Experts Hopeful About Steady Drop In Cancer Deaths

Business Week

Less smoking, earlier detection, and improved treatments are credited for gains against lung, colon, prostate, and breast cancer

The latest federal cancer numbers, released on Dec. 7, show a modest but steady decline in the U.S. over six years for both deaths from the disease and new diagnoses. The improvement is driven largely by declines in the big four cancer killers—lung, colon, prostate, and breast. Specialists attributed the declines to a reduction in the smoking rate, better and earlier detection, and improved treatments, particularly those that can be matched to a patient's specific tumor type.

New diagnoses for all types of cancer decreased almost 1% per year on average from 1999 to 2006, while cancer deaths decreased 1.6% per year from 2001 to 2006. However, experts in the field warn that these successes could be wiped out in coming years by the nation's obesity crisis. Because fat cells fuel tumor growth, about one-third of cancer cases today can be linked to obesity. "The increase in obesity is a real concern and could eventually cause this very welcome decline to reverse," says Dr. Edward J. Benz, president of Dana-Farber Cancer Institute in Boston. "We don't know yet but it is quite possible that obesity will become as much or more of a factor in causing cancer than smoking."

Cancer is currently the nation's second-largest killer after heart disease. An estimated 562,340 people in the U.S. will die from the disease this year, accounting for nearly 1 in 4 deaths. The six-year declines—reported by the National Cancer Institute, the Centers for Disease Control & Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries, or NAACCR—are far from a home run. The annual federal cancer report had shown small declines in the death rate in each of the past five years, but this is only the second year that a decline in diagnoses was recorded (after 2008). And both drops were considered "significant" in the cancer world, where anything more than a 1% decline is something to celebrate when placed against such a formidable disease. The persistence of the declines gives cancer specialists encouragement that steady progress is finally being made in treatment, screening, and prevention, after decades when the trend lines barely budged.

"We still have a long, long way to go but I am optimistic," says Dr. Raymond DuBois, provost of M.D. Anderson Cancer Center in Houston. "If these trends continue for another few years, we will be certain that the progress is real."

 

Under-50 Mammograms

Even though early detection was considered a key factor in the declines, specialists said the findings did not undercut the recommendation on Nov. 16 by the U.S. Preventive Services Task Force that annual mammograms are not needed until age 50 for women who are at low risk for breast cancer. "These new statistics weren't broken down by age," says Benz. "Although I think that early detection by mammograms does contribute to these improvements, whether the results are due to screening starting at age 40 or age 50 cannot be determined."

The task force based its recommendation on an analysis that found that almost 2,000 mammograms would have to be performed on women ages 40 to 49 over 10 years to prevent one breast-cancer death. All those mammograms do pick up a high number of false positives, however, with resulting unnecessary follow-up procedures such as biopsies that can be stressful, costly, and sometimes harmful. That raises concerns that mass screening of younger women is doing more harm than good.

Overall, the new report found that cancer rates were higher for men than for women, but men experienced the greatest declines in new cases and death rates. For both men and women, however, there was little progress in many less common cancers, such as kidney cancer, and even some increases.

Colon and rectal cancer, usually categorized together as colorectal cancer, had the biggest declines. Deaths dropped by 3.9% per year for men and 3.4% per year for women over the six-year period. Colorectal is the third-leading cause of cancer death and much of the improvement was linked to a greater adoption of colon screening, which can be very effective at not only detecting tumors but removing the polyps that could later turn cancerous. However, the researchers noted that there is an increasing incidence of colorectal cancer in men and women under age 50. Colorectal cancer has been linked in some studies to obesity and a high-fat diet.

Incidence-Rate Declines

The report found that, in men, incidence rates have declined for cancers of the lung, prostate, colon/rectum, oral cavity, stomach, and brain. But incidence rates continue to rise for kidney/renal, liver, and esophageal cancer, melanoma, and blood cancers. In women, incidence rates decreased for breast, colorectal, uterine, ovarian, cervical, and oral cavity cancers, but increased for lung, thyroid, pancreatic, bladder, and kidney cancers, as well as for non-Hodgkin lymphoma, melanoma, and leukemia.

"The continued decline in incidence and death rates for all cancers combined is extremely encouraging, but progress has been more limited for certain types of cancer, including many cancers that are currently less amenable to screening, such as cancer of the esophagus, liver, and pancreas," said Betsy Kohler, executive director of NAACCR.

The three leading causes of cancer death for all men, with the exception of Asians/Pacific Islanders, were lung, prostate, and colorectal cancer. Lung, liver, and colorectal cancers were the top three causes of cancer death in Asian/Pacific Islander men. For women, the three leading causes of cancer death were lung, breast, and colorectal cancer for all racial/ethnic groups except Hispanic women, for whom breast cancer ranked first.

Women From Clinical Trial Sing The Praises Of Lysteda

Grand Rapids Press

It's certainly not an easy subject to talk about, but heavy menstrual bleeding can be debilitating for some women, and more than just a nuisance for others.

Rockford resident Karen Van Riper says her condition is so bad, she can't leave the house for several days each month.

Now, for the first time, hormone-free relief is on the way in form of a pill -- Lysteda -- just approved by the Food and Drug Administration after a two-year research clinical trial that included 100 West Michigan women like Van Riper.

"I'm a soccer mom; I'm a Girl Scout leader; I volunteer at my kids' school, but if my period happens, I can't do any of that," said Van Riper, 38. "It was incredibly life changing (to be on the drug)."

Female Pelvic Medicine & Urogynecology, an arm of Grand Rapids Michigan Women's Health group, was the largest participant in the study that led to Lysteda, also known as Tranexamic acid, being set to hit the market next spring.

Beth Rogers, the practice's research director and coordinator of the study in Grand Rapids, said the West Michigan women first participated in a blind trial in which some received the drug while others took a sugar pill. It was almost immediately obvious who was receiving the real thing, she said.

"These are women that always have to carry an extra set of clothing with them -- it was that bad," Rogers said. "These are women that their doctors told them, 'You know it's just part of being a woman.' And now they have another option."

The drug, manufactured by Kentucky-based Xanodyne Pharmaceuticals, works by stabilizing a protein that helps blood to clot. It is currently used to reduce and prevent bleeding following tooth extraction in patients with hemophilia, a hereditary disorder that prevents blood from clotting.

According to the FDA, about 3 million U.S. women of reproductive age suffer from the condition, known as menorrhagia.

Dr. Douglas Van Drie, who led the study in Grand Rapids, estimates about 20 percent to 30 percent of women have a period so heavy that it interferes with their life, causing severe anemia, pain, fatigue and embarrassing leaks.

Treating the condition with low-dose birth control pills is not an option for all women, and it's not always effective, he said.

"If you look back to the 1950s, probably a lot of these things were suffered silently," Van Drie said. "But with more women in the workplace, it's not practical."

Stephanie Chandler's heavy bleeding had led her to take vacation days once a month from her job at an area call center, consider filing for unpaid leave under a federal law, or even confining herself to the bathroom.

The 39-year-old Grand Rapids resident said she participated in the study because heavy bleeding has been a problem since she was a teenager and caused fatigue from dangerously low blood iron levels. Chandler said she has tried birth control and minor surgery and even considered a partial hysterectomy to relieve her symptoms.

"Taking (Lysteda) literally changed my life," she said.

Cancer Survivor, Radiologist Speak Out About New Mammogram Guidelines

mLive

SWARTZ CREEK, Michigan — Three times was the charm for Swartz Creek breast cancer survivor Carla Lazar.

Lazar, 42, has had three mammograms since age 38, each ordered by her primary care physician as a routine part of her preventive health care program.

She’ll never forget the third, done Dec. 22 of 2008 at the age of 41.

It’s the one that saved her life.

It’s also a mammogram she never would’ve had, under controversial new mammography guidelines from the United States Preventive Services Task Force.

The new federal guidelines — which no longer recommend  routine screening for women ages 40-49 unless they are genetically predisposed to breast cancer, and once every two years rather than annually for women ages 50-74 — have caused an uproar within the medical and patient advocacy communities since being released on Nov. 16.

Diagnosed with stage one breast cancer, Lazar underwent lumpectomy surgery to remove the tumor, then three months of chemotherapy followed by seven weeks of radiation.

She credits her medical team and the support of friends and family for her survival — but none of that would’ve been possible without the test that detected the disease, she said.

“My prognosis now is good, God willing. Luckily for me that’s how it played out because I had no symptoms, no risk factors. If my doctor wasn’t diligent in ordering these tests, this might’ve been a very different conversation,” said Lazar.

“If these new guidelines were already in place, I wouldn’t even get my first mammogram until I turn 50. By then, we probably wouldn’t even be having this conversation.”

That’s exactly what has alarmed physicians like radiologist Dr. Linda  Lawrence Murphy, director of imaging for McLaren Regional Medical Center and McLaren Imaging Center.

“We are diagnosing women younger and younger all the time. We’ve gotten so much better at detecting breast cancer at a smaller stage when it is curable. So many are women under age 50. This is a huge step backwards in early detection,” said Lawrence Murphy. “I feel like we are going back to the dark ages in women’s health care.”

Supporters of the Task Force report have said the findings simply indicate not enough lives of younger women are being saved to justify the expense, stress and risk of unnecessary mammography.

Lazar finds that notion disturbing.

“I don’t know if this is about insurance companies not wanting to pay for all these tests but if they save one life, it’s worth it. It’s my life. It may be your own,” said Lazar. “I can understand not putting women through biopsies and additional testing that end up not being anything, but what if it was  something like in my case? I’m so grateful we have a system in place now that is ready to treat this right at the offset.”

Lazar was also bothered that the report advised against teaching women to do breast self-exams.

“I can’t imagine how it could hurt to be proactive with our own bodies. It’s got to be a good thing anytime a woman is in tune with her own body enough to recognize a change,” said Lazar.

Lawrence Murphy said the study had a very big, basic flaw: it was based on results from an older style of film screen mammography that is rapidly being replaced by more accurate digital screening.

“Probably close to 80 percent of women are getting digitals now, which is far superior in detecting cancer in women under age 50, those with dense breasts and those who are peri-menopausal,” said Lawrence Murphy.

Lawrence Murphy said the report distorted the reality of unnecessary biopsies too.

“It’s true mammograms aren’t perfect and we do some biospies that are benign. But these are not major surgeries in the hospital. Most are done using a simple needle under local anestheisa. The patient has a bandaid when she leaves,” said Lawrence Murphy.

Meanwhile, groups like the American Cancer Society, Black Women’s Health Imperative and American Society of Breast Surgeons continue to line up in opposition to the guidelines, which some fear could eventually eliminate mammography coverage as a prevention service and negatively impact Michigan women's health.

“Nobody involved with this report is looking at what we are saving on the other end by curing these women earlier, before it requires more expensive surgery and could’ve spread to other organs,” said Lawrence Murphy. “It’s like telling someone don’t look both ways before you cross the street because it causes anxiety and hasn’t been shown to save lives. It’s just ridiculous.”

Public Health Officials Refusing New Patients

NBC Los Angeles

 

The "unprecedented fiscal challenges" claimed another victim this week as health officials decided to discontinue a cigarette tax-funded program that pays for breast cancer screenings for low-income women.

Mandatory changes were required this week by California Department of Public Health to the division, Every Woman Counts. The specialized division provides a cancer detection program for California's medically underserved women by giving them access to screening and diagnostic services for breast and cervical cancer.

The two biggest changes to the program according to a release are:

    * They will stop paying for breast cancer screening for women under 50.

    * They will stop enrolling all new patients for breast cancer screening until July 1.

The changes according to their Web site are based on the lack of state funding, and the only way to keep within their budget.

A statement released by Dr. Mark Horton, the state health officer, said "the short-term increases in state funding for the program have not been enough to keep pace with the growing demand for and cost of providing breast cancer screening services to the women in this program.

This comes on the heels of the recommendation by the U.S. Preventive Services Task Force. The task force suggested that women younger than 50 do not need regular mammograms. The Los Angeles Times printed a response by Dr. Willie Goffney to the claims of the task force.

Dr. Willie Goffney, a surgical cancer doctor who serves on the board of directors for the California division of the American Cancer Society, said he was disappointed by the state's decision to put the free screening program on hiatus and then limit who can enroll.

“We feel we are moving in the wrong direction. We know that screening for breast cancer and having access to that screening saves lives,” Goffney said. “So to take those resources from people who need that access means more people will fall through the cracks, and will lead to more deaths from breast cancer.”

Many in the industry of providing mammography services are worried that their businesses will not be able to survive, and more importantly, that these changes will deter women under 50 from being tested.

Tumour-Attacking Virus May Offer Brain Cancer Treatment

DNA India

Washington: Scientists at Ohio State University have developed a tumour-attacking virus that both kills brain-tumour cells and blocks the growth of new tumour blood vessels. According to researchers, their study shows that viruses designed to kill cancer cells - oncolytic viruses - might be more effective against aggressive brain tumours if they also carry a gene for a protein that inhibits blood-vessel growth.

The protein, called vasculostatin, is normally produced in the brain.

In this study, an oncolytic virus containing the gene for this protein in some cases eliminated human glioblastoma tumours growing in animals and significantly slowed tumour recurrence in others.

Glioblastomas, which characteristically have a high number of blood vessels, are the most common and devastating form of human brain cancer.

People diagnosed with these tumours survive less than 15 months on average after diagnosis.

"This is the first study to report the effects of vasculostatin delivery into established tumours, and it supports further development of this novel virus as a possible cancer treatment," said study leader Balveen Kaur, associate professor of neurological surgery and a researcher with the Ohio State University Comprehensive Cancer Center-Arthur G James Cancer Hospital and Richard J Solove Research Institute.

"Our findings suggest that this oncolytic virus is a safe and promising strategy to pursue for the treatment of human brain tumours.

"This study shows the potential of combining an oncolytic virus with a natural blood-vessel growth inhibitor such as vasculostatin. Future studies will reveal the potential for safety and efficacy when used in combination with chemotherapy and radiation therapy," she added.

The findings were recently published online in the journal Molecular Therapy.

OxyPharma Announces Positive Results In Arthritis Treatment

Pharma Live

Swedish drug development company OxyPharma today announced the preliminary results of its phase II clinical trial of Rabeximod, an orally administered disease-modifying anti-rheumatic drug (DMARD) for treatment of moderate or severe active rheumatoid arthritis. The study demonstrated clear therapeutic effects of Rabeximod in patients with rheumatoid arthritis, resulting in a significant effect on key biological and disease variables after 16 weeks.

The study was designed to reveal an effect of Rabeximod at 12 weeks (primary endpoint), based on the assumption of a similar onset of action as other disease-modifying anti-rheumatic drugs. Treatment with Rabeximod was given during 12 weeks to 224 patients with moderate or severe active rheumatoid arthritis that were not fully responsive to prior treatment withmethotrexate , with clinical follow-up visits through week 16. Patients, all on a stable dose of methotrexate, were randomized to one of three dosing regimens of Rabeximod (6.25 mg, 15 mg, or 37.5 mg once daily) or placebo. Principal Investigator was Professor Lars Klareskog, Head of Rheumatology Unit at Karolinska University Hospital, Stockholm, Sweden.

Rabeximod showed a delayed onset of action, which resulted in a significant therapeutic effect of the dosing regimen seen at 16 weeks rather than at the 12 week endpoint. At 16 weeks, the 15 mg Rabeximod dose group exhibited statistically significant (p<0.05) effects for seven of the key secondary endpoints of treatment: ACR20, DAS28 response rate, pain, subject global assessment, physician global assessment, number of swollen joints and number of tender joints. At 12 weeks, none of the treatment groups demonstrated a significant effect on the ACR20 response rate, which was the primary endpoint of the study.

The study also demonstrated a good safety profile of Rabeximod. The incidence of adverse events in the Rabeximod 6.25 mg, 15 mg and placebo groups were similar. Skin disorders were the most frequently reported adverse event, with the highest incidence in the 37.5 mg Rabeximod group, all rated mild to moderate in severity. No adverse synergistic effect was seen with methotrexate.

Based on the efficacy and safety results, 15 mg Rabeximod administered once daily appears to be the most optimal dose. These results indicate that the treatment duration of 12 weeks in the study was too short to reach an optimal clinical effect of Rabeximod in combination with methotrexate. The full potential of Rabeximod in the treatment of patients with rheumatoid arthritis will be revealed in studies designed with a longer duration of treatment.

“This is the first clinical trial evaluating the effect of Rabeximod for the treatment of moderate or severe rheumatoid arthritis”, said Ulf Björklund, CEO, OxyPharma. “The study suggests that Rabeximod causes a beneficial modification of disease activity with a delayed onset of its therapeutic benefits. The results thus indicate that a three month treatment period was not sufficient to observe the full therapeutic effect of the drug. This outcome is what can be expected with a disease-modifying anti-rheumatic drug where the effect appears slowly and lasts longer, especially since the compound has a long half-life. As the main variables are statistically significant at week 16, OxyPharma is confident that studies with longer treatment duration will prove oral Rabeximod to be an effective, convenient and safe drug for commercialization”.

Partnering Strategy “The management and the board of OxyPharma consider the results very encouraging for further development of Rabeximod. We have therefore decided to invite pharmaceutical companies for partnering discussions. OxyPharma is in the process of appointing an advisor to assist in this process”, said Mr. Björklund.

Rheumatoid Arthritis Market Estimates of the value of the global rheumatoid arthritis market vary between USD 6 and 13 billion annually. The market growth is significant. There are presently no effective, safe and oral drugs for rheumatoid arthritis treatments.

About Rabeximod: Rabeximod is an orally available small molecule that is first-in-class and classified as a disease-modifying anti-rheumatic drug. Its mechanism of action is an interaction with the inflammatory tissue type A cells, often described as macrophages. In vitro data on human peripheral blood cells show that Rabeximod suppresses the differentiation of monocytes into pro-inflammatory macrophages but not anti-inflammatory macrophages. The inflammatory macrophage is the central orchestrator of the inflammatory response leading to tissue destruction and clinical symptoms. Thus, the macrophages is a key cell in immune presentation of antigens and plays a role in both the initiating phase of the inflammation as well as in perpetuating the inflammatory process.

The commercial use of Rabeximod and related compounds as a rheumatoid arthritis medication is covered by strong patents.

Don't Wait Too Long To Talk About Elder Care

Indy Star

Through nearly 20 years working with the elderly, I've learned something profound. Most people don't fear dying -- they fear the aging process.

According to recent AARP survey, baby boomers are three times more worried about a having a major illness (48 percent) or winding up in a nursing home (48 percent) than about dying (17 percent). They're most concerned about becoming a financial, emotional or physical burden on their families.

The AARP also reports that 89 percent of survey respondents older than 50 want to stay in their own homes, surrounded by their lifetime possessions and comforting memories, for as long as possible. Over the past decade I've witnessed a growing trend to enable and accommodate seniors to stay in their own homes, rather than move into assisted-living facilities or nursing homes. Because there are so many questions around and fears about living situations for the elderly, I encourage my clients to plan well for the inevitable future.

In 2006, life expectancy at birth for the total population reached a record high of 78.1 years, according to the Centers for Disease Control and Prevention. Thanks to modern medicine and personal attention to living healthier lifestyles, today we can expect to live a lot longer than previous generations. What we can't expect or take for granted is quality of life.

Diseases of the heart and cancer still account for nearly half of all deaths for those older than 65. Progressive diseases such as diabetes, respiratory illnesses and Alzheimer's also are becoming more prevalent contributors to mortality. This means our parents may struggle for years with a debilitating illness.

I encourage my elderly clients and their family members to have open, honest dialogues about lifestyle expectations -- and to talk about it early and often. Yes, it can be scary and uncomfortable at first. But it's much worse to wait for a health crisis and then try to assume what your loved one wants. I've seen this unfortunate situation time and time again.

Some questions you should discuss include: How and where does your loved one want to live when they need assistance at home? If they can stay in their home with home health-care nursing, aide or companion assistance, will there be adequate insurance or savings to pay for these services? How much does home care cost compared to assisted living? Would your loved one rather stay with you or another family member?

If you're just too uncomfortable initiating or having the discussion with your parent, suggest having the discussion facilitated by a family friend or a clergyman. Another great resource is a geriatric care adviser. Usually a registered nurse, this professional helps seniors and their families through the complexities of aging; this can include everything from organizing medical information to coordinating care in a crisis. Also, be sure to talk to a financial planner about finances as well as long-term care and life insurance programs.

Since 1980, deaths from Alzheimer's disease have doubled with projected diagnoses expected to climb to 42.3 million by 2020. It's as good a time as any to start a conversation with your aging parent to help them -- and you -- face fears straight on and gain a little peace of mind about the future.

4-Week Decline In Flu-Like Cases

USA Today

Federal health officials reported Monday that cases of flu-like illness in the USA have declined for four weeks in a row, though hospitalization rates remain high, especially for children younger than 4.

The steady decline in the USA and elsewhere prompted the World Health Organization to propose Friday that swine flu may have peaked in North America, the Caribbean and parts of Europe, though the "winter influenza season continues to be intense."

U.S. officials challenged WHO's hopeful assessment, saying it is too soon to declare that swine flu is tapering off.

"We are certainly nowhere near the end," says Daniel Jernigan of the Centers for Disease Control and Prevention, noting that, even after the monthlong decline, "we're still above the peak we had last winter."

Jernigan says there also was a drop in cases at this stage of the 1957 pandemic, which appears to offer the closest parallel to today's outbreak. But flu cases and deaths rebounded after the Christmas and New Year's holidays. "The conditions that influenza likes – winter with people crowding together – haven't even come yet," he says.

Deaths of children continue to mount, the CDC reported, with a record 27 during the week ending Nov. 21. That's the highest one-week total since swine flu, also known as H1N1, was identified in April. Doctors have reported about 200 pediatric swine flu deaths to the CDC, which says many more deaths probably have gone unreported.

As of Monday, 66 million doses of swine flu vaccine were available for states to order, and more were on the way, the CDC's Thomas Skinner says.

U.S. Redoubles Efforts On AIDS / HIV

Reuters

The United States, which is preparing to lift a ban on visits by foreigners infected with HIV, will host a global AIDS conference in 2012 as a sign of redoubled U.S. commitment to fight the pandemic, U.S. Secretary of State Hillary Clinton said on Tuesday.

"We have to continue to seek a global solution to this global problem," Clinton told a news briefing announcing the 2012 biannual conference would take place in Washington D.C., the first time it has been on U.S. soil since 1990.

The International AIDS Society, which organizes the conference, hailed the change and urged other nations that maintain bans on HIV-positive visitors to follow suit.

"The return of the conference to the United States is the result of years of dedicated advocacy to end a misguided policy based on fear, rather than science," IAS President-elect Elly Katabira said in a statement.

Clinton said the end of the ban on HIV-positive visitors to the United States, enacted 22 years ago, would take effect in early January and would be "vigorously" enforced.

Health and Human Services Secretary Kathleen Sebelius said the end of the ban was an important shift.

"It was a policy that tore apart families, kept people from getting tested, forced others to hide their HIV status and forgo lifesaving medication ... and most of all it didn't reflect America's leadership in fighting the disease around the world," Sebelius told the news conference.

The AIDS virus infects 33 million people globally and around a million in the United States, but more people are living longer due to the availability of drugs, according to a recent United Nations report.

However, more than half of the people who need life-saving drugs are not getting them, according to the 2009 AIDS epidemic update by the World Health Organization and Joint UN Programme on HIV/AIDS.

Cocktails of drugs can control HIV but there is no cure.

While the Obama administration has vowed to continue the President's Emergency Program for AIDS Relief or PEPFAR, launched during the Bush administration, some AIDS activists have voiced concern that the issue may not get as much attention as Washington confronts a raft of other global problems.

Eric Goosby, the new U.S. global AIDS coordinator, told the news conference that a full report plotting the future of PEPFAR would be issued later this week and would show expanded U.S. support for the world battle against HIV/AIDS.

Using Technology To Improve Health-Care: An Interview With Humana CIO Bruce Goodman

Wall Street Journal

A lot has changed in the way the health-care industry uses technology since Bruce Goodman became Humana Inc.'s chief information officer in 1999. And, he says, there's still a lot of work to be done.

Mr. Goodman, who joined the Louisville, Ky., health-insurance giant amid the Y2K frenzy over the ability of computers to deal with a year ending in 00, sees both technical and creative challenges looming for his industry. His primary goal is to get doctors, patients and insurers fuller information more quickly.

Mr. Goodman recently discussed these challenges and more with The Wall Street Journal. Here are edited excerpts of the conversation:

An Echo of Y2K

THE WALL STREET JOURNAL: Do you think we'll ever see something like Y2K again?

Mr. Goodman: The health-care industry is going to go through something equivalent to Y2K in a couple of years. There is a new code that the government is promoting around how you describe medical procedures called ICD-10. And that significantly expands the code set when a doctor describes what they have done for a patient.

So the old code said, "broken leg." The new code set gets much more specific as to exactly what part of the leg is broken and why it got broken. Tennis accident, skiing accident; it is really detailed.

You have got to go through all the systems where those kinds of codes are carried and expand those fields and bring in those new code sets. A lot of it can be automated. But it means remediating millions of millions of lines of code across lots of systems—systems hospitals use, we use, doctors' offices use. [When completed] it gives you more capability. You can do much more refined studies in terms of what is going on.

WSJ: How much freedom do you give Humana employees when it comes to using technology?

Mr. Goodman: They have a lot of freedom, but we are in a highly regulated business. We have some very confidential information about our members, and we are very sensitive to the level of security and the devices employees use. Our data center is attacked millions of times a month from the Internet. So we don't have our users using devices that can bring viruses and worms and Trojans and phishing expeditions into the mother ship.

WSJ: How can you tell which ones meet that criteria?

Mr. Goodman: For example, currently the Apple iPhone doesn't. It is not a secure enough platform where we would allow our highly confidential data to move. We tightly control laptops and other things that we give to our people. BlackBerrys, by the way, do satisfy the requirement, and we have those.

WSJ: What's the difference between the iPhone and the BlackBerry?

Mr. Goodman: The main difference is that if you lose a BlackBerry there are ways of ensuring that if somebody else picks it up, they can't get into the network and access your private data. There is a way of basically shutting it down. It's much more challenging to do that on the Apple devices.
Reforming the System

WSJ: There's a lot of talk now about using technology to reform the health-care system. What have you guys done to date?

Mr. Goodman: You want doctors to use your Web site for self service. The difficulty was that a typical doctor's office has patients from dozens of different health plans. So, each health plan has various degrees of advancement in terms of providing Web capability, right? And then the doctors would have to train their staff, which tends to have a fairly high turnover in the front office, to use all of those different systems. So, we got to a certain point of adoption and we were having a hard time getting beyond that.

We went and had a conversation with a competitor, Blue Cross Blue Shield of Florida, and said, "This is silly. Why don't we come up with a uniform Web portal for doctors?" Now more than 95% of all the doctors' offices in Florida use this capability, and it includes Aetna, UnitedHealth, Cigna, a lot of local plans and ourselves, so that the majority of patients that come into a doctor's office, they can go to that one Web site and get the information they need.

[We've since partnered with plans in other states and] we're rolling out in Texas, Illinois, Oklahoma and New Mexico. Not only has it been successful in terms of increasing adoption of the Web, but we have also gone off into clinical transactions, like e-prescribing. The venture has gone from practically no revenue to $70 million in revenue. And it does 600 million transactions a year.

WSJ: Is this the model for how technology can improve health care?

Mr. Goodman: Absolutely. What many people don't realize is that health plans are in a unique position to provide information about the patient.

If a member is seeing more than one doctor or is getting prescriptions from more than one doctor, we see all of that if we insure them. We know when a member didn't refill a prescription, so we can tell a doctor there is a gap in adherence. If doctors are doing e-prescribing using hand-held devices, we can show them lower-cost drug options for their patients at the time of the script writing.

More to Do

WSJ: What parts are missing now?

Mr. Goodman: A number of things. Very few doctors' offices have electronic medical-records systems. And patients don't do a personal health record because a lot of them don't see the value of it. And frankly until you connect all the pieces and crunch it with data analytics, there isn't a lot of value to it. Part of [what will drive] adoption is getting everybody hooked up, and then generating actionable information that is useful to everybody in the system. You could take a lot of money out of the system by doing that.

WSJ: Who has to make this happen?

Mr. Goodman: What's disappointing about what's going on in Washington is that health plans are viewed as the villains, and we're actually in the best position to promote some of these advances because we have the data. We can provide monetary incentives to the doctors and to the [patients] to take advantage of whatever data analytics we do and, therefore, drive the adoption. And with the adoption you improve quality of care and you lower the cost of care.

When you have a not-for-profit organization or a plan, [they just don't have the incentive] to connect the doctors. When you have somebody who's in it for a profit, you have a motivation to root out fraud and abuse and to try to really improve the quality of care, because it costs less if you have good care.

Looking Ahead

WSJ: How will the experience of being a patient be different in the future than it is now?

Mr. Goodman: To get an appointment at a doctor's office you'd go onto the Web, whether you're using a smart phone or not. And when you show up at the doctor's office, let's say it was your first visit, a lot of information that normally they would ask you for has already been downloaded.

In the exam office, there is a monitor and the doctor has everything in front of him or her. If there is a prescription needed, the doctor can do that electronically and can find out what's the most cost-effective drug for you and make sure you don't have a drug interaction [issue], because you have already had all of your prescription information downloaded.

To pay, you have an ID card, or maybe your cellphone, that immediately connects you, and your claim is adjudicated in real time. There is no paperwork.

WSJ: We started by talking about 10 years ago. Looking ahead 10 years, what happens to IT?

Mr. Goodman: I think there is always a place for people that really understand technology and can deliver an industrial-strength capability into the business. Maybe everybody will walk around with a contact lens that has 5G capability and an earplug, and you are integrated into the Internet.

I absolutely think [that sort of thing] is going to happen. I don't know if it is in 10 years, but bandwidth is going up. Cost of computers is going down. Size of computers is going down. Cost of storage, size of storage is going down. Those are the key trends. They make everything possible.

You get an embedded chip. Maybe it gets its energy from your stomach. You could burn 100 calories a day to keep your electronically embedded stuff going.