As 2010 gets underway, there remains a number of unanswered questions about the state of health care and biomedical research in the U.S. It is not yet known, for example, what health-care reform in the U.S. will look like or how the future funding for biomedical research will take shape.
In light of these challenges and opportunities, Stanford law professor Hank Greely, JD, offers his thoughts on steps to take in the New Year and beyond to improve the quality of health care in the Unites States. Greely is an expert on the legal, ethical, and social issues surrounding health law and the bioscience.
If you could draft the final version of the health-care reform bill, what would you like to see in it?
Well, this "final" health-care reform bill will be anything but final. The political compromises necessary to passage seem certain to produce legislation that will not, itself, do much for the long run problems of cost and quality that plague our health care delivery system, and therefore will only be a short-run help on access. But it is an important start and one that will make it easier to take the next essential steps as the system continues to totter.
In the next "final" health care bill, I would very much like to see some effective mechanism for using real competition among health care systems to encourage continuous quality and cost improvements. Stanford’s Alain Enthoven and Victor Fuchs are responsible for some very promising proposals along these lines, for "managed competition" and for a voucher system, respectively.
What area of biomedical research most deserves increased funding in the next year?
First, one year is not a long enough time for any real progress, a five or ten-year commitment would be more reasonable. During that time, I’d like to see us put more money into research on truly "translational" health research-not translating lab discoveries into new drugs and devices, but translating existing drugs, devices, procedures, and knowledge into genuinely better health care and, more importantly, better health.
Innovative high tech treatments are wonderful, but we have a lot of room for improving health with existing tools. We need to figure out better ways than pharma detailers to educate physicians and other health care givers about how to use those tools and better ways for physicians to communicate with, and understand, their patients. We also need better ways to help patients actually to do what physicians and patients already know they should do. Changing behavior is a lot harder than prescribing a pill, but it can be much more useful. If, for example, NIH could find a safe and effective method of weight control that was easy for people to use, the health benefits could be enormous. The answers might be much more in research in psychology than in molecular biology, but we scarcely fund that.
What areas of improvement would you like medical schools to focus on in 2010?
I don’t think medical schools have yet figured out how to handle the overload of scientific information being produced by biomedical research. Every medical field already contains far too much knowledge for any medical student or house staff member to master and that information is growing by (a wild guess) about 10 percent each year.
Medical schools have to get better at teaching doctors to learn throughout their careers-and not just at night and on weekends, curled up with JAMA or NEJM, but during their busy days, perhaps even while seeing patients. High speed and effective electronic educational systems will crucial.
What development in hospitals would most improve the patient experience over the next year?
Better quality control in general; better infection control specifically. In both cases I think the answers are in good systems, not in better trained health care providers, but systems that people find easy to use-that they want to use, with or without electronic bells and whistles.