The Gold Standard for Current Cancer Treatment

Published Online 6/27/2016 in JAMA Internal Medicine.

EandBA couple of months before Elaine died from peritoneal cancer, we hired Anila, a cheerful, hearty Albanian house cleaner. On her first visit, Anila saw that Elaine was bedridden. “Kerosene can save her,” she said. “There is science. Look it up on the Internet.” Later, Elaine and I had a good laugh over it. She said, “Maybe that’s all they have available in Albania.” But in retrospect I’ve thought, “Could it be any worse than the treatment she got here?”

Elaine was a bright light to those who knew her, one of those rare people whose inherent grace put others at ease and made them feel special. A trained pianist, she was also a gifted and productive artist who in her last year painted and gave away more than a dozen original pieces to friends and family. Continue reading “The Gold Standard for Current Cancer Treatment”

When Employers Get Serious About Managing Health Care Risk

Brian Klepper

Posted 4/07/13 on Medscape Connect’s Care & Cost Blog

ALP_H_BK_0010RostLast week I visited with Gary Rost, an unassumingly knowledgeable man and the Executive Director of the Savannah Business Group (SBG), arguably one of the most effective health care coalitions in the country. Their offices are only a couple hours away from my home on the Northeast Florida coast, so it was a quick trip up.

SBG was founded in 1982 as a way of mobilizing employer buying power for better care at lower cost. Its reach now extends beyond Savannah about an hour south, north into South Carolina and west from the coast. The vision described on its site is straightforward and easy for purchasers to appreciate:

“SBG endorses and adheres to the principles of value-based purchasing: performance measurement, transparency, public reporting, pay for performance, informed consumer choice and collective employer leadership.”

Continue reading “When Employers Get Serious About Managing Health Care Risk”

Truth at the End of Life

Elaine Waples

Posted 3/5/13 on TEDMED

Elaine Waples and Her Husband, Brian Klepper

Most of us have spent some time thinking about our own deaths. We do it with a sense of dreadful curiosity, but then we push it aside with “well, we’ve all got to go sometime.”

Unlike most people, I probably know the how, the why, and maybe even the when of that event. It is profound information that turns the world upside down for us, our families, friends and caregivers.

I have cancer that is incurable, aggressive, and has negligible survival odds. My chemotherapy is a long shot. I will leave a spouse, children, siblings and a life that I love and cherish. I cannot imagine existence without them.

Book Review – The Emperor of All Maladies: A Biography of Cancer

Brian’s Note: With yesterday’s announcement that Siddhartha Mukherjee’s The Emperor of All Maladies had won the Pulitzer for General Non-Fiction, I thought it might be appropriate to rerun this review from last December 5, 2010.


The opening page of Siddhartha Mukherjee’s The Emperor of All Maladies begins with a quote by Susan Sontag that is so on-point, yet so rare and fresh, that one can’t help being excited by the prospect of what’s to come.

Emperor of All MaladiesIllness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.

Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

You open the book with great expectations. It is weighty, yes – 570 pages, 100 of which are end notes – but beginning, you immediately find its expansive scholarship wrapped in a writing style so fluid and lyrically engaging that it instantly dispels any hesitancy, and you are captured.

Continue reading “Book Review – The Emperor of All Maladies: A Biography of Cancer”

Boyfriend Doesn’t Have Ebola. Probably.


Originally published on 2/10/10 on Hyperbole and a Half

I took Boyfriend to the Emergency Room last night because he was vomiting up vast quantities of what I thought was blood but actually it was just Craisins. You guys, if you feel like you may become violently ill in the near future, stay away from red food. Failure to do so may create an atmosphere of unnecessary panic and chaos. 

Anyway, the doctor wanted to make sure that Boyfriend didn’t have SARS or stomach AIDS or something, so he had to poke him a lot. While he was doing this to Boyfriend, he pointed to a little reference chart on the wall and asked Boyfriend to rate his pain:

Continue reading “Boyfriend Doesn’t Have Ebola. Probably.”

Want to Actually Make A Difference? Support Water for People

A couple of years ago one of my longtime friends, Scott Kelly, told me about a philanthropic effort, Water for People, that is among the most pragmatic and useful I’ve heard of.  Scott is a water engineer, and he travels with this organization to villages in under-developed countries. With a team, he helps bring clean water to the village – for example, a well, an aquaduct – and then, equally importantly, they develop a support infrastructure to maintain the water source over time.

Scott told me a profound statistic: half the hospital beds in the world are filled with people who drank bad water. Living in the land of milk and honey as we do (and so often take for granted), we forget that a billion people still live in such dire poverty that the struggle to survive is all consuming. Many, many more are on the lower rungs of the ladder, barely holding on.

Bad water saps the vitality from individuals and societies, and keeps them enslaved.

In the spirit of this season, think of the people who are furthest from the bounty that our own good fortune has bestowed on  us. Make a contribution that can help them and their children get started on the road to better lives. Water for People is an organization dedicated to making that happen.



The Zadroga Health Care Bill


Senate Republicans are blocking a vote on a bill to provide medical coverage for first responders to the 9/11 World Trade Center site. I was not aware of this until I saw the full story on The Daily Show Thursday night.  Along with editorial comment, four first responders were guests, who explained that their healthcare benefits had been discontinued and they were fighting with Workers’ Comp carriers for every dime of health care they received.  You can see the show here:

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The bill has passed the house, and is languishing due to Republican stalling tactics.  They refuse to consider it on the floor because the week between Christmas and New Years is “sacred to them and their families”.

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SHAME on the Republican Senators for withholding action on this bill.  This is NOT and should not be a political matter.  It’s A human matter for Americans who sacrificed. You can find contact information at:

Al Weigand is a health care analyst based in Jacksonville, FL.

More on the Global Reimbursement Deal Between BIDMC’s Physician Organization and BCBSMA

Here’s a follow-up to yesterday’s Paul Levy article about the global reimbursement arrangement between the 1800 physician Beth Israel Deaconess Physician Organization and Blue Cross and Blue Shield of Massachusetts’. This video interview and accompanying article are with Dr. Stuart Rosenberg, a “Payment Reform Experimenter-in-Chief.”

Weekend Special: Reckless Medicine


Originally Published on 11/20/10 in Discover here.

Lana Keeton is accustomed to taking her licks standing up. She has worked as a steel broker and boxing promoter who rubbed elbows with Don King in the rough-and-tumble fighting world. She is also a kickboxer who doesn’t like to lose. But in 2001 a routine surgical procedure knocked her off her feet and led to the loss of her health, her business, and her dream home, a three-bedroom condominium in Miami Beach.

Continue reading “Weekend Special: Reckless Medicine”