Fwd: A Black Hole of Patient Safety

Joe's New Gmail jgraedon at GMAIL.COM
Thu Sep 15 12:16:08 UTC 2016

Thanks to George for bringing this important issue to the table and thank you Mark for alerting us. Truly a very crucial point and one that should be central to the evaluative process. 


> On Sep 13, 2016, at 10:46 AM, Mark Graber <mark.graber at IMPROVEDIAGNOSIS.ORG> wrote:
> George, I’ve taken the liberty of sharing your email and the link to the article with the SIDM listserv audience.  You’ve raised an extremely important point, that without autopsies we’ll never know if a cancer death was the result of the malignancy or its treatment.  The IOM report “Improving Diagnosis in Health Care” called for more autopsies in the US.  The example you cite is another argument in favor of this recommendation.
> Thanks for calling this to attention,
> Mark
> Mark L Graber MD FACP
> Senior Fellow, RTI International
> Professor Emeritus, SUNY Stony Brook
> President, Society to Improve Diagnosis in Medicine
> Begin forwarded message:
> From: George <gdlundberg at gmail.com>
> Subject: A Black Hole of Patient Safety
> Date: September 13, 2016 at 10:13:37 AM EDT
> To: Elizabeth Burton <ecburtonmd at gmail.com>, "Dr. Kaveh Shojania" <kaveh.shojania at sunnybrook.ca>, "R.E.Horowitz" <r.e.horowitz at ucla.edu>, robert.wachter at ucsf.edu
> Cc: Mark Graber <mark.graber at improvediagnosis.org>, Paul Epner <paul.epner at improvediagnosis.org>
> Resent-From: <Mark.Graber at Improvediagnosis.org>
> Good morning,
> Please open this 2012 article. I believe that it is open access, full text.
> http://www.nature.com/bjc/journal/v107/n1/full/bjc2012252a.html
> In my CollabRx role, I attended an all day program on Targeted Therapy vs Immunotherapy in advanced cancer.....all types, last Saturday; many academic hotshots. Large numbers of expensive clinical trials inform the field. Progression free survival PFS and overall survival OS are the holy grail of data. And, in fairness, some PPs did address adverse effects.
> Next week I will be publishing a blog at Curious Dr. George by Professor Michael Baum of University College London. He argues eloquently that Quality of Life is co-equal to Length of Life in those  cancer patients who progress beyond curative standard of care (700 000 Americans annually). 
> One speaker lamented the difficulty of academically studying frequency/severity of adverse effects in reports of clinical trials.
> Why did autopsies in clinical trials fall off the cliff? How can the investigators draw meaningful conclusions about beneficial vs harmful effects of these very powerful new agents without autopsies? Was it the cancer or the treatment that killed the patient?
> Considering the cost of current cancer therapeutics, routine autopsy costs would be trivial.
> Reactions???
> Best,
> george
> George D Lundberg, MD
> Chief Medical Officer and Editor in Chief, CollabRx, a Rennova Health Company
> Editor at Large, Medscape
> Consulting Professor of Pathology and Health Research and Policy, Stanford
> Executive Adviser, Cureus
> President and Board Chair, The Lundberg Institute
> 312 560 0290 cell
> @glundberg
> gdlundberg at gmail.com
> Sent from my iPad mini
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