The first three months of 2011 have been very busy times for POI, filled with a variety of activities filling all the hours available and moving our mission forward. A big event for POI in January was the annual meeting of our board where we always get strokes for our successes, and wise re-direction when it is warranted. I am personally grateful for the wisdom and friendship of the board.
The Shenzhen Cervical cancer screening trial ,SHENCCAST II, is in an intense writing phase now with our first manuscript published (Am J Clin Pathol 2011;135:790-795), and second one submitted (on self-sampling) and three more currently being prepared. SHENCCAST III, an evaluation of the Cervista 16/18 HPV assay was completed and the study will be presented at Eurogin 2011 in Lisbon Portugal in May. MECCS II, our HPV primary screening study from Mexico also has 2 manuscripts currently in preparation. However, most our time and for sure our energy these first three months has focused on the continuing preparation for PERCAPS – the Peru Cancer Prevention Study, which I am now happy to say is all approved, registered on clinical trials.gov, and on schedule to launch on the 23rd of May. Joining my colleagues from Peru and I will be our good friend Jorge Salmeron from Mexico, who will assume the role as the primary educator and facilitator for the promotoras, clearly the key position in this important project. We are honored to have Jorge on the team. We will also be joined for the PERCAPS project by two MD/MPH research fellows (one a Fogerty fellow from Brown University, and the other a gynecologic oncology fellow from the Cleveland Clinic). We will also have a medical student from Case Western Reserve University with us for her summer project. Our education mission continues to be strong.
The Peru project, PERCAPS (A Mother, Child, Screen, Treat, and Vaccinate Program) will likely run a few months ahead of CHICAPS, the Chinese Cancer Prevention Study. The screening models in these two projects will be our first attempts to develop the community based models we hope can change the way preventive healthcare is managed world-wide.
Medical care world-wide is in a crisis. In the developing world there is a lack of care and too little funding. In the western world we have too much care that has developed from too much funding, both from personal as well as third party sources. In addition in the US we have a distribution problem, since on all of our doorsteps it is not difficult to find signs of America’s 3rd world. The challenges are enormous and I am of the firm belief that the problems are not due to bad, misdirected, greedy, uncaring people, or governments for that matter. Surely there are a few, but the problems at hand are way beyond the damage from a few.
In the developing world many skilled individuals representing a vast array of organizations have literally spent lifetimes trying to reach the needy with their hearts, their energy, and their collective skills. The question in everyone’s mind is “where do we start to bring about truly effective change?” In my opinion there are similar issues that may have a common solution and for now POI will focus on one common conceptual change.
Healthcare reform in the US has been a bloody battle and the struggle ahead may be worse than what we have seen to date. There is of course no shortage of opinions, and as you might guess after more than 30 years of medical practice I have mine. I, for one, do not believe cutting costs for current services, and paying a small percentage of even regulated fixed fees, is the answer. To some extent it may be necessary but it will not solve the problem. Doctors are working very hard these days to continue to deliver quality care, yet satisfy all the regulations with the required documentation for compliance. The efforts being mounted by individuals as well as institutions to practice efficiently and safely, and cut costs are quite remarkable. I see it daily when I am home and at the Cleveland Clinic. However, there are simply too many smart physicians, and scientists interacting every minute of the day searching for the next best test or treatment. Everyday new studies are published advancing the practice of medicine. These advances are expensive and both doctors and patients want them. And I am here to tell you that in thirty-five years of practice I have rarely encountered a physician who did not want to do the best he or she could for their patients. Proposals and legislation that are in effect roadblocks to progress simply never work. That is why I strongly believe the right approach is not to cripple what we do well, and not to demoralize the caregivers and the innovators, but to identify those elements than can be removed from the medical model and in fact will work better on the outside. To that end POI now pursues the development of a new preventive healthcare model.
An enormous amount of the healthcare dollar is spent identifying who is needs medical care and who does not. We hope by using our expertise with cervical cancer screening, we can develop a preventive healthcare model using cervical cancer prevention as the target medical intervention. We fully expect that many other cancer prevention strategies, some that currently exist and some just peeking around the corner of clinical application, will follow and easily move into our model. We will focus on using a community based participatory research orientation, building the bonds and relationships that will allow us to hand the power to the communities and let them take ownership for those elements of healthcare that in my opinion they will do better, i.e. more efficiently, cheaper, and in vastly larger numbers. This will allow the health infrastructure to direct its finances, knowledge, and energy toward those individuals identified as needing the medical model as it was intended, to heal. There certainly are doctors among us who have made a living doing cancer screening. For some their skills and technology will still be needed, but some may have to re-tool and change their focus. At this point in my life and the life of POI, I know it is immensely easier to develop systems where you have little or none to tear down. For now, that is the world POI chooses to live and work in, but hopefully our outcomes will reach our expectations and the developed world will find some pertinent solutions in our work.
So let’s get going, wish us well!
Jerry Belinson, Cleveland, Ohio, April 22, 2011