How Has The Health Care System Changed? An interview with Dr. Alex Cahana

In an age of proliferating targeted drugs, plummeting DNA sequencing costs, and skyrocketing prices, many people have an answer to the question, “What’s wrong with healthcare?” Physician, Veteran, and ARK Theme Developer Alex Cahana has a stunning answer: “We don’t care about health.”

In a 40 minute interview, Dr. Cahana talks about his experience in the healthcare system, what he believes medicine gets right, what doctors could do better, and the limits to which technology can help us.

From this wide-ranging conversation emerges a cohesive and ambitious vision of personalized medicine. Personalized medicine should be successful when it delivers the right drug, to the right patient, at the right dose, at the right time. Dr. Cahana describes a future where doctors truly know their patients in context – a context provided by wearable devices, molecular biology, and interpersonal conversation.

While many new technologies, techniques and therapies will enable this future, Dr. Cahana provides a framework by which we should judge the relative value of these advances. Dr. Cahana tells us that in evaluating the value added by these technologies, we should ask three key questions: is it necessary? Is it sufficient? Do the economics make sense? Asking these questions will enable healthcare providers to delineate between value and waste.

If this vision of personalized medicine evolves, patients, drug makers, and society should benefit. In this future patients will be empowered on the molecular and technological level to take their health into their own hands. Medicine will be proactive instead of reactive, turning patients into producers, rather than consumers, of health.

Highlighted Quotes from Dr. Alex Cahana’s Interview

• “Today, everything in healthcare is better because of genetics which helps us understand the underpinnings of patient physiology and the power of computing which provides crucial context to doctors about the patient sitting in front of them.”
• “There is an epidemic of over-prescription in the U.S. For every 100 people who go to the doctor for pain, 75 people will get a pain killer prescription… We do not have a healthcare system where the patient is asked for pain, mood, and function at every visit.”
• “Doctors see too many patients and are incented to do things that don’t enhance the quality of the dialogue they have with patients. As a result, doctors tend to overprescribe, over-operate, and over-test.”
• “Assessing the value of a medicine or a device requires answering certain questions: What problem is it trying to solve? Is it important? Is it valuable? Does it reduce the burden of disease on society? After assessing these factors we need to analyze the economics: How much will it save? How does it help patients? How does it reduce the burden of disease?”
• “What’s exciting about the latest molecular therapies is that they empower patients to be better.”
• “We cannot strip away the social determinants of health from outcomes. Looking at simple outcomes strips away context and humanity.”
• “Like in other areas such as web technologies, in the future, consumers will become educated and take charge of their own health.”

About Dr. Alex Cahana:

Dr. Alex Cahana is the Director of Medical Affairs at the Center for Lawful Access and Abuse Deterrence (CLAAD), Subject Matter Expert for the Defense Veterans Center for Integrative Pain Management (DVCIPM) and a Theme Developer to Ark Invest. He is an affiliate Professor in Science Technology and Health Studies and adjunct Professor in Bioethics and Humanities at the University of Washington (UW).

During his tenure at UW he received the American Pain Society (APS) Center of Excellence; the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Best Practice; the World Institute of Pain (WIP) Best Comprehensive Pain Program; and the Honorable Mention for Innovation Health Care of the Association of American Medical Colleges (AAMC).

Dr. Cahana, a decorated combat medical officer in the Israeli Defense Forces, holds degrees in Bioethics, Philosophy and Theology and, in 2012 received the University of Washington President’s Medal for remarkable leadership and service. His work on policy with state and federal legislatures through the Clinton and the Henry M. Jackson Foundations has contributed to the reduction of prescription opioid related deaths.

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_{Dr. Alex Cahana is a Theme Developer for ARK. Theme Developers are independent third parties with whom ARK engages as part of its open source research process. Theme Developers are not employees or consultants to ARK. Theme Developers have no actual authority and should not be viewed as having apparent authority to act on behalf of ARK. The thoughts and opinions expressed by Dr. Alex Cahana are his own and should not be considered, and may differ from, those of ARK.}

_{This material and its contents are for informational purposes only and are subject to change without notice. This material does not constitute, either explicitly or implicitly, any provision of services or products by ARK. Certain of the statements contained in this material may be statements of future expectations and other forward-looking statements that are based on the current views and assumptions of the person making such statements and involve known and unknown risks and uncertainties that could cause actual results, performance or events to differ materially from those expressed or implied in such statements. ARK assumes no obligation to update any forward-looking information contained in this material. Certain information was obtained from sources that ARK believes to be reliable; however, ARK does not guarantee the accuracy or completeness of any information obtained from any third party.}