Dissent Over a Device to Help Find Melanoma
By NATASHA SINGER
TO the casual observer’s eye, the small brownish mole on Tanna Oppel’s upper left arm looks like an insignificant, ovoid blotch. But on the screen of MelaFind, a new computer vision system for imaging skin lesions, a jagged blue line shows the actual border of the mole, revealing an irregular lesion roughly the shape of Texas.
Ms. Oppel is a medical assistant in Manhattan in the office of Dr. Doris Day, one of the first dermatologists to buy the machine. Developed by Mela Sciencesof Irvington, N.Y., the system uses pattern-recognition algorithms to help a dermatologist who has picked out a suspicious pigmented spot to decide whether to perform a biopsy. The device may find an audience among sun-seekers worried about developing an aggressive skin cancer: the National Cancer Instituteestimates that about 9,500 Americans this year will die of melanoma of the skin.
Yet the device is polarizing the field of skin-cancer detection.
For decades, dermatologists have used their eyes, along with a magnifier called a dermatoscope, to try to distinguish abnormal but benign lesions from potential melanoma in order to avoid unneeded biopsies. Some dermatologists argue that these low-tech tools are still the most useful and worry that their colleagues are falling for expensive, cool-looking gadgets that may simply offer extraneous, and perhaps incorrect, data.
“This technology should still be considered to be in the developmental stage,” said Dr. Roberta Lucas, an instructor of clinical dermatology at the Northwestern University Feinberg School of Medicine in Chicago. “We are better off when the system supports doctors who are thorough and unhurried; who examine and listen carefully and who empower patients to practice good surveillance and sun protection.”
In fact, some members of an expert medical panel asked to review MelaFind a few years ago for the Food and Drug Administration warned that the device had the potential to give doctors and patients a false sense of security. While MelaFind can analyze small pigmented spots identified by dermatologists as having signs of melanoma, it is not designed to evaluate other problems: large melanomas, colorless melanomas or two other types of skin cancer — basal and squamous cell carcinoma.
Doctors seek MBA's to grapple with health care reform | Marketplace.org
Doctors used to focus on one thing: practicing medicine. But these days, it pays to know something about business. As health care reform starts upending the economics of medicine, the Kelley School -- a top-20 MBA program, based in Indiana – is looking to cash in bylaunching an online MBA for just doctors.
If an online MBA doesn't sound legit, check out the price tag on Kelley's two-year program: $58,000. That doesn’t include hotel or airfare to Indianapolis, for monthly in-person sessions.
The program takes 40 students. Doctor Anthony Sabatino enrolled to ease his uncertainty.
“Obamacare scares me. What's going to be the long-term effects after 2014 when it's implemented?" he says.
Bill Nemitz: Patient's live-or-die decision still her own
Posted:TodayUpdated: 12:26 AM
The family of an ALS sufferer with soaring medical bills responds to readers who challenge her choice to live.
Telling one's story in public often has its consequences -- not the least being that many people out there aren't shy about chiming in on what you did right or what, in their opinion, you did wrong. And chime in people have in the case of Gail Kennett, a 69-year-old woman from Scarborough with amyotrophic lateral sclerosis, or ALS, also known as Lou Gehrig's disease.
"The availability of Health Care Money is 'limited' not 'infinite,'" wrote one reader, identifying herself as a registered nurse, in an email to me last week. "It must be appropriately 'rationed' ... given to those who WILL benefit from care and withheld from those that will NOT benefit."
Let's recap:
The above article is linked to another Nemitz column published in a previous blog posting:
-SPC
Secretive panel uses data to boost doctors’ pay
Posted July 21, 2013, at 6:51 a.m.
When Harinath Sheela was busiest at his gastroenterology clinic, it seemed he could bend the limits of time.
Twelve colonoscopies and four other procedures was a typical day for him, according to Florida records for 2012. If the American Medical Association’s assumptions about procedure times are correct, that much work would take about 26 hours. Sheela’s typical day was nine or 10.
“I have experience,” the Yale University-trained, Orlando, Fla.-based doctor said. “I’m not that slow; I’m not fast. I’m thorough.”
This seemingly miraculous proficiency, which yields good pay for doctors who perform colonoscopies, reveals one of the fundamental flaws in the pricing of U.S. health care, a Washington Post investigation has found.
Unknown to most, a single committee of the AMA, the chief lobbying group for physicians, meets confidentially every year to come up with values for most of the services a doctor performs.
Those values are required under federal law to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors.
But the AMA estimates of the time involved in many procedures are exaggerated, sometimes by as much as 100 percent, according to an analysis of doctors’ time, interviews and medical journals.
Indeed, if the time estimates are to be believed, some doctors would have to be averaging more than 24 hours a day to perform all of the procedures that they are reporting. This volume of work does not mean these doctors are doing anything wrong. They are just getting paid at rates set by the government, under the guidance of the AMA.
In fact, in comparison with some doctors, Sheela’s pace is moderate.
Take, for example, those colonoscopies.
In justifying the value it assigns to a colonoscopy, the AMA estimates that the basic procedure takes 75 minutes of a physician’s time, including work performed before, during and after the actual scoping.
But in reality, the total time the physician spends with each patient is about half the AMA’s estimate — roughly 30 minutes, according to medical journals, interviews and doctors’ records.
Indeed, the standard appointment slot is half an hour.
Echoes of the Past in anti-ObamaCare Ads | Portside
By Wendell Potter
CINCINNATI, Ohio—Watching Americans for Prosperity’s new anti-ObamaCare advertisement here in Ohio—one of the first states it’s being aired—took me back 20 years. Almost exactly 20 years, in fact.
I was a PR guy for the insurance industry in 1993, and I had joined forces with special interest trade associations, front groups and right wing organizations much like Americans for Prosperity (AFP) to scare the public away from the Clinton health care reform proposal as it was being debated in Congress.
Insurance company executives didn’t like the Clinton plan because we feared it would have a negative impact on profits. Knowing that shrinking profit margins would not motivate many folks to get behind our effort to kill the bill, we came up with the idea of getting the public to fear it for made-up reasons.
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