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AJMCtv® Interviews, August 2017

Evidence-Based OncologyAugust 2017
Volume 23
Issue SP10

AJMC®TV interviews let you catch up with experts on what’s new and important about changes in healthcare. The interviews provide insights from key decision makers-from the clinician, to the health plan leader, to the regulator. When every minute in your day matters, AJMC®TV interviews keep you informed. You can access the video clips at ajmc.com/interviews.

How Being a Nurse Prepared Dr Patricia Flatley Brennan to Be NLM Director

Being a nurse prior to becoming director of the National Library of Medicine (NLM) offered Patricia Flatley Brennan, RN, PhD, a greater appreciation and understanding of the need for information at the point of care and to provide patients with information to practice self-care and self-management.

How will your experiences as a practicing nurse help inform your work as the director of NLM?

My practice in nursing was in intensive care nursing and psychiatric nursing, and it provides 2 inspirations that drive my work. The first is, I understand the criticality of information at the point of care, particularly under emergency circumstances. So, it makes me very aware of the importance of having a large repository of information that is the evidence for healthcare, but also effective ways to deliver at the point of need.

The second is, through my practice in psychiatric nursing, I learned the importance of patient engagement and the importance of ensuring the participant in care had the kind of information he or she both needed to participate as a partner in care and also self-manage. So, I recognize that our resources, while they’re largely built by biomedical scientists for the practice of professional care, they need to be translated and made accessible for individuals for self-care and self-management.

Dr Craig Portell Highlights New and Exciting Treatments for Non-Hodgkin’s Lymphoma

Craig Portell, MD, of the University of Virginia Health System, discussed some of the most exciting developments in the treatment of non-Hodgkin’s lymphoma, including CAR T therapies and targeted therapies, such as venetoclax.

What is the latest in treatments for non-Hodgkin’s lymphoma?

There are many new and exciting treatments for non-Hodgkin’s lymphoma that are coming up. Some of them are changing the standard rituximab antibody, doing new novel ways of targeting CD20 in non-Hodgkin’s lymphoma. Some of them are having very good outcomes and prolonging progression-free survival when compared to rituximab.

There’s also cellular therapies, such as CAR (chimeric antigen receptor) therapy, where patients’ own T cells are activated and stimulated to attack non-Hodgkin’s lymphoma cells as well as other normal B cells. It’s kind of a targeted way of doing an allogeneic stem cell transplant. Those are labor intensive and difficult to do, but as we move forward in the field, as it gets easier to do, I think those are going to be very promising.

Of course, we also have many small molecule targeted therapies that are becoming increasingly used in non-Hodgkin’s lymphoma, including ibrutinib, idelalisib, and any of the other targeted therapies in the B-cell receptor pathway. Finally, one of the more exciting drugs in targeted therapy is venetoclax. We just recently had a publication out of Journal of Clinical Oncology, which showed efficacy of venetoclax, how we use it and where we use it, and monitoring for tumor lysis is very important when we move to using venetoclax more and more in non-Hodgkin’s lymphoma.

Dr Zirui Song: Working at the Intersection of Clinical Medicine and Health Policy

Zirui Song, MD, PhD, resident at Massachusetts General Hospital, discussed his research interests, which center on strategies to control healthcare spending while improving the quality of care. He also expressed the importance of examining health equity within the United States healthcare system.

What is the main focus of your research?

The main purpose of my work has been to evaluate strategies for controlling the growth of healthcare spending. These have involved several different approaches: those that work on prices, those that work on quantities, and those that work on the collective product of prices and quantities, which is spending.

Most of my work has centered around evaluating a global payment contract or Alternative Quality Contract, in Massachusetts. In addition, some of the related work has surrounded evaluations of Medicare payment changes for physicians and for health plans and Medicare. Largely, the broader theme is, what can policy makers do to slow the growth of healthcare spending while we try to, at the same time, improve the quality of care that patients get.

What topics would you like to explore next for your research?

I would like to continue working at the intersection of clinical medicine and health policy. I plan to continue working on evaluating policy strategies to control healthcare spending while improving care quality. The overarching goal, is to improve the value of healthcare spending in the United States, the value for the dollar that we spend, whether that be the public dollar for the Medicare or Medicaid system or the private dollar for populations under 65.

I would also like to pursue work that looks at the equity in our healthcare system, because for all of the policies that are trying to do good, one of the things that we can’t forget is the equity and equality of what we do as physicians, as policy makers.

Dr David Cutler Assesses the Political Odds of Drug Pricing Reform

Members of Congress from both parties may have difficulty finding a common solution to high drug prices, but President Donald Trump could be instrumental in bringing prices down if he acts on his pledges, according to David M. Cutler, PhD, of Harvard University.

The need to rein in drug prices is an area where Democrats and Republicans agree. Do you think they might be able to pass legislation addressing rising drug costs? What might it look like?

On drug costs, as with everything in healthcare, the best guess is always no change. Both sides are upset that there are people who can’t afford medications, but what they would do about it is different, so the ability to compromise will be difficult.

There are things they can do about the FDA, and they’re doing a little bit of that, but the other major issues about things like prices of new medications, price increases, how much you can charge people who are uninsured, things like that, I don’t see a lot of agreement upon. I think the wild card here is the President, whose sympathies on this seem to lie much more with the Democrats than with the Republicans. If he decided to do something there and he was going to work with the Democrats and bring things along, he could force the issue more. I don’t know whether he will.

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