Daily Rounds: Cheesecake Factory Medicine; Alzheimer's Failure; Obese Organ Donors; Dense Breasts

Big Med: Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care? (The New Yorker) — "I’d come from the hospital that day. In medicine, too, we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality. Unlike the Cheesecake Factory, we haven’t figured out how. Our costs are soaring, the service is typically mediocre, and the quality is unreliable. Every clinician has his or her own way of doing things, and the rates of failure and complication (not to mention the costs) for a given service routinely vary by a factor of two or three, even within the same hospital. It’s easy to mock places like the Cheesecake Factory—restaurants that have brought chain production to complicated sit-down meals. But the “casual dining sector,” as it is known, plays a central role in the ecosystem of eating, providing three-course, fork-and-knife restaurant meals that most people across the country couldn’t previously find or afford. The ideas start out in élite, upscale restaurants in major cities. You could think of them as research restaurants, akin to research hospitals. Some of their enthusiasms—miso salmon, Chianti-braised short ribs, flourless chocolate espresso cake—spread to other high-end restaurants. Then the casual-dining chains reëngineer them for affordable delivery to millions. Does health care need something like this?"

Pfizer, J & J Scrap Alzheimer's Studies As Drug Fails (Reuters) — "Pfizer Inc and Johnson & Johnson said they were scrapping further studies of one of the most anticipated experimental Alzheimer's disease treatments after the drug failed to help patients with the memory-robbing condition in a second high-profile late stage clinical trial. The companies said they would discontinue all other studies of the drug bapineuzumab in its intravenous (IV) form, including two more late stage trials and follow-up extension studies, in patients with mild to moderate Alzheimer's. The result marked the second such failure announced in recent weeks and was especially disappointing as bapineuzumab had been given a better chance of success in the patients studied in the second trial."Weight Can Be An Obstacle To Organ Donation (The New York Times) — "Add one more unexpected consequence of Americans’ expanding waistlines: A growing number of potential organ donors are ineligible to donate because of their weight. “It’s an ongoing struggle that I think every transplant center has to deal with,” said Dr. Sandra Taler, a nephrologist at the Mayo Clinic who studies the health of living transplant donors. Rising obesity has spurred a small but growing effort to pay closer attention to the health of obese donors, whose risks are still incompletely understood. There is no binding donor weight limit, but a little more than half of transplant centers cap donor body mass index at 35. About 10 percent don’t allow donors with B.M.I.’s over 30, generally considered the cutoff for obesity, while the rest allow some heavier people to donate."

The Latest Mammogram Controversy: Density (The Wall Street Journal) — "In 2005, while still undergoing chemotherapy, radiation and surgeries, Ms. Cappello, an education administrator in Woodbury, Conn., started a campaign called "Are You Dense?" to educate other women about dense breast tissue. Thanks in part to her efforts, last month, New York became the fourth state, after Connecticut, Texas and Virginia, to require radiologists to inform women if they have dense breasts along with their mammogram results. Similar bills are pending in 12 states and Congress. They face opposition from insurers and major medical groups concerned that the information could raise health-care costs and scare women unduly. Studies show that having dense breasts raises the risk of developing breast cancer fourfold to sixfold. "It's a greater risk factor than having a mother or sister with the disease," but few women know this, says Deborah J. Rhodes, a preventive medicine specialist at the Mayo Clinic in Rochester, Minn. "Most of the physicians ordering these tests are also in the dark about this and the implications for women," she says."