Health Policy
Cancer Treatment Research
Faculty in the Division of Health Policy are engaged in econometric and epidemiologic studies of cancer and its care. The goal of their research is to improve outcomes, reduce disparities, and influence health policy to improve cancer screening and treatment.
Heather Taffet Gold, Ph.D., Assistant Professor of Public Health, studies the cost-effectiveness of and population variation in cancer treatment, as well as the diffusion of new technology. Her methodological interests include the use of econometric modeling and applications of geographic information systems to evaluate socioeconomic and geographic disparities in cancer care. Her current projects assess disparities in radiation treatment for ductal carcinoma in situ and early invasive breast cancer to compare health outcomes (rates of survival and disease recurrence) and cost implications of suboptimal treatment. Her research also focuses on pharmacogenetic testing and studying how to tailor drug therapy to an individual's genetic makeup. As an example, she completed a study to evaluate the cost-effectiveness of using a genetic test to guide dosing of a chemotherapy drug to treat metastatic colorectal cancer, since patients with a certain genetic variant metabolize the drug differently and may have severe side effects unless they are given a reduced dose. She also works with the NCI-sponsored HMO Cancer Research Network to study social and economic issues related to cancer treatment in several HMOs across the country.
Dr. Gold was the lead author of an article published in Cancer entitled “Correlates and effect of suboptimal radiotherapy in women with ductal carcinoma in situ or early invasive breast cancer,” which described her work indicating that many breast cancer patients received delayed or incomplete radiotherapy, and this resulted in worse health outcomes. For this paper, she received the 2009 award for Outstanding Paper by a Young Investigator from the Society for Medical Decision Making. The study was profiled in The New York Times and CBS News, as well by many other news organizations.
Madelon L. Finkel, Ph.D., an epidemiologist and Professor of Clinical Public Health, has extensively studied and written about health policy issues, including women’s health and policy recommendations for breast cancer screening.
Dr. Finkel wrote Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening (Praeger Press, 2005) to help women make informed decisions about mammograms. Her book explores the controversy surrounding mammography, examining issues such as how breast cancer develops, how valid the screenings are, if and at what age women should begin to be screened, and how frequent the screenings should be. It also discusses the efficacy and cost-effectiveness of different screening methods, explains how women can see federal reports on mammography facilities, and presents a time line showing changing public advice on mammography across the years.
Dr Finkel’s 10th book, Truth, Lies, and Public Health: How We Are Affected When Science and Politics Collide (Praeger Press, 2007) focuses on the politicalization of research findings. When ideology, whether it is the ideology of scientists and clinicians or of politicians, distorts scientific findings and public health judgment, public welfare can be endangered. The book provides numerous examples to illustrate the consequences of co-opting the scientific integrity of an issue. Politics can often prevent the implementation of policy supported by irrefutable science.
Dr. Finkel is presently collaborating with colleagues at the Christian Medical College and Hospital in Vellore, India. In March 2007 she traveled to Vellore to initiate a cervical and breast cancer screening program in rural India. Cervical cancer is the number one cause of cancer mortality among women in India. It is hoped that a low-tech screening program utilizing trained public health nurses to visually inspect the cervix, coupled with an educational program, will reduce the incidence of this deadly disease.
