Seeing dozens of in-depth conversations with medical specialists – from different countries, offering different perspectives on a given topic – encourages patients and their families to be more confident and pro-active in discussing their situations with local treating physicians.
Where people watch our video interviews from:
See About section for more information or read our story below:
Our story – why this project?
Dr. Anton Titov: “In 2014, a “fibrotic scar”, which my mother had in her lung, expanded and was re-classified as lung tumor. This was sudden and sad – we’re a close-knit family.
I consulted a highly experienced thoracic surgeon at a top hospital in Boston and received this gloomy summary:
“Just to be clear, the multiple abnormalities in the lung largely removes it from the realm of surgery. There is no hurry with the biopsy because we don’t have very good options. I don’t mean to be pessimistic, but her best option is very slow growing tumor.”
I had no reason to challenge his verdict: I’ve interacted with this senior surgeon during my residency, he had the utmost competency, knowledge and respect among peers.
So all we could do is… nothing.
Nevertheless, I dove into medical research articles on this tumor and reached out to contacts accumulated since I started working at Harvard teaching hospitals in 1994 and during my PhD in Molecular Biology in a Nobel Prize-winning laboratory at The Rockefeller University.
Both literature search and contact network exploration focused me on two experts who made this exact type of lung tumor a major focus of their research and clinical work. One of these experts, interestingly, also worked in Boston – in fact, he worked next door to the first thoracic surgeon I consulted about my mother.
After reviewing the case, this other, “next-door” surgeon immediately put my mom on his operating schedule and briskly proceeded with pre-operative tests. In a few days, he reverted to us with a completely different assessment of my mother’s situation:
“All of the mediastinal and hilar lymph nodes are negative. I think we can proceed to right upper lobectomy on the original date of surgery. The plan would be to remove any extension into the right lower lobe. The other groundglass lesions will be left alone. The remaining lesions will likely pose little risk to her life.”
While I had no reason to doubt the “we can do nothing” verdict of the first expert, my mother and I certainly preferred action to inaction.
Thus, just two weeks after I identified and reached out to the second surgeon – found through literature search and professional contact network – my mother underwent a minimally invasive (VATS) operation to remove her lung tumor. She was discharged home 6 days later.
I then had this follow-up message from the surgeon:
“Completely resected. It extended in the right lower lobe but we had an adequate margin. All [lymph] nodes were negative. All margins were negative. There is no need for chemotherapy or radiation, just surveillance imaging Q6 months for 2 years and yearly thereafter.”
This was 3 years ago.
My mother is now 85, she leads an independent life, walks for miles, and continues to have a close and joyous relationship with my growing daughter.
For me, a true revelation in this story was not the fact that there I was, plugged into a Harvard medical system for 20 years, getting a pessimistic “nothing to do” verdict from one major surgeon – and then getting a completely different assessment and action plan from another expert, working just next door to the first one, in the same hospital system.
“If we do not resect and let the tumor keep growing, however slowly it does grow, the risk of internal transformation of this type of tumor into a more aggressive “classic” lung cancer would become nearly certain. Whereas for other small lesions this risk is very small. So we have to remove the primary tumor.”
It is this explanation, confirmed by another medical oncologist who studied the behavior of such lung tumors, that convinced us of a need to act and take operative risks.
Both experts were profoundly knowledgeable in their field. Both were highly experienced. It was not a question of one doctor being “better” than the other. For me, the difference between them was the intensity of focus and awareness of the changing landscape of treatment of this type of tumor.
It was like having a stomach ulcer and reaching out to the best gastroenterologist before the Helicobacter pylori was accepted as the cause of ulcers. Everywhere you would turn to, you’d get a “classic” advice to “lower your stress and reduce stomach acidity”. But if you were to find Barry Marshall and Robin Warren – you’d get a very different advice (which was ridiculed at the time by most medical experts). But it was Drs. Marshall and Warren who would cure your ulcer, not all other experts.
Yes, we all know that misdiagnosis and suboptimal treatment decisions happen all the time, but when one experiences them first hand and in a loved one – it makes a personal impact.
Patients may think they have all corners covered, they have health insurance and perhaps they could reach a top-notch doctor in their community or at a fancy foreign clinic. But just as my mother and I experienced, being at a top hospital does not guarantee a precise diagnosis and the best treatment – even when it’s available and affordable!
History of medicine is, of course, full of such examples:
In colorectal cancer, Prof. Bill Heald developed a superior method of colorectal cancer resection in the early 1980s (TME operation), but it was not accepted “until mid- or even late 1990s” – here is a top rectal cancer surgeon from Stockholm discussing how this superior rectal cancer treatment was slow to spread around the world.
In the UK, a scientific review of epilepsy patients concluded that “Approximately 55% of the population of adults receiving treatment for epilepsy have never received specialist advice. Reassessment of these patients uncovers diagnostic uncertainty, failure to classify (leading to sub-optimal therapy) and lack of information and advice about all aspects of epilepsy care.”
Another UK medical review found that “As many as 20% to 30% of epileptics may have been misdiagnosed. Many of these patients may have cardiovascular syncope, with abnormal movements due to cerebral hypoxia, which may be difficult to differentiate from epilepsy on clinical grounds.”
Whether it’s multiple sclerosis, heart attack (especially in women) or ovarian cancer, a significant percentage of patients are misdiagnosed, delayed to receive appropriate care or never get a personalized treatment plan that the right experts for them could have provided fast and efficiently.
Our goal is to highlight and to spread as widely as possible an awareness of better diagnostic and treatment options that are often available. And they are often available not far away from home but locally – simply by exploring more options, talking to local clinicians, perhaps daring to challenge the “first verdict” of a “grey-haired professor”.
Convincing patients, who are under stress and may not have the knowledge and wherewithal to push medical system hard, until all options are explored and the right one is found, is hard.
It was hard for me despite my knowledge and experience with medical science. But it is possible. I believe that personal video conversations with top experts around the world is a more effective approach than reciting printed texts and convoluted articles. Honest and direct talk with physicians from many countries can help and encourage patients and their families to be more active and assertive in seeking a better treatment option – first and foremost locally in their communities.
Since I started the project I have been made aware (by Dr. Jason Hwang, co-author of Innovators Prescription, a bestseller by Clayton Christensen of HBS) of Project Echo (http://echo.unm.edu/), which is indeed somewhat similar to what we are building. It gives me great pleasure in validating the concept of global interaction between top medical experts, perfectly matched to patient’s problem, and local doctors who care for the patient. It is about collaboration, not competition, and about breaking the silos, not building barriers for better flow of knowledge and compassion. This is what we are about.
Why video interviews?
Video interview format provides personified, easily digestible, evidence-driven, bite-size medical information to people. This format is especially popular and accessible to people outside the “Western world”, because videos are perfect for mobile phones and often it’s the only internet access people have. Bandwidth is not a problem, our videos are hosted on a private platform that optimizes videos for low-bandwidth networks.
I am convinced that dry long-form medical texts on websites filled with blinking advertisements and sponsorships (“Web MD”-style) are not fit for 21st century. They are also riddled with conflicts of interest.
Seeing an interview, where a knowledgeable and experienced physician shares professional and personal wisdom, makes an emotional impact that goes beyond factual information transfer. This emotional impact matters perhaps more than facts do.
Seeing conversations with multiple experts from different institutions and different countries speak confidently on a given topic and exploring a given issue from multiple angles empowers patients to be more confident when they discuss treatment options with their doctors.
This is a significant part of our public health impact – to empower patients to take better control of their health, and feel stronger in their interaction with local medical providers.
If you don’t know what’s possible, how can you ask for it?
No conflicts of interest
Importantly, this project has zero conflicts of interest.
We are 100% independent, we are not affiliated with any commercial or academic entity. We are absolutely “non-denominational”. We also do not mention any names of hospitals where the experts we interview work at, only a university name they are affiliated with.
There is absolutely no advertisement or any sponsorship on our websites.
Our project’s strategy could be called an “Art gallery model”.
In a gallery that displays a Monet painting, a thousand people pass through and see the masterpiece for free or for a small fee. Then one person might come along and buy the Monet. This will pay for whole gallery upkeep. Therefore, tens of thousands of people benefit from seeing the masterpiece for free and one affluent connoisseur pays for it all with a purchase.
Our project works similarly: hundreds of thousands of people from around the world see all our video conversations with world’s best experts for free. Our videos have information translated into 23 languages and we run 15+ language-localized websites.
It takes about $10,000 of all-in costs to make one video interview. The van Goghs and Monets in our “gallery” are our experts. Then one person, usually a sophisticated “professional”, like a management consultant or an international lawyer comes along and becomes interested to check if her family member’s diagnosis and treatment plan are on par with what the world best experts could offer. So she purchases our services. This enables us to sustain and grow the project with more interviews.
To date, a ratio of free video views to a paying client is >10,000 to 1. Thus, public benefit significantly dominates over commercial part. We think it s a fair deal.
Advertisement-driven business models are riddled with conflicts of interest and require chasing gazillions of page views. This in turn leads to bait-and-switch, low quality content.
Also, considering the fact that Facebook and Google draw 85% of online advertising budgets, it’s a futile effort to chase page views and ad cents.
Therefore, provision of a specific online service is perhaps the only way to sustain and grow such “medicine+media” project.
Obviously very few of site’s visitors can afford such services or, indeed, could understand the real value of services (although we work hard to explain it). But many thousands of people find and watch our interviews for free, and that fulfills our mission of sharing expertise and wisdom of top experts with people who could use this information for their benefit.
How do we finance the project?
This project is financed entirely by facilitating expert opinions and routing clinical cases to those experts around the world who match the case most closely. This strategy seeks to replicate my mother’s lung tumor situation – when the second surgeon’s expertise – because it matched my mother’s situation perfectly – completely transformed her treatment plan.
We also provide a referral system to the experts around the world who match the patient’s situation like lock and key. And it’s a two-way benefit for experts and patients. A given expert would much prefer to take care of the patient who fits perfectly his clinical and research interest.
Experts also benefit by communicating their clinical wisdom on medical topics of their interest to the whole world. After all, educating the public beyond one’s own patients is a part of physician’s professional calling.