DURHAM — Alex Kemper’s medical career has been focused on the kind of catastrophe that lurks in children who seem perfectly healthy – diseases that are found only when doctors specifically seek them out.
Kemper is a pediatrician and professor at Duke University Medical Center. He has served on several national panels involving the evaluation of screenings to determine which invisible ailments present enough of a risk to warrant testing all children at birth or during childhood.
And now he is taking on a more prominent role in the world of deciding who should get which medical tests. Last month, he was appointed to the U.S. Preventive Services Task Force, a federal body that makes recommendations regarding screenings of all types that are considered a standard for the nation’s medical community.
It’s a complex business, a fact highlighted by controversial decisions the panel made in recent years to recommend fewer screenings for breast and prostate cancers.
Although some may think any screening that might turn up a potentially catastrophic disease should be done, other factors, such as surgeries prompted by false positive results, are also at play. Kemper has built his career on weighing those pros and cons.
“Understanding the balances of benefit and harm can be really hard,” says Kemper. “The benefit of prevention may not be apparent for years and years, but we’ve learned the value of intervening early for a lot of issues. We’ve also learned a lot more about the harms of medical care.”
Dr. Virginia Moyer, the Texas pediatrician who is the task force’s chair, says Kemper’s expertise in pediatric screenings and his patience in wading through complex data will be crucial to his new role.
“The experience he has in developing guidelines for pediatric care is going to be absolutely invaluable to the task force,” says Moyer, who is also vice president of the Chapel Hill-based American Board of Pediatrics. “He has a willingness to work very hard and give his time on a voluntary basis to improve our national health care.”
A vision for helping
Kemper, 46, grew up in Florida and studied biomedical engineering at Johns Hopkins University. He says the more he learned about medicine, the more interested he became in making existing tools work better – rather than making new ones.
“I learned that there was great value in terms of improving health, not in the development of new tools or new tests, but doing a better job of applying what we already know works,” Kemper says.
He went on to earn a medical degree from Duke and then completed degrees in public health and medical statistics at UNC-Chapel Hill. It was during that time that his interest in screenings took hold, focused at first on an affliction from which he suffers: poor vision.
As a medical issue, solutions were readily available. But Kemper was drawn to the public health side of poor vision, working on ways to connect eye care with people who need it. A key component of that effort is early screening among children.
“We know that if you can’t see well it impacts a lot of things, like your ability to do well in school,” he says. “And there are people walking around with vision problems that could be remedied.”
After six long winters in Michigan, where he worked on expanding testing for lead poisoning among children, he returned to the Triangle to take his job at Duke. There, he treats patients and conducts research, in addition to his work on screening guidelines.
He serves on a federal committee that recommends which screenings should be given to all newborns. The program started in the 1960s, and it has successfully lessened the impact of rare but preventable conditions – many of which could cause irreparable harm if not treated until a child shows symptoms.
A recent recommendation Kemper worked on for the committee – which is endorsed in 2012 by the U.S. secretary of Health and Human Services – was to begin screening newborns for critical congenital heart disease, a condition that affects 1 in 1,000 babies. A simple test can detect low oxygen levels in blood, which may signal the disease is present and allow early intervention.
Kemper also serves on a national committee that creates guidelines for regular pediatric care, such as how often children should see a doctor and when screenings are necessary. Both groups gather the evidence for and against a particular practice but let another panel decide how to proceed.
Grading the tests
Kemper is looking forward to his new role on the preventive services task force because it will allow him to go beyond gathering evidence to be more involved in decision-making.
“What’s exciting for me is I will be in a position where I will be one of the voting people,” he says.
The task force rates a particular procedure with letter grades based on its likely benefit versus harm. The cost is not considered.
An A or B means a screening is recommended for everyone in a particular group. A grade of C means its benefit does not necessarily outweigh the risks, leaving it up to doctors and patients to make individual choices.
A grade of D means the risks of the procedure outweigh the benefits. An I means there is not enough information to come up with a score, which in some cases will trigger further study.
Regular screenings of women under 50 for breast cancer received a score of C in 2009, prompting protests from doctors and advocacy groups, such as the American Cancer Society. In another recent controversial decision, specific tests for prostate cancer received a score of D.
In addition to these volunteer roles, Kemper is also the deputy editor for Pediatrics, the nation’s top journal devoted to children’s health. He reviews the more than 4,000 manuscripts submitted every year and spends most Sundays on the phone, weighing the submissions’ merits with another editor.
Most of his work on screenings deals with studies and statistics. But Kemper says he’s often reminded of his ultimate goal.
“I get very personal emails from parents whose kids have gone through the screening and it helped them, which is really gratifying,” he says. “At the end of the day, this is about making people healthier.”
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