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Cancer screenings, menthols and the moonshot

Presented by The Michael J. Fox Foundation for Parkinson's Research: The ideas and innovators shaping health care
May 02, 2024 View in browser
 
Future Pulse

By Erin Schumaker, Daniel Payne and Ruth Reader

Presented by 

The Michael J. Fox Foundation for Parkinson's Research
WASHINGTON WATCH

BOSTON, MA - SEPTEMBER 12:  U.S. President Joe Biden delivers remarks at the John F. Kennedy Library and Museum on his Cancer Moonshot Initiative on September 12, 2022 in Boston, Massachusetts. The measure aims to cut the cancer death rate in half over the next 25 years and provide greater support to caregivers and survivors.  (Photo by Scott Eisen/Getty Images)

Biden's set a goal of reducing the cancer death by half over 25 years. | Getty Images

Federal agencies and private organizations are mobilizing to improve cancer screening access, the president's cancer cabinet announced Wednesday.

Biden's health agencies are chipping in on the effort, as are agencies as varied as the Energy and Labor departments and the U.S. Fire Administration.

Improving access to cancer screenings is a key part of the president's cancer moonshot initiative, which has the ambitious goal of reducing the cancer death rate by half over 25 years — and improving the lives of cancer patients and their caregivers.

"It is important for every American to know that cancer screenings are lifesaving — early detection can make all the difference in beating the disease," President Joe Biden said in March.

Why it matters: Americans missed nearly 10 million screenings during the pandemic, according to the White House, putting them at risk for later-stage cancer detection and worse health outcomes.

The White House says that expanding screenings is a top moonshot priority.

But it's noteworthy that the moonshot's latest actions on screenings lean heavily on federal agencies and private organizations at a time when Biden is struggling to secure more funding from Congress for his moonshot.

Even so: Advocates of improved cancer care aren’t thrilled with Biden right now.

That’s because his administration last week delayed an FDA rule to ban menthol cigarettes, POLITICO's Adam Cancryn and David Lim reported. At one point, officials had touted the prospective ban as evidence of progress the administration planned to make fighting cancer.

Tobacco companies and some civil rights groups opposed the ban on the grounds that it could create a black market for menthol cigarettes, which would disproportionately affect minorities, and could lead to over-policing Black communities, where menthol smoking is more popular. The NAACP, however, is in favor of the ban.

Others, including cancer groups and anti-smoking advocates like the American Cancer Society, Cancer Action Network and the Campaign for Tobacco-Free Kids weren't happy about the policy reversal.

Rep. Robin Kelly (D-Ill.), chair of the Congressional Black Caucus’ Health Braintrust, said in a statement that she was "deeply disappointed" by the decision. "The FDA’s experts have been clear that menthol cigarettes are harmful to public health," Kelly said, adding, "This is a commonsense plan which could have saved hundreds of thousands of lives."

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This is where we explore the ideas and innovators shaping health care.

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DANGER ZONE

NEW YORK - SEPTEMBER 5:  A nurse prints out an EKG monitor reading in the emergency room at Coney Island Hospital September 5, 2002 in the Brooklyn borough of New York City. The public hospital serves a large multi-ethnic patient population including many Russians, Pakistanis and Central Americans residing in the South Brooklyn area. The emergency room receives approximately 60,000 patients each year. (Photo by Mario   Tama/Getty Images)

AI could detect heart problems earlier, a new study found. | Getty Images

An artificial intelligence system that reviews electrocardiograms could help doctors decide which patients are at high risk of death — and intervene to improve their chances, according to new research in Nature Medicine.

The paper reviewed the difference in care among 16,000 patients, half of whom had doctors who were aided by AI systems that flagged high risk of future mortality.

Those warnings seemed to work, the researchers found. Use of the AI tool was associated with “a significant reduction” in all-cause mortality.

How’s that? Among the patients whose doctors got AI-based alerts, 3.6 percent died within 90 days. But within the same time period for patients whose doctors didn’t get AI alerts, 4.3 percent died.

The difference was starker among patients considered high-risk.

Even so: Previous efforts to use AI to identify patients at risk haven’t worked well.

Even if AI systems succeed in initial testing, health and AI experts say, their performance could shift over time, especially if the data on which they’re trained continues to change.

That leaves health leaders waiting to see how government regulators will handle the technology — and what they will be responsible for — in determining its safety and efficacy.

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EXAM ROOM

A doctor wears a stethoscope.

How AI will reshape a doctor's work remains an open question. | Joe Raedle/Getty Images

AI could help physicians translate care plans into a patient’s native language, add empathy to the clinical experience and allow for more remote care, but the technology also raises concerns about biased algorithms that could harm some people or amplify erroneous health information.

Those were some of the themes scientists from Harvard, Yale, and Google discussed this week at the invitation of Harvard’s T.H. Chan School of Public Health.

“You don't need to regulate the technology itself. You need to regulate how it's used,“ said Lucila Ohno-Machado, deputy dean for biomedical informatics at Yale University School of Medicine.

Milind Tambe, director of Google Research’s “AI for Social Good” program, said he worries that AI could be misapplied in health care. AI has great promise, he said, but it’s not clear what its best use is.

For this reason, Ohno-Machado said it could be important to enact laws around certain uses like deepfakes, or digital impersonations.

Within the world of medical devices,“we need to have procedures and mechanisms to do sensible auditing,” said Andrew Beam, assistant professor of epidemiology at Harvard, citing a private-sector plan to create assurance labs that would vet AI tools.

Why it matters: Health systems are adopting a growing array of those tools to help with everything from administrative tasks to assisting with diagnosis. They’re also considering how advanced AI and chatbots could play a role in triaging patients.

Both federal and state legislators are considering how or whether they should regulate AI. Bias in algorithms has emerged as a key concern and lawmakers also are interested in creating rules that would require transparency into how AI programs work.

What’s next? The private sector-led Coalition for Health AI, which is standing up the assurance labs, hopes to launch them this summer.

 

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