Tag Archives: medicine

Real data — in real time — can advance health outcomes

September 11, 2001 changed a lot of people’s lives. For Ronac Mamtani, a senior in college about to launch his financial career at a firm across the street from the Twin Towers, that day crystalized for him his desire to help others and inspired his pivot to a future in medicine.

What I enjoyed most about my oncology training at Penn Medicine in Philadelphia was the specific training in clinical epidemiology and biostatistics. These fields have set the foundation for my research career. I tell people I wear two hats: I’m a medical oncologist who takes care of patients with bladder cancer, and I’m a health-outcomes researcher using “real-world data” — data captured outside clinical trials — to find a way to better understand risks and benefits of cancer therapy.

In oncology we rely heavily on clinical trials to make treatment recommendations, and that’s good. Clinical trials are the gold standard. The problem is that clinical trials are long and expensive. There are strict eligibility criteria, and fewer than five percent of cancer patients actually will participate.

Let’s say a clinical trial finds treatment A more effective than treatment B. I might have a patient who wants to know: should I take treatment A after treatment C, or before treatment C? Clinical trials often don’t answer questions about best sequence. With big data, I could answer that question. We can get data from electronic records, study treatment patterns, use advanced statistics to compare treatment groups, and define the optimal treatment sequence.

With data-driven research, we are applying cuttingedge analytics on large data sets derived from electronic records on millions of people to understand treatment effects. A familiar analogy would be Uber. You want to know the driver, the car, the location, how long, how much — and big data allows Uber to deliver all of this information quickly and efficiently. We want to use big data to determine the right drug, at the right place, at the right time, for the right person.

Private philanthropy empowers innovation in medicine. It provides us flexibility to pursue out-of-the-box thinking and get projects off the ground. Equally important is that philanthropy plays a role in healing. It allows patients and their families to be a part of moving innovation forward.

And private philanthropy is directly improving the way we make decisions in clinic by providing funding to develop predictive analytics that we can apply to big data sets. We can analyze the shared experiences of millions of patients who were not eligible for clinical trials. We can do this in front of a computer and get answers quickly.

RONAC MAMTANI, M.D., M.S.C.E., is a medical oncologist who cares for patients with bladder cancer at the Abramson Cancer Center at Penn Medicine. He also is a health outcomes researcher using “real-world data” – data captured outside of clinical trials – to find ways to better understand the risks and benefits of cancer therapy.

Accessing the miracle of regenerative medicine

Regenerative medicine and unlocking stem cell biology will open many doors toward treating patients with orthopedic problems (and hopefully, one day, help patients avoid invasive surgeries). Philanthropy is pivotal in helping fund some of the important projects that sometimes cannot be funded through the NIH or other sources.

As a surgeon and a scientist, I see the field of regenerative medicine as extremely exciting because we are on the cusp of understanding stem cell biology. We are getting a window into how Mother Nature regenerates. It’s exciting because we have possibly unlocked certain mysteries of how cells differentiate into specific types of tissue. And once we understand it better—through basic hard work and science—we can steer those cells to do what we want them to do, which will help people avoid complicated and painful surgeries.

In orthopedic surgery we deal with things like broken body parts, muscle defects, spinal issues, bone fractures. Much of what we do is reconstructive surgery. If you tear your ACL, we can replace the torn ligament with a piece of tendon from another part of the knee. If you have spinal stenosis, we can do a spinal fusion. If your hips or knees are terribly arthritic, we can replace them. This is the current convention, and it gives many people tremendous relief from pain and suffering. But the next frontier should be not reconstruction, but regeneration. With the right amount of research, we will be able to regenerate cartilage, bones, tendons, muscle.

The field of regenerative medicine is evolving, and many institutions are looking at it, including Brigham. We aim to be one of the innovators and leaders in this field. Within our department’s vision is to launch a premier center for regenerative medicine, and we are in the process of recruiting a new director to spearhead the program.

Philanthropy is enormously helpful in these massive endeavors. Researchers are constantly endeavoring to get grants through the National Institutes of Health (NIH), which is our main vehicle for funding. But only about 10-15 percent of grants submitted actually get funded. Philanthropy is a way to bridge the gap so that scientists can do their research without having to constantly watch grant funding, having to let people go, and interrupting their studies.

DR. JAMES KANG, chairman of the department of orthopedic surgery at Brigham and Women’s Hospital (BWH) in Boston, specializes in spinal surgery. As a surgeon/clinician/scientist, he is an internationally recognized leader in intervertebral disc degeneration research, having done pioneering work in the biology and molecular mechanisms of disc degeneration, as well as devising novel therapeutic interventions using stem cells and gene therapy.

New Bismarck chaplain sees how world longs for God


Father Thomas Grafsgaard, 33, is the chaplain of Legatus’ Bismarck Chapter, which was just chartered in October. Father Grafsgaard, ordained on June 13, 2013, is pastor of Saint Joseph Church in Beulah and Saint Martin Church in Hazen, North Dakota. He grew up in Bismarck and dreamed of becoming a doctor before he heard the call to the priesthood. He recently spoke with Legatus magazine.

When did you first suspect that you were called to the priesthood?

I’d always wanted to be a doctor, so I went to St. John’s University in Minnesota and got a biology degree. But during my junior year, I couldn’t stop thinking about the priesthood. I didn’t know why. I didn’t want to be a priest. I wanted a wife, a family, kids, and to be a doctor, but that call was relentless.

I studied abroad in Ireland in 2006, and it became pretty clear over there that God was calling me to the seminary. I’d say the call didn’t originate with me — it was definitely a call that God gave to me. I couldn’t imagine not being a priest now.

What is it about the priesthood that most brings you joy?

I certainly enjoy celebrating Mass. In hearing confessions, I am deeply edified and humbled by that. With the ministry of giving Christ’s mercy to people, it’s overwhelming, it’s such a gift that He left to His Church. I also enjoy being with people in every step of life. I could have a baptism followed by a funeral, wedding, or teaching in the classroom. Every day is different, and I love that. I’m learning new stuff every day, as far as what it means to be a priest and what it means to be a pastor.

What are some things you’ve learned in your six years as a priest?

I’ve learned the importance of simple kindness and charity, and also I’ve learned quickly how much the world longs for God. Being out in public, wearing the Roman collar, you see how much people are thirsting for God. To be a public witness to the reality of God and God’s presence in the world, it’s overwhelming and it’s very beautiful.

How did you get acquainted with Legatus?

Bishop David Kagan [of Bismarck] had contacted me, saying that there was going to be a meeting for people interested in an organization called Legatus. I knew nothing about Legatus and had never heard of it. But the bishop asked if I would be open to being the chaplain for our Chapter. From there, it just grew. I’ve come to really enjoy the Legates in Bismarck, and am very grateful to Bishop Kagan for having asked me.

What have been some of your impressions about the Legates?

I am edified by how much they desire to live their faith in the workplace, by being that leaven in society in living the Gospels and upholding Catholic social teaching. The Legates here in Bismarck have a tremendous desire to share, not necessarily by overt evangelization in the workplace, but in very subtle ways, to live the Gospel in a culture that is not always easy to do, especially in the workplace.

Who are your spiritual heroes?

Certainly, John Paul II. I was able to see him when I was a young high school student on a retreat-pilgrimage after my senior year in high school. Also, Pope Benedict XVI for his humility and his tremendous knowledge of history. I wrote my master’s thesis on Pope Benedict and the New Evangelization, so I’ve had a deep admiration for him for a long time.

What kind of spiritual impact did that retreat have on you?

You think the Church is big, but when you’re in North Dakota, you forget how universal the Church is, especially with the languages that are spoken, the cultures that Catholics live in around the world. I think that retreat helped me to understand more fully what it means to be Catholic.

Threats to the integrity of the medical profession

Patrick Lee writes that secularism and materialism have distorted the medical profession . . .

Dr. Patrick Lee

Medicine is a noble profession dedicated to helping patients maintain or restore their health and life. Health and life are intrinsic goods of the human person. Thus the medical profession is defined not by its provision of some commodity, but by its mission to contribute to human flourishing. But our culture threatens this truth, both in specific policies and in pervasive attitudes.

Next August a regulation from the Department of Health and Human Services is slated to mandate health insurance providers to cover “contraceptive” devices — including many that are sometimes abortifacient. This is a particularly egregious example of governmental intrusion to classify procedures as health care which are in fact the diametrical opposite of that.

Physician-assisted suicide is now legal in three states and there are organized movements to bring it to others. Physicians are being pressured to kill the severely disabled, the dying and the suffering — and to help create a culture that tells them their lives are not worth living. And regarding the beginning of life, physicians are under intense pressure to cooperate with contraception, sterilization and abortion.

Yet these recent overt threats are later symptoms — perhaps lethal in themselves — of the progression of an underlying, more extensive disease. They stem from ideas that permeate our culture (especially in medical schools) that block any coherent view of the true mission of the medical profession. The chief of these influential ideas are materialism and secularism.

The basic premise underlying the truth that medicine is a distinct and noble profession is that the human person is of incalculable dignity — each person is irreplaceable, inherently valuable and should be treated with reverence. And so the patient enters a sacred trust with his physician. The physician doesn’t just have a job, but a mission to cooperate actively with a patient to help the whole person with respect to his health.

Since health is only one of many intrinsic goods of the person, the person seeking health care is the ultimate authority in deciding whether or not to accept the physician’s recommendations. Therefore, paternalism — making all the decisions for the patient — is wrong. Yet the patient’s rightful autonomy does not mean that the physician is obliged to do whatever the patient demands. The physician is committed to the patient’s true well-being, and the physician is also a real moral agent with moral responsibility for his actions. Thus, the physician is not just a functionary or a technician hired to produce a specific product or result. The physician (and the whole health-care team) should cooperate with the patient to serve his overall well-being with respect to health.

Materialism denies that the human being has a spiritual aspect. Secularism is the view that religion is a mere distraction and even harmful. Secularism also often leads to the view that there is no objective meaning and value in the universe — and that we ourselves endow it with whatever meaning and value we choose. Health-care professionals need not themselves be materialists or secularists for their outlook on patients to be profoundly influenced by these views. Such views permeate our culture and there is often an assumption that even if one does not personally hold them, one’s actions must be guided by them in the public domain. Hence there is often a tendency to lose sight of the patient as a whole person and to view him as a mere machine. Then, instead of trying to help a person decide how best to fulfill his particular responsibilities, the medical challenges become viewed as mere technical problems to be fixed.

It is often rightly said that a physician needs to treat the whole person. But it doesn’t mean that the physician must try to solve issues outside his expertise. Rather, it means that the physician should remember that he’s treating health issues that will fit within the whole set of responsibilities and vocation of a person of inestimable worth.

Materialism and secularism together create an environment which obscures the actual nature of the people in need of health care. To the extent that human beings are viewed as mere complex machines (materialism), health-care professionals will find it virtually impossible to treat patients with reverence. And to the extent that reality is viewed as lacking any inherent meaning and value (secularism), health care will be reduced to mere mechanics, and then health-care professionals will be fair game for bureaucrats insisting that destructive and lethal procedures must be part of their training and practice.

In truth, we are created in the image of God, and we are sacred. Health-care professionals need to remind themselves of that, need to be vocal about their beliefs and need to strive to treat their patients with reverence and awe, begging God for his guidance and grace in their important mission.

Patrick Lee, Ph.D., is the John N. and Jamie D. McAleer Professor of Bioethics and the director of the Institute of Bioethics at Franciscan University of Steubenville.

Bad Medicine

Catholics are concerned whether socialized medicine is compatible with the faith . . .

Legatus Magazine, October 2009

Legatus Magazine, October 2009

When Kishore Jayabalan tore a knee tendon in Rome three years ago, he went to St. Camillus – a public hospital. He waited four days to get local anesthesia in order to have minor surgery. His hospital roommate had been on a waiting list for six months to get a hip replacement. The hospital provided no towels, no nightgowns and water only with meals.

“If we were thirsty between meals, we had to send friends or family to buy bottled water outside the hospital,” said Jayabalan.

As the debate over health-care reform rages across the country, the faithful are concerned whether socialized medicine is compatible with Catholic social teaching. They’re also asking whether government-run health care is wise, given the trouble with socialized systems in Europe and Canada.

Kishore Jayabalan

Kishore Jayabalan

Jayabalan wasn’t required to pay out of pocket for his operation, but others pay a heavier price. Italian women, for example, are generally not permitted to have an epidural during childbirth (except for C-sections) no matter how much pain they are in.

The problem of socialism

For decades, U.S. bishops have advocated comprehensive reform that leads to universal health care. At the same time, Catholic teaching and tradition is wary of socialism. In fact, the entire body of Catholic social teaching over the last 150 years has warned against socialism because of its often devastating impact on private property, the role of the family and the role of organized religion.

Many papal encyclicals — including Rerum Novarum (Pope Leo XIII, 1891), Quadragesimo Annus (Pope Pius XI, 1931) and Centesimus Annus (Pope John Paul II, 1991) — warn against socialism.

“In Deus Caritas Est, Pope Benedict talks about how the state cannot provide everything,” explained Jayabalan, head of the Acton Institute’s Rome office. “The state exists to ensure justice: punishment for crime, respect for private property and the rule of law. But the state cannot — and should not — love people and provide charity. It is the private individual who must provide charity.”

Many of those individuals are Catholics with a long tradition of caring for the sick and the poor. One out of every six patients needing a hospital admission in the U.S. goes to a Catholic hospital. The Church runs 624 hospitals, 41 hospice organizations, 11 hospital systems; admits 5.5 million patients and conducts 92.7 million outpatient visits every year.

“In the New Testament, Jesus travels through the country healing the sick,” said Fr. Thomas Rosica, CEO of Salt and Light TV and former chaplain of Legatus’ Toronto Chapter. “Among the most powerful and practical parables that Jesus taught is that of the Good Samaritan. Our compassion for the suffering of our neighbors commits us to meeting their pain.”

Socialized medicine

waitingroom_webYet as noble as the desire is for socialized medicine, serious problems — rationed care, long waiting times, lack of qualified medical personnel and overspending — exist in every country with such a system.

“In Canada, there are 800,000 people on waiting lists. In the United Kingdom, there are 1.2 million people on waiting lists,” said Dr. Donald Condit, an orthopedic surgeon and policy expert for the Acton Institute.

In 2005, Canada’s Supreme Court struck down a law that prohibited people from buying private health insurance to cover procedures already offered by the public system. “Access to a waiting list is not access to health care,” the court’s ruling said. “In some cases patients die as a result of waiting lists for public health care … and many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life.”

A 2006 Fraser Institute study reported that the average delay between referral and orthopedic surgery in Canada was 40.3 weeks, said Condit. In the U.S., the wait is less than four weeks.

Catholic social teaching supports the principle of subsidiarity — the tenet that nothing should be done by a larger and more complex organization which can be done as well by a smaller and simpler organization. With socialized medicine, however, government bureaucracies make decisions far removed from the doctor-patient relationship.

Research and development often lags in countries with government-run health care. Medical technology is developed because of a profit incentive, not at the behest of legislators.

“The profit motive for companies is much less under socialized medicine because the state dictates how much to charge for procedures and medicines,” said Jayabalan.

Bureaucrats in socialized medical systems run cost-benefit analyses on whether patients are worth treating. In the U.K., the National Institute for Clinical Excellence produces clinical appraisals on the cost-effectiveness of treatments — in many cases denying patients access to the latest medicines.

Universal health care

Despite the problems that riddle socialized health care systems around the world, some faithful Catholics support the principles of universal health care with the caveat that human life is respected from conception to natural death. Universal health care, however, does not necessarily have to come from the government.

Kathy Saile

Kathy Saile

“We agree that ‘no one should go broke because they get sick,’” said Kathy Saile, the U.S. bishops’ director of domestic social development. “That’s why the U.S. bishops have worked for decades for decent health care for all. The Catholic Church provides health care for millions, purchases health care, picks up the pieces of a failing health system and has a long tradition of teaching ethics in health care. Health-care reform that respects the life and dignity of all is a moral imperative and an urgent national priority.”

However, the vision for universal health care as proposed by Congress and the Obama administration may come with a high price tag. Pro-life leaders and the bishops are asking Obama to keep his word that he will not sign a health-care reform bill “if it adds one dime to the deficit now or in the future, period.”

The left-leaning secular media are skeptical and the Congressional Budget Office says the House version of the health bill (H.R. 3200) will cost $1.5 trillion over the next 10 years, and will increase the federal deficit by $239 billion between 2010-2019. If enacted, massive deficits or massive tax increases would result. This year’s federal budget deficit has already topped $1 trillion for the first time in history.

Analysts also worry about giving more control to the federal government, which already handles 34% of U.S. health care through the Veterans Administration, government workers and Medicare/Medicaid.

The Obama administration “has been found wanting in defense of human life with funding of abortion here and overseas, stem cell research and reversing the Mexico City policy,” said Condit. “And we should give them more control?”

Perhaps most troubling, critics say, is that the president is trying to push health care reform through too quickly.

“People feel like something is being pulled over their heads, and that sentiment is coming out at the town hall meetings,” said Dr. Steve White, a lung specialist and former head of the Catholic Medical Association.

“I think we have to stop the whole process and regroup,” he said. “Why the urgency? It’s extremely complex. Even the Congressional Budget Office has raised red flags. We’re in the middle of a recession. We need reform, but there are serious financial and ethical risks.”

Sabrina Arena is a Legatus Magazine staff writer.


The public option

The Obama administration and congressional leaders are debating whether a new government-run health plan, modeled after the soon-to-be-bankrupt Medicare program, must be included in health-reform legislation.

Grace-Marie Turner

Grace-Marie Turner

“The public plan option has been a lightning rod for opposition to health reform because many people believe it is a track to a single-payer, government-run system,” Grace-Marie Turner, president of the Galen Institute, wrote in the New York Times in August. “This new government-run health insurance program would impose mandates on employers and individuals to get and pay for health coverage, drastically expand Medicaid and impose strict new federal regulation of the health insurance market.

“What the president miscalculated in putting health reform at the top of his change agenda is that the thing people cherish most about health care is security. Change scares them, as politicians across the land are suddenly seeing.”