That was the challenge that Dr. Arthur Kellerman laid down to people attending the AACR Science of Cancer Health Disparities conference in Miami on September 30.

Dr. Kellerman, an emergency room physician, told a sobering story of his patient Diane, who arrived in the emergency room in pain.  Asked to describe what hurt, she pointed to her right breast.  When her gown was lifted, doctors and nurses could see a huge cancer that had broken through her skin.  Uninsured, she had tried to treat it with over-the-counter salves. She died two months later.

He said that, like Diane, 1000 Americans die every week because they don’t get health care that meets medical standards.

In his keynote address, Money, Maps, and Moms, Kellerman pointed out that the United States spends more taxpayer dollars per person than any of the countries like France or Canada with government health care, yet ranks far below them in outcomes for that care.

In terms of amenable mortality — deaths of people under 75 that could have been prevented with timely and effective health care — the United States is now last among 14 Western European countries, Canada, Australia, New Zealand, and Japan.

109.7 of every 100,000 Americans die from treatable conditions, compared to rates in the three leading countries of 64.8 in France, 71.2 in Japan, and 71.3 in Australia.  If the United States could have matched the average amenable mortality in those three countries, 101,000 fewer people would have died over two years.

Dr. Kellerman quoted James S. Marks of the Robert Woods Johnson Foundation, who wrote, “Why Your Zip Code May be More Important to Your Health than Your Genetic Code” in talking about the importance of geography or place and its impact on cancer incidence, treatment, and access to care and the influence of environment on diet, exercise, and other potentially cancer-causing exposures.

In another story, Dr. Kellerman talked about a homeless patient who came back to the emergency room with infections around the protruding screws that had been placed in his legs a couple of weeks before to treat broken bones.  After his surgery he’d been discharged back to the street, with no place else to go.

Both orthopedic and internal medicine residents were called down to readmit the old man and both adamantly refused, getting into a loud argument in front of the patient and the entire ER over whose job it was.

A wise attending physician finally picked up the phone and asked for a number.  “Are you going to call the chief resident?” one of the doctors asked.  “Don’t worry.  He’ll back me up.  We’re not admitting this guy.”

“No,” the older doctor said, “I’m calling your mother to see what she would do.”

Blushing, both residents reached for their admitting orders.

Finally, Kellerman issued what he called the top cancer challenges for the twenty-first century:

• Money: Health care and cancer care costs too much.  We need to deal with costs making sure that people are getting the most effective care, not just the care they can afford.
• Unequal treatment: How many more lives could we save if we simply delivered, consistently, the things that work.
• Geography:  We must unravel the effects of place on cancer incidence, treatment, and outcomes.
• Professionalism:  We must kindle a fierce commitment to professionalism in the fields of medicine and public health.  Our patients depend on us to do our best. We owe them no less.

Arthur L. Kellerman, MD, MPH holds the Paul O’Neill – Alcoa Chair in Policy Analysis at the RAND Corporation.  Prior to that he  was Professor of Emergency Medicine and Associate Dean for Health Policy at the Emory School of Medicine in Atlanta.  He founded the Department of Emergency Medicine at Emory and was its first Chair.

Former Senator Tom Daschle

Former Senator Tom Daschle, President Elect Obama’s pick for Secretary of Health and Human Services, had a chance to sit down with his ex-colleagues on Thursday. Daschle moved one step closer to the new president’s cabinet after completing his first Senate confirmation hearing.

Mr. Daschle was questioned by the Senate Health, Education, Labor and Pension (HELP) Committee. Committee Chairman Ted Kennedy (D-MA), making his return to the panel for the first time since being diagnosed with brain cancer last May, set the tone of the two-hour hearing in his opening remarks, calling Daschle a “valued friend.” “Tom Daschle is a leader of great integrity and strong dedication,” Kennedy said. “He has admirers all across the country and on both sides of the aisle.” (The Politico, 1-8-09)

Questions for the most part appeared to be friendly from the committee. The senators were mainly interested in how much Daschle plans to work across the aisle with Republicans in order to help shape a bi-partisan plan for health care reform.

The next step for Mr. Daschle is to appear before the Senate Finance Committee, who shares jurisdiction with the HELP committee on some health issues.

Senator Ted Kennedy (D-MA) announced he will be stepping down from the Senate Judiciary Committee in the 111th Congress to focus on health care reform. “As chairman of the Senate Health, Education, Labor and Pensions Committee, I expect to lead a very full agenda in the next Congress, including working with [President-elect] Obama to guarantee affordable health care, at long last, for every American,“Kennedy said.

Kennedy, who has been a long time leader in health care reform, has been working with President Elect Obama’s transition team along with fellow democrat Max Baucus, Chairman of the Senate Finance Committee, on legislation that will overhaul the current health care system in America. Kennedy plans a return to the Senate full-time after an absence following a diagnosis of a brain tumor. When he returns, he and Baucus plan to introduce legislation early in the 111th Congress.

“American families – and our economy – are in crisis over health care. We can’t get coverage to the 61 million who are either uninsured or underinsured without a major overhaul of the system, and there’s no way to really solve America’s economic troubles without fixing health care for the long term. I believe the policy ideas in this paper are the right way to start,” said Baucus.

Click here to read the Senator’s “Call to Action.”