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Scientists discuss health care challenges

BY JOSHUA BAXT

The Burnham Institute

Burnham Institute for Medical Research recently brought together four highly regarded scientists to discuss some of health care’s most challenging issues in a forum at the Scripps Seaside Forum in La Jolla.

Moderated by Burnham President and Chief Executive Officer John Reed, M.D., Ph.D., the panel included Philip Pizzo, M.D., from Stanford University; Evan Snyder, M.D., Ph.D., from Burnham; Eric Topol, M.D., from the Scripps Translational Science Institute; and Michael Kalichman, Ph.D., from UCSD.

Their topics ran the gamut from what should be done to improve the health care system to how could individualized medicine improve health and whether patients understand enough about clinical trials.

From his vantage point as dean of Stanford University School of Medicine, Pizzo said he sees that our health care system can skew the choices physicians make. He said he is particularly concerned about how massive student debt forces physicians to choose high-earning specialties, rather than becoming much-needed primary care physicians. He also warned about the ways gifts from pharmaceutical and device companies can influence care decisions.

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“Unfortunately, small gifts can go a long way,” Pizzo said.

Snyder, who directs the Program in Stem Cell and Regenerative Medicine at Burnham and is also a pediatrician, discussed the moral and ethical implications of advancing medical technology.

For example, premature infants are considered viable at 24 weeks; however, it costs hundreds of thousands of dollars to treat these babies. Snyder noted that caring for premature infants is the only ethical way to proceed, but pondered how those resources could be used to reduce overall infant mortality.

Topol, director of the Scripps Translational Science Institute, said he is concerned about how drugs and devices are prescribed for people who often receive little or no benefit from them. He pointed to implanted defibrillators, which fire in only 10 percent of patients who receive them, and drugs that only work for people with certain genetic profiles.

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“We need to do a better job of understanding the genetics behind who will benefit from a specific drug,” Topol said. “That’s the promise of individualized medicine.”

Kalichman, who directs the Research Ethics Program at UCSD, spoke of the ethical challenge of designing a strong clinical trial. He pointed out that participants must be well informed about the trial’s risks and benefits, but the trial descriptions are often so complex that it can be difficult for the average person to provide informed consent.

“These are difficult issues because there are two competing positive outcomes that may be at odds,” Kalichman said.

The discussion also covered the future of stem cell therapies, the genetics behind healthy aging and how the public must be better educated to address these and other ethical issues.

The program was the annual President’s Council event for Burnham. The President’s Council consists of Burnham’s major donors and other stakeholders.