I moderated a panel discussion at the recently completed Pathology Futurescape conference sponsored by the CAP Foundation. The panel members spoke to the topic of Corporate Innovation as an Engine for Change and included the following corporate representatives: Gene Cartwright (GE), David Okrongly (Siemens), Dirk Soenksen (Aperio), and Mark Newburger (Apollo PACS). During the course of the discussion about the future of integrated diagnostics, Gene Cartwright suggested that we need to move resources from the therapeutic to the diagnostic silo in order to achieve the promise of pre-symptomatic/pre-clinical diagnoses for patients. This basic idea is incorporated in the concept of the early health model being championed by both GE and Siemens and about which I have posted a number of previous notes. There was insufficient time during the panel discussion to discuss any of the practical details about how to achieve such a reallocation of resources and about which I would now like to speculate.
I have come to the conclusion that the key to increasing available resources for diagnostics in the U.S. healthcare delivery system is embedded in the concept of therapeutic efficacy. By this I mean that we need to begin to organize a broad diagnostic effort to determine whether the various drugs being prescribed and administered to patients, particularly expensive chemotherapeutic agents, are achieving their intended results. Put another way, is the chemotherapy being administered to patients inhibiting the course of the disease or curing the patient? Therapeutic efficacy can be measured by means of biomarker monitoring and medical imaging.
The necessary first step in this process will be to determine criteria for measuring therapeutic efficacy by drug by disease and recommending the diagnostic tests and procedures used to measure efficacy. After these criteria have been developed, the program can proceed. A number of possible drug treatments will never be initiated because of negative results obtained from companion diagnostics. Other drugs will be discontinued at some point during therapy because of lack of measurable efficacy. A portion of the dollar savings achieved by the termination of drugs can be reallocated to offset the increased cost of the diagnostics used to assess drug efficacy on a much broader basis.
Needless to say, broader scrutiny of the therapeutic efficacy of drug therapy and terminating proven ineffective therapy will not be greeted with enthusiasm by the pharmaceutical companies despite the fact that the technology exists to mount such programs and the idea aligns closely with a fundamental principle of medicine -- Primum, non nocerum (First, do no harm). Fortunately, neither GE or Siemens, as compared to Roche, has any stake in drug manufacturing. Perhaps they may be willing to throw their weight behind these efforts.
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