Newsletters - A Bell Curve for Myeloma?

A Bell Curve for Myeloma?

A Message from Dr. Tony Blau

Harvard surgeon and author Atul Gewande’s fascinating article, The Bell Curve, describes his investigation into the differences in outcomes among patients with cystic fibrosis, a genetic disease that results in repeated lung infections of increasing severity, pancreatic insufficiency and death often in young adulthood.  When plotting the survival times of patients cared for across all cystic fibrosis treatment centers, the distribution falls along a bell curve.  As Gewande explains: “a handful of teams with disturbingly poor outcomes for their patients, a handful with remarkably good results, and a great undistinguished middle.”  

Gewande found that the very best performing cystic fibrosis centers were noteworthy not for their reputations, but for their fervent attention to seemingly trivial diminutions in lung function, aggressively intervening to prevent progression to irreparable damage.   

As an attending physician in Seattle caring for patients undergoing allogeneic stem cell transplantation at the Fred Hutchinson Cancer Research Center many moons ago, I embraced a similar approach, directing our medical team to intervene at even the suggestion of slight perturbations, aiming to avert explosive, life threatening crashes.  During rounds, I declared that a good doctor is measured not by how well they perform in the ICU, but by how effectively they are able to prevent their patients from needing to go into the ICU.  A trial that randomizes patients to care by highly attentive doctors versus less attentive doctors is impractical, and thus I can’t prove that extreme attentiveness matters, but I believe that it does.      

Variation in outcomes is also well described for patients with multiple myeloma, with those cared for by oncologists specialized in the treatment of myeloma achieving generally better outcomes than those cared for by general oncologists.  You can’t spend more than a couple of minutes on a myeloma focused education or social media website before encountering the well-rehearsed directive that patients with myeloma should seek care from a myeloma specialist.  While this is certainly sound advice it is difficult for many patients to follow because there aren’t enough myeloma specialists to go around and because many patients live long distances from the nearest myeloma specialist.  It’s also worth noting that if the experience with cystic fibrosis holds, then one might expect differences in outcomes between patients cared for by different myeloma specialists.  

As the reader might have anticipated, I think that All4Cure can solve these problems.  By providing access to an external network of experts and a growing database that describes the treatments that are likely to work best for a given patient under a given set of circumstances, we aim to empower general oncologists to function as myeloma experts.  Thank you for your support, and if you haven’t yet registered for All4Cure we welcome you to join us!