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Published on January 15, 2008

Author: Manlio

Source: authorstream.com

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A Socially Responsible Health Care System in the Era of Longevity Genes :  A Socially Responsible Health Care System in the Era of Longevity Genes 2006 Leon and Josephine Winkelman Lecture April 4, 2006 Robert P. Kelch, M.D. Executive Vice President for Medical Affairs University of Michigan Goals for Today:  Goals for Today Astonish you with research findings about longevity Excite you with the treatments that are just around the corner Alarm you with the changing health care landscape Engage you in a discussion about creating a more socially responsible system, together A Socially Responsible Health Care System in the Era of Longevity Genes:  A Socially Responsible Health Care System in the Era of Longevity Genes Research: What we could see Treatments: What we will experience Health care landscape: What we must face Ideas for the future: What we can achieve The Fountain of Youth – Have We Found It? :  The Fountain of Youth – Have We Found It? Yes! Tour Buses Are Leaving Daily!:  Yes! Tour Buses Are Leaving Daily! What the Science Does Tell Us:  What the Science Does Tell Us We have the potential to live A LOT longer: 1900 – Life expectancy -- 47 years 1930s – under 60 years. (Social Security) 2000 – 77 years 2020 – 100+ years Single proven method for extending life: extreme calorie restriction – causes longevity genes to “kick in” SIR2 gene is a “longevity gene” A compound called resveratrol causes SIR2 activity. Where’s resveratrol found? Source: Unlocking the Secrets of Longevity Genes, Scientific American, March 2006. Slides 6-7 What the Science Does Tell Us:  What the Science Does Tell Us Red wine! Another hurrah for science When fruit flies were fed resveratrol, saw 30% increase in longevity Now studying mice to see whether SIRT1 (mammalian version of SIR2) lengthens life In Our Lifetime . . . :  In Our Lifetime . . . No Fountain of Youth to turn back time But, could see medicines that activate longevity genes to treat Alzheimer’s disease, cancer, diabetes and heart disease. Clinical trials under way Greater understanding about factors in youth that protect against the aging process. Researchers from U-M and across the country convened in March for an NIH workshop on this topic U-M Research – One Example:  U-M Research – One Example Richard Miller looking at correlation between size and longevity (smaller is often better). His research: Dwarf mice His hypothesis: Dwarf mice live longer because many of their cells are resistant to injury or stresses that cause aging Research now focused on why – cellular mechanisms? In vivo? Genetic variations? Formerly the world’s oldest mouse: Yoda, (on left, sniffing his cage mate, Princess Leia). Died just after his 4th birthday Source: Richard Miller, M.D., Ph.D., Geriatrics Center and Department of Pathology, Size Counts: Stress and Aging at Michigan slide set, Sept. 2005. Other Exciting Aging Research:  Other Exciting Aging Research Linda Partridge, Weldon Professor of Biometry at University College in London: Rate at which organisms age can evolve: -- As a side effect of mutation accumulation -- As a side effect of earlier success Aging evolves in response to extrinsic hazard – greater the hazards, more rapid the aging Genes of insulin-like growth factor signaling pathways shown to affect lifespan of worms, fruit flies and mice. Telomerase findings -- Shorter telomeres associated with increased mortality from heart disease and infectious disease Sources: Of worms, mice and men: altering rates of aging, Daedalus, Winter 2006 NIA Symposium: Stress, Telomeres and Aging, February 2005 summary. Aging Research: Biggest Bang for the Buck?:  Aging Research: Biggest Bang for the Buck? Blue data: Olshansky et al., Science, 1990 Source: Richard Miller, Ph.D. A Socially Responsible Health Care System in the Era of Longevity Genes:  A Socially Responsible Health Care System in the Era of Longevity Genes Research: What we could see Treatments: What we will experience Health care landscape: What we must face Ideas for the future: What we can achieve Personalized Medicine – Already Here; More Coming Soon:  Personalized Medicine – Already Here; More Coming Soon * Personalized Medicine Coalition definition Personalized Medicine, continued:  Personalized Medicine, continued Source: U.S. News commentary by Bernadine Healy, March 6, 2006 A Socially Responsible Health Care System in the Era of Longevity Genes:  A Socially Responsible Health Care System in the Era of Longevity Genes Research: What we could see Treatments: What we will experience Health care landscape: What we must face Ideas for the future: What we can achieve Get Ready, the Seniors Are Coming:  Get Ready, the Seniors Are Coming Source: 65+ in the United States: 2005, U.S. Census Bureau The Seniors Are Coming, continued:  The Seniors Are Coming, continued Source: Leading Change in the Health Care System: A Collection of Essays from America’s Foremost Innovative Minds, Aetna Foundation, Inc., 2005 What We Spend – and What it’s Worth:  What We Spend – and What it’s Worth Source: A Need to Transform the U.S. Health Care System: Improving Access, Quality and Efficiency, The Commonwealth Fund. Percent of GDP spent on health care, 2002 Despite Spending, U.S. Performs Poorly on Life Expectancy at Age 65:  Despite Spending, U.S. Performs Poorly on Life Expectancy at Age 65 Source: OECD Health Data, 2005. What We Spend, continued:  What We Spend, continued Sources: A Need to Transform the U.S. Health Care System: Improving Access, Quality and Efficiency, The Commonwealth Fund. The Dartmouth Atlas of Health Care Web site, www.dartmouthatlas.org/faq.shtm Percutaneous transluminal coronary angioplasty interventions per 100,000 population in 2002 And More Spending . . .:  And More Spending . . . Source: A Need to Transform the U.S. Health Care System: Improving Access, Quality and Efficiency, The Commonwealth Fund. Health Care Costs Concentrated in Sick Few:  Health Care Costs Concentrated in Sick Few 1% 5% 10% 55% 69% 27% Source: A. C. Monheit, "Persistence in Health Expenditures in the Short Run: Prevalence and Consequences," Medical Care 41, supplement 7 (2003): III53–III64. Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 1997 50% 97% $27,914 $7,995 $4,115 $351 Expenditure Threshold (1997 Dollars) After All That Spending . . .:  After All That Spending . . . Sources: Modern Healthcare By the Numbers, December 2005 A Need to Transform the U.S. Health Care System: Improving Access, Quality and Efficiency, The Commonwealth Fund. Put Another Way . . .:  Put Another Way . . . My Diagnosis: Significant Changes Need -- STAT:  My Diagnosis: Significant Changes Need -- STAT What Do We Have? The Perfect Storm:  What Do We Have? The Perfect Storm What Do Americans Really Want?:  What Do Americans Really Want? Choice Control Convenience Low cost A Socially Responsible Health Care System in the Era of Longevity Genes:  A Socially Responsible Health Care System in the Era of Longevity Genes Research: What we could see Treatments: What we will experience Health care landscape: What we must face Ideas for the future: What we can achieve What We Can Achieve Universal health care coverage:  What We Can Achieve Universal health care coverage What We Can Achieve Transformation of political and social milieu from a “pioneer” attitude to an egalitarian one :  What We Can Achieve Transformation of political and social milieu from a “pioneer” attitude to an egalitarian one Source: Leading Change in the Health Care System: A Collection of Essays from America’s Foremost Innovative Minds, Aetna Foundation, Inc., 2005 What We Can Achieve Reduce or eliminate variation in care; Ensure effective care is pervasive:  What We Can Achieve Reduce or eliminate variation in care; Ensure effective care is pervasive Reduce or eliminate variation, continued:  Reduce or eliminate variation, continued What We Can Achieve Simplification of the health care system :  What We Can Achieve Simplification of the health care system What We Can Achieve Align incentives with behaviors: quality goes up, costs go down, value goes up :  What We Can Achieve Align incentives with behaviors: quality goes up, costs go down, value goes up I Hope I’ve . . .:  I Hope I’ve . . . What I Think Will Happen:  What I Think Will Happen The Time Is Right:  The Time Is Right “Americans can be relied upon to do the right thing – after they’ve exhausted all the other possibilities.” -- Winston Churchill Thank you.:  Thank you.

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