136, 170); letter-spacing: 1px; line-height: 19px; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; font-style: normal; font-variant: normal; orphans: 2; text-align: left; text-indent: 0px; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">THE PITCH</h3><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="introParagraph" style="margin: 0px 0px 10px; padding: 0px; border: 0px; outline: 0px; font-size: 12px; vertical-align: baseline; background-color: transparent; color: rgb(132, 158, 173); text-align: left; letter-spacing: 1px; text-transform: none; line-height: 19px; font-family: Georgia, 'Times New Roman', Times, serif; font-weight: bold; background-position: initial initial; background-repeat: initial initial; ">It was June, six days before the Supreme Court announced its ruling on whether the Affordable Care Act would stand.</span> Patel and her colleagues were about to present their new care models to about 100 health benefit plan leaders of the Pacific Business Group on Health at its annual strategy retreat. The meeting was in a conference center, once a turn-of-the-century mansion, now landlocked in a sea of San Jose tract homes. The conference room walls were papered in easel notes from the previous day, filled with ideas on how to provide the best possible medical care to their employees in the face of escalating health-care costs.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><br>Patel was second up in the presentation, a little nervous and barely tall enough to be seen behind the podium. She stated the problem in her target area: Cancer is the second-leading cause of death in the United States, with costs estimated to be $173 billion by 2020. These rising costs are unsustainable.Milstein introduced the Stanford fellows and summarized the writing on the wall: "The only way we're going to bring per-capita health-care spending in line with revenue growth is to create a continuous flow of more efficient ways of delivering health care. Today, our research fellows will illustrate the first wave of Stanford-designed care models, and we ask that you to consider testing our ideas."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">And what do many poor-prognosis cancer patients get for all the money spent? "Horrible treatment," she said, citing a statistic that silenced the room: Seventy-three percent of terminal cancer patients never have an end-of-life discussion with their oncologists. "Many patients are rushed off to chemotherapy without understanding the big picture. And when predictable treatment side effects happen at night and on weekends, patients who are unable to reach their oncologist end up in misery in emergency rooms and hospitals. Later in their illness, many die painfully in intensive-care facilities that bankrupt their families emotionally – and sometimes financially."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">During her presentation, Patel's eyes became dark pools that threatened to overflow. A few people in the audience wept silently, perhaps remembering loved ones who had similarly suffered.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"Overall, these added services improve the quality of life of patients, giving them what they need and want without delay," she added after describing her model. "And best of all, we lower health insurance costs … simply by doing the right thing."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Afterward, leaders from Disney, Tesla, Boeing and Safeway asked Milstein and the fellows for more details on implementing their models.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">The following week, however, some of Patel's conference calls to health-care providers and insurers didn't go as well.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">At a large clinic in the Midwest, the medical director said to Patel, "Our cancer center is one of the few areas where we're profitable. Thanks just the same, but we'll pass."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">A representative from a large national private health insurer said, "We can't afford to alienate any more of our oncologists by lowering their income."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Another health-care insurer in Seattle referred to her proposal, only half-jokingly, as a "death panel," using the Tea Party's misnomer for the counseling sessions on end-of-life cancer care and hospice that were to be reimbursed under the Affordable Care Act. This provision, which was misinterpreted as government committees encouraging seniors to forgo treatments to save money, was pulled from the act before it passed.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">By the end of the second week of presentations, Patel was deflated. Her care model was dead last in attracting test sites, and she began to realize that a major flaw in her plan was that it threatened the livelihood of the plan's most important participants – oncologists.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">The near-term savings from her care model would come off the bottom-line revenues of oncology practices and cancer centers. Unlike other medical specialties, private-practice oncologists earn most of their money through selling drugs – 65 percent of total revenues come from drug sales and another 21 percent from fees associated with drug infusions, imaging and radiation services, according to the National Oncology Practice Benchmark 2011 Report published in the Journal of Oncology Practice.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">This report goes on to show that only 8 percent of a typical private-practice oncologist's earnings, strictly speaking, comes from "patient time," the revenues earned through conversations about cancer, treatments, side effects, outcomes and end-of-life issues.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"Current incentives are often misaligned to reward doing the most aggressive and expensive actions, as long as patients are satisfied, because this leads to the highest return to the practice," says Thomas J. Smith, director of palliative care at Johns Hopkins, in a 2010 article in Oncologist. "Some consequences include U.S. cancer treatment costs that are twice that of any other nation with no or minimal differences in survival, late referrals (if at all) to hospice, and 14 to 20 percent of patients receiving chemotherapy within 14 days of their death, when it is highly likely to harm and cause complications."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Private-practice oncologists, on the other hand, argue that they are losing money because Medicare reimbursement rules don't cover overhead costs for drug administration, inventory and bad debt. They understandably want to fight the erosion of their revenue base, which has fallen 33.5 percent in the last six years. But as the Affordable Care Act seeks to wean the medical system away from the fee-per-service structure, Patel hopes her model can be the bridge from the old compensation model to a new one, based on shared savings from more humane and effective treatments.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">After the first two weeks of sales pitches, Milstein organized an expert panel to critique the fellows' presentations, prepping them for more presentations over the summer. Milstein was joined by Rob Rebitzer, a CERC consultant and a former partner in Accenture's health-care consulting group. Together, they offered advice on speaking more simply and slowly, "like Mr. Rogers," to certain groups. And they suggested clarifying that the substantial savings from each new care model would be shared by employers, physicians and patients within large health insurance groups.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">For Patel's plan, they recommended that criticism of oncology compensation structures be replaced with ideas on oncology profit-sharing incentives. And overall, Patel should stress the win-win aspects of her model – better care that saves the system money.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">At the end of the session Milstein spoke from the heart to his fellows: "I know it's difficult to offer advice to a room full of senior health-care professionals who are all older than you, but think back on all the knowledge that you've gained over the last year. And remember, you represent <em style="margin: 0px; padding: 0px; border: 0px; outline: 0px; font-size: 13px; vertical-align: baseline; background-color: transparent; background-position: initial initial; background-repeat: initial initial; ">hope</em> to these people."</div><h3 style="margin: 20px 0px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 11px; vertical-align: baseline; background-color: transparent; text-transform: uppercase; color: rgb(76, 136, 170); letter-spacing: 1px; line-height: 19px; font-family: 'Trebuchet MS', Arial, Helvetica, sans-serif; font-style: normal; font-variant: normal; orphans: 2; text-align: left; text-indent: 0px; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">IN THE WAITING ROOM</h3><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="introParagraph" style="margin: 0px 0px 10px; padding: 0px; border: 0px; outline: 0px; font-size: 12px; vertical-align: baseline; background-color: transparent; color: rgb(132, 158, 173); text-align: left; letter-spacing: 1px; text-transform: none; line-height: 19px; font-family: Georgia, 'Times New Roman', Times, serif; font-weight: bold; background-position: initial initial; background-repeat: initial initial; ">By the end of July – after dozens of presentations on her advanced-cancer-care model, Patel got good and bad news. </span>The good news was that five groups expressed interest in piloting her program. One large hospital in California agreed to test most of her new care model. A large employer agreed to offer financial incentives to fully implement her care model with a health system serving a large number of its employees. Three others were leaning toward implementation but had not given the final go-ahead.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">The bad news: Patel's mother came back to Stanford for a follow-up appointment with her oncologist to make sure her breast cancer hadn't recurred. The mammogram showed no tumors, but the bone scan showed an anomaly, and now Patel and her mother were going through the tortuous process of waiting for results.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">"My mother is my best friend," says Patel. "I talk to her about everything. Except my worries about her cancer."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Watching the compassionate handling of her mother's case by the veteran Stanford breast cancer specialist forever changed Patel's view of how physicians should talk to cancer patients and their families. It impressed her with the need for a calm, experienced, neutral coach to talk a patient through the life-changing experience of a cancer diagnosis. She realized that there are thousands of factors, seen and unseen, involved in cancer treatment decisions. And that an informed patient – with the support of friends, family, counselors and oncologists – needs to be at the center of those decisions. Now she wants to share what she's learned with others.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Mrs. Patel recently spoke about how proud she is of her daughter: "Four years after my cancer, I'm still here. I thank my daughter for that. I can't wait to see how she will make a difference in helping other cancer patients."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">As Patel sat in the waiting room with her mother, she mentally ran through worst-case scenarios of other cases she's seen, and she worried. But she understood that her mother needed to be able to make these decisions on her own.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 13px; vertical-align: baseline; background-color: transparent; text-indent: 20px; color: rgb(99, 99, 99); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: left; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Then Patel was handed her mother's bone scan report. She looked it over and breathed a sigh of relief. It was clear. And at that moment, she took off her white coat and tried to simply be a supportive daughter.</div><div><br></div><div><a href="http://stanmed.stanford.edu/2012fall/article3.html?src=longreads">http://stanmed.stanford.edu/2012fall/article3.html?src=longreads</a><br><br></div>

Against the odds - A band of rebels fights to save health care - Stanford Medicine Magazine

Manali Patel, MD, had dark circles under her eyes after a rough week battling tumors at the Stanford Cancer Institute. Patel, 33, doe-eyed a...

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How Drug Company Money Is Undermining Science: Scientific American

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><p style="margin: 0px 0px 25px; padding: 0px; border: 0px; outline: rgb(0, 0, 0); font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); line-height: 24px; color: rgb(34, 34, 34); font-family: georgia, times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">When Robert Lindsay chose to become a medical researcher in the early 1970s, he did not do it for the money. His field—the effect of hormones on bone—was a backwater. It was also a perfect opportunity for a young researcher to make his mark and, he hoped, help millions of people who suffered from the bone disease osteoporosis. As the body ages, sometimes bones lose the ability to rebuild themselves fast enough to keep pace with the normal process of deterioration, and the skeleton weakens. Neither Lindsay nor anyone else understood much about why this happened, but there was reason to think that hormones might play a role. Some women develop osteoporosis shortly after menopause, when their hormone levels drop sharply, perhaps upsetting that balance between bone creation and destruction. If so, Lindsay reasoned, replacing the hormones with a pill might halt or even reverse the progress of the disease. From a tiny, underfunded clinic in Glasgow, Scotland, he set up one of the first clinical trials of estrogen replacement therapy for bone loss in postmenopausal women. Lindsay's star was rising.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 25px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-color: rgb(0, 0, 0); outline-width: initial; outline-style: initial; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); line-height: 24px; color: rgb(34, 34, 34); font-family: georgia, times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; position: static; z-index: auto; ">His next project had big commercial implications and got the attention of the drug industry. Having moved to Helen Hayes Hospital, a rehabilitation center north of New York City, in 1984 he published work that established the minimum effective dosage of an antiosteoporosis estrogen drug called Premarin. Because the findings suggested that fighting osteoporosis was tantamount to encouraging millions of women to use the drug, it made Lindsay an important person in the eyes of the drug's manufacturer, Wyeth-Ayerst Laboratories. Indeed, the company gave him a role as an author of its informational video <i style="margin: 0px; padding: 0px; border: 0px; outline: rgb(0, 0, 0); font-size: 16px; vertical-align: baseline; background-color: transparent; background-position: initial initial; background-repeat: initial initial; ">Osteoporosis: A Preventable Tragedy</i>.</p><p style="margin: 0px 0px 25px; padding: 0px; border: 0px; outline: rgb(0, 0, 0); font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); line-height: 24px; color: rgb(34, 34, 34); font-family: georgia, times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">By the mid-1990s, when Wyeth got caught in a patent battle over Premarin, Lindsay was a staunch Wyeth ally. He came out against approval of a generic version of the drug that would have cut into sales even though the generic form would have made it easier for osteoporosis patients to receive therapy. His reasoning was that such versions might not be precisely equivalent to the brand-name drug, a fact that can be true with certain drugs but was also a position that happened to echo the company line. "All we're asking is that we don't approve something now and regret it" later, he told the Associated Press in 1995. Lindsay's close relationship with Wyeth and other drug companies carried on for decades, in ways that were sometimes hidden. He started allowing Wyeth to draft research articles and began taking tens of thousands of dollars from pharmaceutical interests that stood to gain from his research.</p><p style="margin: 0px 0px 25px; padding: 0px; border: 0px; outline: rgb(0, 0, 0); font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); line-height: 24px; color: rgb(34, 34, 34); font-family: georgia, times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">The scandal is not what Lindsay did so much as that his case is typical. In the past few years the pharmaceutical industry has come up with many ways to funnel large sums of money—enough sometimes to put a child through college—into the pockets of independent medical researchers who are doing work that bears, directly or indirectly, on the drugs these firms are making and marketing. The problem is not just with the drug companies and the researchers but with the whole system—the granting institutions, the research labs, the journals, the professional societies, and so forth. No one is providing the checks and balances necessary to avoid conflicts. Instead organizations seem to shift responsibility from one to the other, leaving gaps in enforcement that researchers and drug companies navigate with ease, and then shroud their deliberations in secrecy.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 25px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-color: rgb(0, 0, 0); outline-width: initial; outline-style: initial; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); line-height: 24px; color: rgb(34, 34, 34); font-family: georgia, times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; position: static; z-index: auto; ">"There isn't a single sector of academic medicine, academic research or medical education in which industry relationships are not a ubiquitous factor," says sociologist Eric Campbell, a professor of medicine at Harvard Medical School. Those relationships are not all bad. After all, without the help of the pharmaceutical industry, medical researchers would not be able to turn their ideas into new drugs. Yet at the same time, Campbell argues, some of these liaisons co-opt scientists into helping sell pharmaceuticals rather than generating new knowledge.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 25px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-color: rgb(0, 0, 0); outline-width: initial; outline-style: initial; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); line-height: 24px; color: rgb(34, 34, 34); font-family: georgia, times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; position: static; z-index: auto; ">More ...</p></div><a href="http://www.scientificamerican.com/article.cfm?id=how-drug-company-money-undermining-science&print=true&src=longreads">http://www.scientificamerican.com/article.cfm?id=how-drug-company-money-undermining-science&print=true&src=longreads</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

How Drug Company Money Is Undermining Science: Scientific American

When Robert Lindsay chose to become a medical researcher in the early 1970s, he did not do it for the money. His field—the effect of hormone...

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US TROOPS TO BE DEPLOYED TO SINAI

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQya13tHWQfL0zCh3yEdiafsM2q8kYuNZCxqhwqg5ie57C8r1HLVXAnj_p-JRgyYesZviRjZxHocPaLbQJIcPXfyoBP2lN7JSLScohMXiG9Oh1ggxyyhc3M-jo0zZkihj6xsOxEFhTf3Wl/s1600/US-troops-deploying-israel.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQya13tHWQfL0zCh3yEdiafsM2q8kYuNZCxqhwqg5ie57C8r1HLVXAnj_p-JRgyYesZviRjZxHocPaLbQJIcPXfyoBP2lN7JSLScohMXiG9Oh1ggxyyhc3M-jo0zZkihj6xsOxEFhTf3Wl/s320/US-troops-deploying-israel.jpg" width="320" /></a></div><h1 class="s1mainStoryHeadline"><span style="font-size: x-large;"><span style="color: red;">Obama’s pledge of US troops to Sinai next week won Israel’s nod for ceasefire</span></span></h1><span class="articleDescription"><span style="font-size: large;"><span style="font-size: small;">Via</span> </span>DEBKA<i>file</i></span> <br /><br /><br /><div style="text-align: justify;"><span class="articleBody"></span></div><span style="font-size: large;">Israeli Prime Minister Binyamin Netanyahu agreed to a ceasefire for halting the eight-day Israeli Gaza operation Wednesday night, Nov. 21, after President Barack Obama personally pledged to start deploying US troops in Egyptian Sinai next week, <span class="debka">debka</span><span class="file">file</span> reports. The conversation, which finally tipped the scales for a ceasefire, took place on a secure line Wednesday morning, just hours before it was announced in Cairo. The US and Israeli leaders spoke at around the time that a terrorist was blowing up a Tel Aviv bus, injuring 27 people.</span><br /><span style="font-size: large;"><br /> Obama’s pledge addressed Israel’s most pressing demand in every negotiating forum on Gaza: Operation Pillar of Cloud’s main goal was a total stoppage of the flow of Iranian arms and missiles to the Gaza Strip. They were smuggled in from Sudan and Libya through southern Egypt and Sinai. Hostilities would continue, said the prime minister, until this object was achieved.</span><br /><span style="font-size: large;"><br /> Earlier, US officials tried unsuccessfully to persuade Israel to accept Egyptian President Mohamed Morsi’s personal guarantee to start launching effective operations against the smugglers before the end of the month. The trio running Israel’s Gaza campaign, Netanyahu, Defense Minister Ehud Barak and Foreign Minister Avigdor Lieberman, were willing to take Morsi at his word, except that Israeli security and intelligence chiefs assured them that Egypt has nothing near the security and intelligence capabilities necessary for conducting such operations.</span><br /><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5hmyxJMSlw1nSKKMXOq0X61aMrlrXVlMeNfM67eJGAjIuxAvOj6fGy_g52oGazBEpI1HX_lWfATE6zR4Wism1tSkhS5-EEmaR7tjBgF2rvsxlm6lGPPF8TzNioVLpDb-7iqvYIwQirFIe/s1600/2011-634489308713979080-397.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5hmyxJMSlw1nSKKMXOq0X61aMrlrXVlMeNfM67eJGAjIuxAvOj6fGy_g52oGazBEpI1HX_lWfATE6zR4Wism1tSkhS5-EEmaR7tjBgF2rvsxlm6lGPPF8TzNioVLpDb-7iqvYIwQirFIe/s320/2011-634489308713979080-397.gif" width="255" /></a></div><span style="font-size: large;">When Secretary of State Hillary Clinton arrived in Jerusalem from Bangkok Tuesday, she tried assuring Netanyahu that President Obama had decided to accelerate the construction of an elaborate US system of electronic security fences along the Suez Canal and northern Sinai. It would also cork up the Philadelphi route through which arms are smuggled into the Gaza Strip. (The US Sinai fence project was first disclosed exclusively by <b><span class="weekly">DEBKA</span><span class="weekly">-Net-Weekly</span> 564 </b>on Nov. 9).</span><br /><span style="font-size: large;"><br /> US security and civilian units will need to be deployed in Egyptian Sinai to man the fence system and operate it as an active counter-measure for obstructing the smuggling of Iranian weapons supplies.</span><br /><span style="font-size: large;"> The prime minister said he welcomed the president’s proposal to expedite the fence project, but it would take months to obtain Egyptian clearance. Meanwhile, the Palestinians would have plenty of time to replenish their weapons stocks after Israel’s Gaza campaign. It was therefore too soon to stop the campaign at this point or hold back a ground incursion.</span><br /><span style="font-size: large;"><br /> Clinton was sympathetic to this argument. Soon after, President Obama was on the phone to Netanyahu with an assurance that US troops would be in place in Sinai next week, after he had obtained President Morsi’s consent for them to go into immediate action against Iranian smuggling networks.</span><br /><span style="font-size: large;"> Netanyahu responded by agreeing to a ceasefire being announced in Cairo that night by Clinton and the Egyptian foreign minister, and to holding back the thousands of Israeli reservists on standby on the Gaza border.</span><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFVsX5Q5zZGPKsFuwrKRuw9vznZ4GGafgW6czSfUPJ7kgttYqyYZRC26zVAyeQ95wpi3C7zO_QzVR7k7l0etc6E8Gq5lqCKu5OJvtHBpdFfFKmWh97wQUri1DTwE2M6tljhzN3OP4c-tCh/s1600/barack-obama-israel-000.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="233" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFVsX5Q5zZGPKsFuwrKRuw9vznZ4GGafgW6czSfUPJ7kgttYqyYZRC26zVAyeQ95wpi3C7zO_QzVR7k7l0etc6E8Gq5lqCKu5OJvtHBpdFfFKmWh97wQUri1DTwE2M6tljhzN3OP4c-tCh/s320/barack-obama-israel-000.jpg" width="320" /></a></div><span style="font-size: large;"><span class="debka">debka</span></span> <span style="font-size: large;"><span class="file">file</span>’s military sources report that the first air transports carrying US special forces are due to land at Sharm el Sheikh military airfield in southern Sinai in the next 48 hours and go into action against the arms smugglers without delay.</span><br /><span style="font-size: large;"><br /> This development is strategically significant for three reasons:</span><br /><br /><span style="font-size: large;"> 1.  Once the missile and arms consignments depart Iranian ports or Libyan arms bazaars, Tehran has no direct control of their transit from point to point through Egypt until they reach Sinai and their Gaza destination. All the same, a US special forces operation against the Sinai segment of the Iranian smuggling route would count as the first overt American military strike against an Iranian military interest.</span><br /><span style="font-size: large;"> Netanyahu, Barak and Lieberman are impressed by the change the Obama administration has undergone since the president’s reelection. Until then, he refused to hear of any military action against Iran and insisted that Tehran could only be confronted on the diplomatic plane.</span><br /><span style="font-size: large;"><br /> 2.  President Morsi, by opening the Sinai door to an American troop deployment for Israel’s defense, recognizes that the US force also insures Israel against Cairo revoking or failing to honor the peace treaty Egypt signed with Israel in 1979.</span><br /><br /><span style="font-size: large;"> 3.  In the face of this US-Israel-Egyptian understanding, Hamas cannot credibly claim to have won its latest passage of arms with Israel or that it obtained guarantees to force Israel to end the Gaza blockade.<br /> Indeed, Gaza’s Hamas rulers will be forced to watch as US troops in Sinai, just across its border, break up the smuggling rings filling their arsenals and most likely laying hands on the reserve stocks they maintain under the smugglers’ guard in northern Sinai, out of reach of the Israel army. This means that the blockade on Gaza has been extended and the focus of combat has switched from Gaza to the Sinai Peninsula. </span>

US TROOPS TO BE DEPLOYED TO SINAI

Obama’s pledge of US troops to Sinai next week won Israel’s nod for ceasefire Via DEBKA file Israeli Prime Minister Binyamin Netany...

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