When facing a frightening new cancer diagnosis, some people ask their doctors, “What would you do if you were me?” Here, our Curious Dr. George asks oncologist Kevin Knopf, MD, how he would handle his own advanced Hodgkin lymphoma.

Curious Dr. George: Please consider this hypothetical scenario—as a very busy practicing clinical oncologist during the COVID-19 pandemic, you were not paying much attention to your own health when you noticed a weight loss of 7 pounds, a dry cough, and a little fever and sweating at night. Your home COVID-19 antigen tests were negative, but you found some enlarged cervical lymph nodes. Your physician confirmed the lymphadenopathy and palpated an enlarged spleen. Your hematocrit was 39, and WBC 16, 000. CT scan detected both para aortic and mediastinal lymphadenopathy. Biopsy of a cervical node was diagnosed as nodular sclerosing Hodgkin lymphoma. How do you proceed?

Kevin Knopf, MD, MPH: First, which chemotherapy regimen would I pick, given the treatment is with curative intent? Three standard choices: ABVD, BEACOPP, and A-AVD foster intense debate amongst oncologists. A recent Twitter poll by Dr. Aaron Goodman (of the University of California, San Diego) had opinions split evenly between ABVD, R-BEACOPP, and A-AVD. The choice has subtle nuances; my feeling is ABVD is probably fine for young patients where the risk of bleomycin pulmonary toxicity can be monitored closely; for myself I would choose A-AVD and monitor carefully for neuropathy.

Where to be treated? Where I work in the East Bay of California’s San Francisco Bay Area, there are centers for the University of California, San Francisco (UCSF) and Stanford, and Dr. Andreadis—a friend—is at UCSF, and Dr. Barbara Galligan, my former resident whom I helped mentor into oncology, are all excellent. By a thin margin I would choose Dr. Rajesh Behl in Berkeley in the East Bay. He is a smart oncologist and I appreciate his dry sense of humor. Getting in and out of his office for treatment would be easy, and it is with the infusion nurses that I would spend 98% of my time.

I am fortunate that my insurance would cover the complete cost and my choice of physicians, but this illustrates an area of oncology I spend a lot of time thinking and writing about: cost effectiveness and health equity. There are broad disparities in cancer care—within the U.S. and worldwide—such that many patients with a curable cancer, such as Hodgkin lymphoma, are not cured.

Pricing for cancer care seems arbitrary and is not really negotiated. In classic economics, one would pick amongst my 5 treatment options based on the lowest cost of care, as the outcome is almost certainly equal. There is a mind-blowing aspect of American health insurance: when Obamacare was enacted, insurance companies’ net profit was capped at 15% of the medical loss ratio, meaning the more my insurance company spends, the more money they can make. My premiums have jumped 15% in 2023. A-AVD is 108-fold more costly than ABVD. Cancer care in the U.S. is virtually “all accelerator, no brake,” and the cost of care keeps rising each year, and health disparities widen.

Sociologist C. Wright Mills quipped “the most important thing you can do in a capitalistic society is choose the right parents.” I chose wisely and ended up with “Cadillac” health insurance. All other industrialized nations have a single-party payer system to pay for care, while U.S. health care delivery is based on a for-profit model. American health care works out well in this particular hypothetical example, but overall, we rank about 50^th in the world in terms of healthcare efficiency—tied with Bulgaria.

There are casualties. Half of the U.S. has medical debt, 50% of women with metastatic breast cancer are being pursued by debt collectors, and 42% of newly diagnosed cancer patients will go bankrupt within 3 years of diagnosis. We have a tragic and widening cancer disparity gap in the U.S. and a large care gap between first-world nations and low- and middle-income countries. In many parts of the world, a similar patient would not receive curative chemotherapy. People speak of the American health care “system,” but that would imply a formal interconnected design rather than our Byzantine way of paying for health care. So I might come out of this diagnosis just fine, and not bankrupt, but that was just a simple twist of fate.

Dr. Knopf can be reached at kevinbknopf@gmail.com.

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Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

In 2018, we published a Curious Dr. George post featuring Thomas N. Seyfried, PhD, about cancer possibly being mostly a metabolic—rather than genetic—disease. Since then, the field of cancer genomics has expanded enormously, and we have published many posts in support of better understanding and treatment of many types of cancer based on the genomic approach. Here, Dr. Seyfried and two of his colleagues at Boston College—Derek Lee, MS, and Tomás Duraj, MD, PhD—provide an update on their perspective.

Curious Dr. George: Our recent Curious Dr. George post on pancreatic cancer stimulated you to push back on existing therapeutic strategies that have been failures for so long, and suggest an entirely different approach. Why do the current treatments of pancreatic cancer fail, and what new approach might be worth considering?

Thomas N. Seyfried, PhD; Derek Lee, MS; and Tomás Duraj, MD, PhD: Current therapeutic approaches for managing the most common form of pancreatic cancer (pancreatic ductal adenocarcinoma , or PDAC)—and many other cancers, for that matter—have failed to significantly reduce deaths in severe cases. The promise of effective precision medicine based on the somatic mutation theory of cancer has not been realized. This is evident from the latest statistics published by the American Cancer Society showing that, every day, almost 1,700 people die of cancer or cancer-treatment-related causes. While it is understandable and important to highlight recent advancements, the long-term (10-year) survival rate for PDAC is still less than 5%.

It is also important to be realistic about the side effects of many first-line treatments for PDAC. Many of the current “targeted” treatments can result in severe fatigue, gastrointestinal disturbances, liver failure, and myriad other complications. These adverse effects are unacceptable and contribute further to the physical and mental stress already associated with a cancer diagnosis. Treatment modalities based on an incorrect theory of cancer origin will not provide optimal management for most patients.

In contrast to the somatic mutation theory, the mitochondrial metabolic theory can better explain the origin of cancer and provide more rational therapeutic strategies for management. For example, KRAS mutations negatively impact oxidative phosphorylation (OxPhos), thus forcing tumors to be more dependent on aerobic fermentation than on OxPhos for driving dysregulated growth. OxPhos inefficiency coupled to energy synthesis through aerobic glucose and glutamine-dependent fermentation is now recognized in nearly all cancers. Unfortunately, the metabolic dependencies of cancer cells are just an afterthought, if considered at all.

We have yet to find a report showing any cancer cells that can grow in the absence of glucose and glutamine. Ketone bodies and fatty acids are non-fermentable fuels and cannot therefore replace either glucose or glutamine for sufficient energy production in cancer cells with OxPhos insufficiency. An effective non-toxic therapeutic strategy for managing cancer would therefore involve the simultaneous down-regulation of the glucose-driven glycolysis and the glutamine-driven glutaminolysis pathways using diet-drug combinations, while transitioning the body to non-fermentable fuels, e.g., fatty acids and ketone bodies.

A transition of the body from glucose to nutritional ketosis—glucose/ketone index (GKI) values of 2.0 or below—will induce significant physiological stress on the already metabolically inflexible cancer cells while, at the same time, providing an efficient energy source for healthy cells that evolved to transition from glucose to ketone bodies under dietary energy reduction. A combination of both carbohydrate restriction and high-intensity exercise will stimulate glucose and glutamine clearance from circulation.

Adherence to this approach can be challenging for some, but shifting the role of the patient from passive observer to active participant in their non-toxic metabolic treatment strategy will help enable longer-term management of their cancer.

Dr. Seyfried can be reached at thomas.seyfried@bc.edu, Dr. Lee at leebig@bc.edu, and Dr. Duraj at tomas.duraj@bc.edu.

Additional references for successful application of ketogenic metabolic therapy in animals and humans:

İyikesici MS, Slocum AK, Slocum A, Berkarda FB, Kalamian M, Seyfried TN.Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer. Cureus. 2017 Jul 7;9(7):e1445. doi: 10.7759/cureus.1445.

Elsakka AMA, Bary MA, Abdelzaher E, Elnaggar M, Kalamian M, Mukherjee P, Seyfried TN. Management of Glioblastoma Multiforme in a Patient Treated With Ketogenic Metabolic Therapy and Modified Standard of Care: A 24-Month Follow-Up. Front Nutr. 2018 Mar 29;5:20. doi: 10.3389/fnut.2018.00020.

Augur ZM, Doyle CM, Li M, Mukherjee P, Seyfried TN. Nontoxic Targeting of Energy Metabolism in Preclinical VM-M3 Experimental Glioblastoma. Front Nutr. 2018 Oct 5;5:91. doi: 10.3389/fnut.2018.00091. eCollection 2018.

Mukherjee P, Augur ZM, Li M, Hill C, Greenwood B, Domin MA, Kondakci G, Narain NR, Kiebish MA, Bronson RT, Arismendi-Morillo G, Chinopoulos C, Seyfried TN. Therapeutic benefit of combining calorie-restricted ketogenic diet and glutamine targeting in late-stage experimental glioblastoma. Communications Biol. 2019 May 29;2:200. doi: 10.1038/s42003-019-0455-x.

Seyfried TN, Shelton L, Arismendi-Morillo G, Kalamian M, Elsakka A, Maroon J, Mukherjee P. Provocative Question: Should Ketogenic Metabolic Therapy Become the Standard of Care for Glioblastoma? Neurochem. Res. 2019 Apr 25. doi: 10.1007/s11064-019-02795-4.

Seyfried TN, Mukherjee P, Iyikesici MS, Slocum A, Kalamian M, Spinosa JP, Chinopoulos C. Consideration of Ketogenic Metabolic Therapy as a Complementary or Alternative Approach for Managing Breast Cancer. Front Nutr. 2020 Mar 11;7:21. doi: 10.3389/fnut.2020.00021.

İyikesici MS, Slocum AK, Winters N, Kalamian M, Seyfried TN. Metabolically Supported Chemotherapy for Managing End-Stage Breast Cancer: A Complete and Durable Response. Cureus. 2021 Apr 26;13(4):e14686. doi: 10.7759/cureus.14686.PMID: 33927959.

Seyfried TN, Shivane AG, Kalamian M, Maroon JC, Mukherjee P, Zuccoli G. Ketogenic Metabolic Therapy, Without Chemo or Radiation, for the Long-Term Management of IDH1-Mutant Glioblastoma: An 80-Month Follow-Up Case Report. Front Nutr. 2021 May 31;8:682243. doi:10.3389/fnut.2021.682243. eCollection 2021.PMID: 34136522.

Seyfried TN. The effects of diet on prostate cancer outcomes. Nat Rev Urol. 2022 Jul;19(7):389-390. doi: 10.1038/s41585-022-00612-2.PMID: 35676538.

 

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Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Curious Dr. George
Cancer Commons Editor in Chief George Lundberg, MD, is the face and curator of this invitation-only column

Anthony M. Magliocco, MD
Founder & CEO, Protean BioDiagnostics

The use of advanced molecular testing of various cancers over the last 10-15 years has driven development of the field of precision oncology. Now, many patients with a variety of cancer types can benefit from targeted therapies. However, accessing precision testing and treatment can be a major challenge. Our Curious Dr. George asks Anthony M. Magliocco, MD, Founder and CEO of Protean BioDiagnostics, how his company enables better access.

Curious Dr. George: Proper selection of precision treatment requires reliable testing of individual, potentially lethal tumors. While comprehensive cancer centers and academic medical centers have pioneered this service, some 80% of Americans with cancer are treated elsewhere. Your Orlando, Florida-based company, Protean BioDiagnostics, purports to be “the only cancer diagnostic system that integrates pathology review with evidence-based testing.” How does that work and how can physicians and patients anywhere access your services?

Anthony M. Magliocco, MD: Thank you for this important question. As you mentioned, with the completion of the Human Genome Project and tremendous advances in understanding cancer biology, we have learned that there are many molecular subtypes of cancer that can be treated with specific targeted agents, creating the discipline of precision oncology. A great example is lung cancer, where we have learned that a significant proportion of cases are driven by development of EGFR mutations and that these cases will respond well to anti-EGFR therapies. This sounds great so far, but the problem is that less than half of Americans with lung cancer get access to proper EGFR molecular testing, and even if they do, many do not end up getting access to effective therapies.

One of the key problems in the U.S. is that cancer care is fragmented, and the majority of cases are treated by generalist oncologists outside of major academic centers. This creates many challenges, as the field of molecular diagnostics and precision oncology is moving very quickly and becoming extremely complicated, with different classifications and treatment options for cancers that arise in different organs. The choices for testing and treatment have become overwhelming for the generalist.

Protean seeks to solve this problem in two main ways. First, we have created a full precision oncology system, the Protean MAPS™ platform, which provides easy access to Protean services in which tests are organized into guideline-based bundles, and results are integrated into easy-to-understand reports. In addition, Protean provides pathology review services to ensure that the primary diagnosis is correct and the correct tissue samples are being selected for molecular testing. Protean also supports community-based general oncologists with access to decision-support tools and virtual tumor boards, as well as support for clinical trial matching.

Protean provides quick and easy access to testing services in our Orlando CAP CLIA lab, which is licensed for all U.S. states including California, Pennsylvania, and New York, and supports diagnostics with a large network of specialist pathologists and molecular experts. The lab provides a full menu of proprietary testing, including cancer screening and monitoring tests, genetic risk tests, pathology services including Pathology AI assessments, rapid molecular testing and comprehensive molecular analysis with large panels, 3D genomics, and access to global methylation profiling.

Clients can easily access Protean’s lab services using secure electronic portals. Protean then organizes tissue acquisition, blood testing with a network of phlebotomists, and genetics when needed with at-home testing and counselling. It makes life easy for oncologists and their office staff. Protean’s ultra-rapid testing services provide results within a few days, enabling patients to obtain faster access to treatments and clinical trial options. Protean’s data services include secure cloud-based medical data management and integrations using current interoperability standards, as well as data tools, including bioinformatics and machine-learning and AI approaches.

In summary, Protean provides easy access to the latest advances in precision oncology for any practitioner or patient in the U.S. or beyond. Our advanced testing, digital pathology, and telemedicine coupled with complex data management make Protean a unique health technology company focused on delivering better access to novel treatments and clinical trials for cancer patients everywhere. Protean maintains a very active research program and is continuously updating its menu of services to accommodate the rapid advances in cancer diagnostics and treatments.

Our goal is to close the existing cancer care gap and accelerate access to the best cancer treatments for all.

Curious Dr. George: Thank you for telling us all about Protean. What is the best way for patients and caregivers to contact Protean? Can they access the process directly, or must they go through a licensed provider?

Dr. Magliocco: Patients can certainly come to us directly to request reviews and testing at this link. We do not need a healthcare provider to order services, although they certainly can, and we can work with patient care teams as needed. Many services are covered by insurance plans as well.

For direct-pay patients, we typically will charge $400 for registration and review of the case materials and pathology slides, with full recommendations for any additional testing, if needed, and a telemedicine consultation with an expert is included.

After registration, we work with the patient to collect their medical records using secure communications and can arrange for any additional testing that might be required, including accessing previous specimens, coordinating genetic testing, or arranging for blood and liquid biopsy testing services.

I also have an educational YouTube channel for patients, Cancer Informant, where I post periodic videos. Patients can find more information and updates on the Cancer Informant website.

Dr. Magliocco can be reached at magliocco@proteanbiodx.com.

 

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Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

When confronted with a new cancer diagnosis, some people ask their doctors, “What would you do if you were me?” Previously, our Curious Dr. George asked John H. Strickler, MD, how he would handle his own hypothetical diagnosis of metastatic pancreatic cancer. Now, Dr. Strickler provides an updated answer, outlining new options for the nearly 95% of pancreatic cancer patients with KRAS mutations. Dr. Strickler is Associate Professor of Medicine in the Division of Medical Oncology at Duke University and Co-Leader of the Duke Molecular Tumor Board.

Curious Dr. George: Cancer Commons provides information about options to patients with advanced cancer, usually beyond standard of curative care. As an experienced academic and practicing clinical oncologist at Duke University, you have particular interest, training, and experience in gastrointestinal cancer.  What would you do if you personally were discovered to have an asymptomatic, unsuspected, ductal adenocarcinoma of the tail of the pancreas that had already metastasized to your liver?

John H. Strickler, MD: Pancreatic cancer remains one of the most lethal malignancies. Advancements in chemotherapy, immunotherapy, and targeted therapies have helped countless people with advanced solid tumors, but for pancreatic cancer most of these advancements have not made a meaningful impact. However, despite the grim survival statistics and poor prognosis associated with this disease, there is reason to have hope. With improvements in supportive care, chemotherapy, and molecular diagnostics, some patients are living longer and living better. While we have a long way to go, finally progress is being made.

If I were diagnosed with metastatic (stage 4) pancreatic adenocarcinoma, the first thing I would do is find an experienced multi-disciplinary team. This team would give me the best outcomes possible. Members of this team would include experts on the following fields:

Medical Oncology: Although the primary function of the medical oncologist is to provide chemotherapy, typically he or she formulates the treatment plan and coordinates care. In my hypothetical case, the medical oncologist would recommend either gemcitabine alone, gemcitabine with nab-paclitaxel, or FOLFIRINOX. All of these treatments would be reasonable, but combination chemotherapy (gemcitabine + nab-paclitaxel or FOLFIRINOX) would offer the greatest disease control and longest survival.

Additionally, the medical oncologist would be responsible for ordering next-generation sequencing on my tumor tissue to determine if my tumor harbors an “actionable” genetic alteration. Although these actionable genetic alterations are rare, they may make me eligible for immunotherapy or other targeted therapies. Nearly 90% of patients with pancreatic cancer have a KRAS mutation, and advancements in drug chemistry are finally making KRAS “druggable.” KRAS^G12C mutations are now considered treatable with highly selective KRAS inhibitors, such as sotorasib or adagrasib. Inhibitors of other more common KRAS mutations are now entering the clinic. We are all hoping to see more breakthroughs.

Genetic counseling: Approximately 5% of all patients with pancreatic cancer have a germline (hereditary) mutation in BRCA1/2 or PALB2, and these hereditary mutations predict benefit from platinum-based chemotherapy and PARP inhibitors. Other rare germline mutations can also predispose a patient to pancreatic cancer. Current national guidelines advise germline testing in all patients diagnosed with pancreatic cancer, regardless of family history. Genetic counseling is advised for any patient who tests positive for a pathogenic germline mutation or has a strong family history.

Palliative care: Many patients are hesitant to consider palliative care. There is a misconception that palliative care represents end-of-life care. I hope that we can change this misconception. Pancreatic cancer often presents with complicated symptoms that are difficult to manage. Even if I present completely pain free, symptoms from pancreatic cancer can change rapidly. Given the incurable nature of this disease, it is helpful to have a team of doctors who can help me and my family prepare for the future. I view palliative care as a critical “extra layer of support” to fight a very difficult illness.

Other important members of the team: As a medical oncologist, I have learned that I am only as good as the people around me. I cannot overstate the importance of having experienced and dedicated nurses, advanced practice providers (NPs and PAs), and clinic staff to provide extra support. Additionally, by finding a skilled multi-disciplinary team for my hypothetical diagnosis, I would have access to other experts, including radiologists, pathologists, surgeons, radiation oncologists, and gastroenterologists. All of these physicians would be key to my health and symptom management.

Final thoughts:

As a gastrointestinal medical oncologist, I have seen how difficult pancreatic cancer can be for patients and their loved ones. This remains a disease with high symptom burden and poor outcomes. If I were facing this disease myself, I would recognize that it takes a community of dedicated clinicians to keep me living longer and living better. As a patient, I would make myself available to clinical trials and other research. It is through these research efforts that we will change the course of this terrible disease and improve outcomes.

More details about ways to support pancreatic cancer research and resources for patients and families fighting this disease can be found at the Pancreatic Cancer Action Network.

Dr. Strickler can be reached at john.strickler@duke.edu.

People with cancer often face additional health conditions, or “comorbidities,” that complicate treatment. High blood pressure, or hypertension, is a major comorbidity that affects many cancer patients. Our Curious Dr. George asks Robert E. Matthews, President and CEO of MediSync in Cincinnati, Ohio, about how his company’s tools are helping physicians better manage their patients’ blood pressure.

Curious Dr. George: All physicians and medical organizations know that hypertension is a major attributable cause of many serious and fatal illnesses, such as coronary artery heart disease, heart failure, and stroke. As many as 48% (119 million) of American adults have hypertension. The American Heart Association, the American Medical Association, the American College of Cardiology and hundreds of other organizations have set a new target of 130/80 (revised from 140/90) for blood pressure control and have launched a major initiative to achieve such. Yet, the Centers for Disease Control and Prevention (CDC) reports that fewer than 48% of American patients with hypertension meet even the less stringent historical 140/90 goal.

Your group practice, PriMED Physicians in Ohio, using the MedsEngine AI tool from MediSync and the NICaS (non-invasive cardiac system with impedance cardiography) test coupled with solid clinical leadership reports that its cooperating institutions have consistently exceeded 90 or even 95% blood pressure control for more than 10 years. Exemplary.

Your approach to matching the correct drug or drugs and dosages with each patient’s unique blood pressure pathophysiology would seem to be the key. Why does your organization succeed, and how might others follow your lead to success?

Robert E. Matthews: Helping patients with hypertensive diseases (HTN) reduce blood pressure (BP) to 140/90 or lower has been and remains a struggle for physicians. Since 1999, CDC reports have shown that far more than half of all diagnosed patients fail to achieve this level of BP control. Recent studies strongly suggest an even more stringent BP goal of lower than 130/80 would benefit most patients.

PriMED Physicians in Dayton, Ohio, has a consistent record of achieving >90% BP control across all HTN patients with very slight month-to-month variations. PriMED has a database tracking key quality metrics, including BP for every patient at every visit for over 10 years.

In October 2023, 94% of all of PriMED’s HTN patients; 95% of all the patients with both HTN and diabetes and, remarkably, 96% of all African American patients from socio-economically challenged zip codes had a BP of less than 140/90. These outcomes reflect a different way of providing chronic disease care. You yourself recently encouraged that, now that we know these results are possible, more groups should be using PrIMED’s methods, which are briefly described here:

• PriMED formally established a corporate goal of achieving greater than 90% “control” (control is defined as meeting the evidence-based standard definition of control) for several major chronic diseases in 2002 via a groupwide vote of all physicians. Hypertension was the first disease tackled.
• After surveying non-healthcare companies noted for their consistent quality and discovering that all of them adopted a quality science approach, PriMED and its management partner, MediSync, underwent almost a year of extensive training in the Six Sigma quality science, tools, and statistics.
• Six Sigma instructs that great care be taken to enumerate the challenges to achieving target goals and, further, to discover the root causes of those obstacles. PriMED and MediSync inquired extensively into the challenges of getting 90% of all HTN patients to the target BP. PriMED’s “root cause analysis” of the problems that result in sub-optimal outcomes is enumerated in this talk co-sponsored by The Lundberg Institute and the Commonwealth Club of California.
• Most medical groups conclude that “the patient is the problem” when treating hypertension. PriMED and MediSync recognized that the patient is the smallest part of the challenge. The actions of physicians and other providers are key to success.
• Simplistically described, elevated blood pressure can be the result of several hemodynamic factors, including (1) vasoconstriction, (2) elevated heart rate, (3) elevated stroke index, reflecting a more violent contraction, (4) excessive fluid status, and (5) some combination of 1 through 4. When there are multiple causes, calculating the portion of each cause is very helpful.
• PriMED’s physicians determined that using a simple, Food and Drug Administration-approved, in-office test called Impedance Cardiography (ICG) provides sufficiently accurate analysis of the hemodynamics behind elevated blood pressure. Statistical analysis demonstrated that, when PriMED’s providers used ICG, their outcomes were significantly improved. Without ICG outcomes were worse.
• Over time, PriMED recognized 28 additional demographic and comorbid conditions that can influence provider choices for optimal pharmacotherapy by patient. Given the variables described above, PriMED’s calculations include 50 key variables which, in turn, generate over 240 million permutations.
• All quality sciences prove that doing complex work successfully requires a carefully constructed process. A process is a series of steps designed to achieve the target outcome. If different actors do their work in an individualized manner, quality will be significantly lower.
• PriMED and MediSync first created a “paper and pencil” process to guide providers to select the optimal drugs from the 13 different classes of anti-hypertensive drugs for each patient.
• In 2017, MediSync made available and PriMED adopted an IT application called the MedsEngine that pulls vast amounts of data from any patient’s electronic health record and identifies and calculates the variables to make individualized drug recommendations for the patient. Provider use of this application is highly correlated to outcome success.
• The MedsEngine permitted PriMED to automate more disease calculations for cholesterol, diabetes, and heart failure—diseases for which the group also has excellent outcomes especially by national standards.

Medicine in general and primary care in particular have yet to broadly adopt or embrace the quality improvement techniques and methods that are ubiquitous in virtually all other economic sectors. It is clearly possible and urgently important that primary care does a far better job getting chronic diseases controlled. Once a few medical groups accomplish remarkable goals, there is no further debate about whether it is possible. Hundreds of millions of patients can live longer, healthier lives on average if we meet the challenge of better outcomes.

Mr. Matthews can be reached at bob.matthews@medisync.com.

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