Blog Posts for Yousuf Zafar, MD

Is Patient Medical Knowledge the Solution to Our Healthcare Value Crisis?

July 25, 2019

Yousuf Zafar, MD
Clinical Associate Director, Duke Forge

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Advocacy groups shout it from the rooftops. Research careers are built around it. And medical education has integrated it into many curricula. I’m talking about shared decision-making—the idea that medical decisions should be made in partnership with the patient. In theory, it makes a lot of sense. If I, as a clinician, educate the patient about a decision, or if a patient reads every Up-To-Date article on their condition, that patient should make a more informed decision that reflects the best possible care. And that best care should be evidence-based and of the highest value. Right?

Not necessarily.

It seems obvious that if we arm patients with knowledge, they are more likely to receive high-value care, and receipt of that high-value care is important for patients—not just to improve their outcomes, but to reduce the strain on their pocketbooks. This is particularly important in the current era of greater cost sharing and coverage denials for low-value care. But do we know whether more medical knowledge increases use of high-value care and decreases use of low-value care?...Read more


 

The Missing Pieces in Precision Medicine

August 27, 2018

Puzzle pieces. Image via Pexels (Pixabay)

Yousuf Zafar, MD
Clinical Associate Director, Duke Forge

“One day, all cancers will be rare cancers.”

I remember oncologist and Flatiron vice president Neal Meropol saying this at a national oncology conference a few years ago. His point was that in the past, we typically applied ‘one-size-fits-all’ therapies for metastatic colon cancer to treat 30,000 patients a year. Now, however, we can apply a series of molecular modifiers, each of which adds predictive or prognostic data to the diagnosis and allows us to deliver more precise treatment. For example, only 4% of patients with metastatic colorectal cancer - those with mismatch repair-deficient (MMRd) colon cancer - are likely to benefit from new immunotherapy drugs. With molecular diagnostics, we can avoid treating tens of thousands of patients for whom these drugs are unlikely to work and instead prescribe them for the relatively small number of patients most likely to benefit from them.

But here’s the problem with precision medicine: little attention is paid to what happens after the treatment decision is made. In other words, once the mutation is revealed and the care is delivered, the focus on precision ends. One of the biggest hurdles to controlling costs is a lack of innovation in precision delivery of healthcare.

What is ‘precision healthcare delivery’? I first heard this term from physician and healthcare consultant Blake Long about the challenges faced by famous physician and author Atul Gawande as he attempts to redesign healthcare delivery for a new enterprise backed by Amazon, Berkshire Hathaway, and JP Morgan. Blake explained that Gawande is charged with making care more efficient and less costly, while optimizing the individual patient experience – in short, he needs to innovate in precision healthcare delivery...Read more


Want to Disrupt Oncology to Improve Care and Outcomes? Start with Clinical Trial Registry Data.

March 29, 2018

Yousuf Zafar, MD
Clinical Associate Director, Duke Forge

Looking for a ride? Or a dinner reservation? Chances are, there’s an app on your phone that will give you a real-time solution. Consumer industries are being revolutionized as applied data science allows them to match availability with demand. However, if you’re looking for a clinical trial for cancer patient, you may not be so lucky. But why is it so hard to match patients with appropriate clinical trials?

Why is it so hard to match patients with appropriate clinical trials?

Here’s an example from my own practice: I recently saw a young woman with metastatic colorectal cancer. Her tumor harbored a rare but important mutation in the BRAF gene that made it more likely to grow faster and less likely to respond to conventional treatment. Whenever possible, colorectal cancer patients who have this mutation should be treated on a clinical trial.

Because my cancer center did not have a suitable trial open, I searched for colorectal cancer trials on ClinicalTrials.gov, the national clinical trials registry. I found one listed as open and enrolling, just 8 miles away at Chapel Hill. I emailed colleagues at UNC that evening. But later the following day, they responded that the trial was full and no longer accepting patients...Read more