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Thinking about Life Sciences

http://blog.aesisgroup.com

Wednesday, July 11, 2007

How Doctors Think: Implications for Life Science Business & Finance

While this blog concerns the business and investment side of the Life Sciences, you may have noticed that
interweaved throughout many of the discussions are concepts concerning the actual practice of medicine.
These involve issues such as the relationship between medicine and surgery, the relative importance of
diagnostics, therapeutics and prognosis, paradigm shifts in surgical thinking and so forth. These articles give
a glimpse into how clinical medicine and what takes place between doctors and patients impacts on the wider
issues of business and finance.
The list below is up-to-date as of July 11th, 2007. Since this blog will continually be added to (hopefully each
day), feel free to click on Practice of Medicine to obtain a more complete list should you be reading this
posting after that date. Using that link is much easier than having to go back and revise this blog posting
every time. If that were the case my work week would total more than the 120 hours/week that are routinely
put in by surgical interns.
Please note that that “practice of medicine” is not necessarily the core topic of each of these columns.
Instead, such "practice of medicine" issues are discussed in passing or in relation to the business and finance
issues that are the primary focus of these postings and this blog in general.

Convergent Medical Technology: Part I - What is it?

Discusses the concept of “diagnosis of exclusion” (per exclusionem) in the context of the definition of
convergent medical technologies. The clinical diagnosis of Alzheimer’s disease is, for example, a diagnosis
of exclusion while the pathologic diagnosis of Alzheimer’s is not. In passing, the concept of a diagnosis as
being both a process as well as an endpoint is touched upon. Read also why (as of July 10th) the Wikipedia
definition of “diagnosis of exclusion” is not correct.
10 July 2007, 9:46 AM | Add Comment

The Many Surprising Implications of Hip Resurfacing Implants

Discusses how minimally invasive surgery is not just a matter of smaller incisions and faster patient
recovery time. Indeed, by minimizing the collateral damage that occurs while reaching and manipulating
the target surgical tissues, minimally invasive surgery makes routine re-operation possible. This has
transformed the practice of surgery from that involving definitive, one-time, last-resort procedures into
potentially a series of limited, repeatable interventions.
8 July 2007, 2:04 PM | Add Comment

The Diabetes Divide: Is Diabetes a Surgical or Medical Disease?

Describes the different approach to the patient entailed by either a medical (pharmaceutical) or
surgical (interventional) strategy and how different diseases require one or both of these arms of
Medicine. Note that Medicine with a capital “M” represents the entire field encompassing within it
medicine and surgery (and psychiatry). In general, surgical diseases are local in extent, and/or require

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rapid treatment and, of course, have a surgical intervention available with a sufficiently favorable
risk-benefit balance. This discussion sets the context for proposing that there are more surgical aspects to
insulin-dependent diabetes than conventionally considered.
14 May 2007, 10:16 PM | Add Comment

Personalized Medicine and Technology Convergence: Decisive Trends

This article talks about the relationship between personalized medicine (a hot topic) and convergent
medical technologies (an increasingly hot topic). While it has been said that the age of personalized
medicine is coming rapidly upon us, I point out how since the time of ancient civilization, surgery has had
a decidedly personalized approach to the patient. To the extent that devices are the technical embodiment
of surgery, personalized medicine (or should we write personalized Medicine) will increasingly also involve
more surgical approaches to the patient.
16 April 2007, 10:01 AM | Add Comment

What Patients Want: A Story of Choice, Trials, Evidence-Based Medicine

Evidence-based medicine is often predicated on the assumption that there is one option that will rise to
the surface as being preferred (standard-of-care in legal parlance) as compared to other therapeutic
options. This article discusses the recent SPORT trial comparing surgery with conservative treatment and
comes up with the surprising conclusion that while the trial was not as definitive as hoped, the value of
patient choice was clearly demonstrated. Physicians keep this in mind in balancing the art and science of
Medicine; the industry should be aware as well.
19 March 2007, 10:42 PM | Add Comment

Medical Design Excellence Awards Offer Decisive Glimpse Into Future of Health Care

Good medical design entails many aspects. Because healthcare is intrinsically complex, simplicity is
absolutely essential to the good design of medical devices, equipment and processes. Many in the industry
lament how difficult it is for physicians to adopt new technologies. “How hard is it to type in
prescriptions” is a familiar refrain. But considered from the side of the physician, additional extra steps
that do not contribute directly to patient benefit will have a hard time being accepted even if they have
other potential benefits.
20 February 2007, 5:24 PM | Add Comment

What’s More Important in Medicine: Diagnostics, Therapeutics or Prognosis?

This article begins with a brief synopsis of the genesis of Western Medicine and the initial divide between
the Knidian school (focused on diagnosis) and the Hippocratic school (focused on patient care and
prognosis). Or modern system is decidedly focused on therapeutics but we are seeing that shifting as
diagnostics (as in personalized medicine) and, looking forward, prognosis (as in applications of genomics)
regain their relative importance. Clearly there are significant implications for business and investment as
highlighted in the discussion about GE Healthcare’s acquisition of Abbott Diagnostics.
5 February 2007, 10:50 PM | Add Comment

Lance Armstrong and the Future of Cancer Care

The approach to the patient with cancer is going through a complete paradigm shift. Of course, everyone
is familiar with the increasing prevalence of cancer as a chronic disease. The term “cancer survivor” is not
such a rare one anymore. All of these trends, predominantly driven by advances in technology, change
how patients are diagnosed, treated and ultimately, of course, their prognosis.

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22 January 2007, 10:38 AM | Add Comment

Drug-Eluting Stents, Part Two: Triple Storm Catching Industry Attention

In a commentary on the recently developed ABSORB bioabsorbable stent by Abbott I discuss how some
conditions require a temporary solution (such as a broken arm being treated with a cast) and others entail a
more permanent solution (such elbow protection every time a skateboarder goes out to perform). The
point is that given the local circumstances in certain regions of the coronary arteries which are susceptible
to plaque formation and blockage (just like a skateboarder is susceptible to breaking limbs), a more
permanent solution is likely to be necessary.
28 November 2006, 4:26 AM | Add Comment

‘Medicare Part D’: What the Benefit Means For Medical Technology

While most competitive analysis is sector specific – such as one type of statin drug (Pravachol) being
compared to another (Lipitor) it is important to recognize that there is even potential comparison and
competition between sectors. The example is given of gastro-esophageal reflux disease (GERD) in which
there are both effective drug and interventional techniques and that broad measures of risk-benefit, patient
choice and cost need to be applied to understand the market dynamics.
15 May 2006, 7:43 PM | Add Comment

Drug /Device Safety Debate to Yield Big Changes, Grow More Controversial

Safety has always been important in medicine but its relative importance has waxed, waned and waxed
again over time. During the Age of Hippocrates – the birth of western medicine – safety was at a
premium and in the modern era the remarkable efficacy of contemporary medicine and surgery has shifted
the risk-benefit balance. However, we are seeing a new emphasis on safety as typified by but not
exclusively dominated by the Vioxx and Avandia controversies.
1 May 2006, 3:36 AM | Add Comment

Dr. Jerome Groopman – Harvard Medical School professor, renowned physician-scientist in the field of
cancer and AIDS and an accomplished essayist and author – has recently written a fabulous book “How
Doctors Think” and it comes strongly recommended. I’ve sometimes half-joked that everyone should go
through either U.S. Marine bootcamp or a medical/surgical internship sometime in their lives. Of course,
that’s not practical for everyone, but the point is that such training involves more than simply learning about
cleaning M-16s or tying surgical knots but this experience inculcates a certain physical and mental discipline
along with some very powerful – though not always flawless – ways of thinking. Just as in the various
postings above, Dr. Groopman’s book also muses on many the strengths and frailties, commonalites and
vagries of medical thinking.
It's a rich source of ideas but also a provider of deeper insights into the business & investment world of the
life sciences.
Ogan Gurel, MD MPhil
gurel@aesisgroup.com
http://blog.aesisgroup.com/

Practice of Medicine Surgery blog Aesis Research Group Ogan Gurel MD

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