January 15, 2010

Evidence-based medicine key to health reform

Evidence-based medicine key to health reform

True health care reform will be achieved not by insurance reform, but by developing and applying evidence-based medicine, according to Jeff Balser, M.D., Ph.D.

Jeff Balser, M.D., Ph.D.

Jeff Balser, M.D., Ph.D.

“The real value in health care is changing the way we deliver care. It's not arguing about how we pay for care,” said Balser, vice chancellor for Health Affairs and dean of the Vanderbilt University School of Medicine.

“It's basic, fundamental science,” he told Vanderbilt physician-scientists attending a research retreat last week at the Frist Center for the Visual Arts, “key discoveries that make it possible to think about directing chemotherapy to the individual tumor, but then also having systems that let you do that in large populations.

“If you don't have both, you get nowhere.”

Balser, who began his career as an M.D./Ph.D. student at Vanderbilt in the late 1980s, said that one of the University's greatest strengths is its support and nurturing of young physicians-scientists.

The Vanderbilt Office for Clinical and Translational Scientist Development, which organized last month’s retreat, oversees several degree-granting and mentoring programs, including the Elliot Newman Society, to help prepare the next generation of physician-scientists for successful careers.

“Vanderbilt invests a lot in you and sees you as the future of the research enterprise,” Nancy Brown, M.D., associate dean for Clinical and Translational Scientist Development, told the group.

That investment is already paying dividends, as indicated by the research reports given during the half-day retreat.

Jonathan Schoenecker, M.D., Ph.D., assistant professor of Orthopaedics and Rehabilitation, discussed efforts to find the “personalized dose” of blood thinner to give patients following orthopedic surgery. That is exactly the amount needed to prevent a subsequent blood clot without slowing healing and increasing the risk for infection.

Edward Siew, M.D., clinical instructor in the Division of Nephrology and Hypertension, described the search for novel biomarkers to improve early detection of acute kidney injury in critically ill patients.

Siew and Schoenecker are Elliot Newman Scholars.

“Personalized medicine” approaches like this potentially will improve outcomes, reduce hospital stays and cut health care costs by billions of dollars every year, Balser said.

Other speakers included Dan Roden, M.D., assistant vice chancellor for Personalized Medicine, who gave an update on Vanderbilt's DNA databank, and Daniel Beauchamp, M.D., chair of the Section of Surgical Sciences, who described advances in understanding colorectal cancer metastasis.