Biggest challenge facing the American Healthcare system?

[Human_Genome]

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There was a huge thread going on about that a while ago, wondering if anyone saved it? the search function does not work.

 

[8744]

The biggest challenge facing the American health care system is that in two years I will be a doctor.

Be afraid.

 

[pathdr2b]

Originally posted by Panda Bear
The biggest challenge facing the American health care system is that in two years I will be a doctor.

Be afraid.

Seriously, I think the biggest threat to health care is the rising incident rates of cancer among minorities and the disadvantaged. Huge drain on the financial side for the unisured/underinsured not to mention the years of potentially productive life lost to such a wasteful disease.🙁

 

[DW]

Originally posted by Panda Bear
The biggest challenge facing the American health care system is that in two years I will be a doctor.

Be afraid.

I was gonna say the biggest challenge in the future was a generation of doctors pathologically addicted to a certain internet forum 😉

 

[lola]

Originally posted by DW


I was gonna say the biggest challenge in the future was a generation of doctors pathologically addicted to a certain internet forum 😉

i can just see myself now... hold on mr. smith, i need to check out the new threads in the lounge before examining you.

 

[penn03]

Actually, the incidence of cancer isn't any higher than it has been in the past. You also need to take into consideration the fact that the average life span of the American has increased significantly in the past century... so it only makes sense that we would see more degenerative and chronic diseases than before. I don't think minorities are disproportionately affected, either -- at least not by cancer. We should be more concerned with the increasing prevalence of economically draining conditions like diabetes (which does disproportionately affect minorities by almost a 2:1 ratio) and which costs the US healthcare industries and government a combined 18 billion per year.

I think the biggest threat to the American healthcare system is the increasing demand of patients wanting to be treated for every little non-threatening ailment, thus driving up costs. Also, we can't forget that one of the biggest threats comes from inside the healthcare industry -- the pharmaceutical companies -- they charge exorbitant prices and lobby for the extension of patent laws to prevent cheaper, generic drugs from being manufactured. They also try to basically buy doctors into prescribing their drugs by offering free samples, vacations, dinners, etc, etc. All this eventually comes back to the consumer in the form of everything from increased insurance costs, higher social security taxes, less comprehensive insurance coverage, etc.

 

[pathdr2b]

Originally posted by penn03
Actually, the incidence of cancer isn't any higher than it has been in the past. I don't think minorities are disproportionately affected, either -- at least not by cancer. We should be more concerned with the increasing prevalence of economically draining conditions like diabetes (which does disproportionately affect minorities by almost a 2:1 ratio) and which costs the US healthcare industries and government a combined 18 billion per year.

With all due repsect and as current Cancer Epidemiology Training Fellow at the National Cancer Institute, I know for a fact URM's ARE disproportionately affected (check the SEER data) with higher cancer incidence rates overall AND lower survival rates. That's why in the president's latest budget to the NCI, addressing health disparities is one the 5 areas getting extra $$ this year.

You are however, right about diabetes being an important health issue as well.

 

[penn03]

Okay, well if you're an expert I'm not going to argue, although my first question would be: what age group of URMs has the highest incidence of cancer? And, what types of cancer? Are these cancers presumed to be primarily of genetic or of environmental origin? I think this issue (higher incidence rate in minorities) is fundamentally a socioeconomic issue (i.e., minorities, on average, have lower incomes than non-minorities). They do not have proper access to health care (because they either do not qualify for government assisted health insurance or do not know how to obtain the necessary support). So, if you took a sample of minorities in a high income bracket with health insurance coverage (let's say income > 60k) and compared them with a similar set of non-minorities, and also a group of low income, uninsured minorities and a group of low income (poverty level or below) non-minorities, are there significant differences in incidence?

I'd also like to point out that as a cancer epidemiologist, you are inherently biased in saying that the biggest threat is cancer 🙂

 

[pathdr2b]

I'm not yet an expert but hope to one day be one. I do study this stuff 60 or so hours a week.

Originally posted by penn03
Okay, well if you're an expert I'm not going to argue, although my first question would be: what age group of URMs has the highest incidence of cancer?

1) 30-50

Originally posted by penn03
And, what types of cancer?

2) Pretty much everything EXCEPT skin for reasons that should be obivious. By "everything", I'm talking about cancers such as prostate, breast, cervical, lung, pancreatic, major organs. However, survival for skin is lower because these type of cancers often show up in URM's on the feet and I don't know about you but when was the last time you looked at the bottom of your feet?

Originally posted by penn03
Are these cancers presumed to be primarily of genetic or of environmental origin?

3) Both. Some types of genetic cancers ie BRCA1/2 have recenty been shown to not only be more prevelant from a percentage point of view but also involve multiple "founder" mutations in URM's. This is thought to be because URM's tend to be a very heterogeneous group genetically which actually makes getting to the bottom of the role of genetics in cancer among URM's very difficult. For environmental factors, just think about the city of Baltimore. Inner city Baltimore was basically very industrilized say 75 years ago which is where many URM's live due to socioeconomic factors. Therefore, these kids high levels of "liquid" cancers (leukemia) due to the exposure to industrial chemicals. As you stated, socioeconomic factors do play a large role no matter the race in environmentally linked cancers. We all know that rich folks don't live next to sewage treatment plants.

Originally posted by penn03
So, if you took a sample of minorities in a high income bracket with health insurance coverage (let's say income > 60k) and compared them with a similar set of non-minorities, and also a group of low income, uninsured minorities and a group of low income (poverty level or below) non-minorities, are there significant differences in incidence?

4)Unfortunately the answer is no. Most (but not all) studies show that even with stratification based on income and other factors, there are no significant differences in either incidence or survival between low and high income URM's. The realization of this fact is my main motivation for a career that focuses on answering why these disparities exist.

Finally let me say the this information is not absolute. There are studies which show there are no differences but these are few and far between. Also from what I see in the clinic, I just don't buy it.

Hope this helps and thanks for the interview practice!

 

[pathdr2b]

Originally posted by penn03
I'd also like to point out that as a cancer epidemiologist, you are inherently biased in saying that the biggest threat is cancer 🙂

My FORMAL training is as a basic scientist (Biological Chemistry). So my approach to cancer I think is a little different than that of a strict cancer epidemiologist although I know where you're coming from in making that assumption. In the "real" world and from what I've seen, people doubt the "credibility" of epidemiologists that don't have the basic science training to back up their research.