The unsatisfactory outcomes Americans obtain from our notoriously profligate annual expenditures on health care are well-documented. A recent New York Times article explores an out-of-the-box explanation for the weak U.S. performance on these key measures of overall health.

 The study found that government funding of employment training programs, old-age pensions, and rent subsidies has an overlooked (at least in the U.S.) and fortuitous benefit. Possibly counterintuitively, countries with high spending on health care relative to social spending had higher infant mortality rates and lower life expectancies than countries that spent more on social services. Such spending serves self-interest, if we could only see it.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

For most of the past 20 years I have had the privilege of talking with and learning from medical students in small group discussions. As medical students leave the classrooms of the first and second year and transition into the third year, they confront a new reality: they are now actually encountering patients directly for the first time and are working with physicians in the daily care of patients. The more encounters they have with patients and their families and with their clinical mentors, the more stories they have to tell, which often lead to vexing questions that shed light on many of the problems of our health care system in the United States. 

One of the common themes throughout each year is the growing disenchantment with primary care, for a variety of reasons. Most of the students are assigned at some point to a clinical mentor who is a practicing internist seeing many patients each day in a primary care setting. Students often present cases of patients with complex medical and psychosocial issues that require interaction with and support from the physician. Not infrequently do we hear accounts of how patient non-compliance is a barrier to a constructive outcome. The idea of seeing patients over time with the same medical problems, while not heeding medical advice, strikes many students as a frustrating aspect of primary care. Also the students talk of these same physicians continuing to work into the evening, doing mountains of administrative work because of multiple insurance forms to complete. 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

A recent New York Times article cast a critical eye on one of the latest entries in the high stakes, high technology medical arms race. Proton beam therapy, the procedure under discussion, purports to treat cancer. But even though not a single randomized clinical trial has been done, Medicare is still willing to shower 50,000 scarce Federal dollars to providers for proton beam therapy for prostate cancer.

Considering that there are no studies evaluating the long-term outcomes, and no studies evaluating potential serious side effects of proton beam therapy, Medicare might just as well be burning $25,000 every time it pays for such a procedure. Worse, this is not an isolated scenario.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

In this age of expiring drug patents and stalled pipelines, I was pleasantly surprised to find in my morning batch of news releases four reports of promising, eclectic ways to fight diverse diseases. The efforts represent the entire trajectory in drug discovery, from the most basic research to a stage 3 clinical trial. Read on!

STRATEGY: Alter the insect vector
A genetically modified mosquito might sound like something from a science fiction film, but it is a powerful intervention in the horrific cycle that is malaria. George Dimopoulos and colleagues from the Johns Hopkins Malaria Research Institute altered a gene in the Anopheles mosquito in a way that ramps up its immune response against the parasite that causes malaria. The GM mosquitoes live as long as and lay as many eggs as their non-manipulated brethren. Perhaps with a few more tweaks they can take over, biting but not infecting.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

The United States spent $2.5 trillion on health care in 2009. That's "trillion". With a "T". This expenditure represents outlays of $8100 per person and 17.6% of our gross domestic product (GDP). Exactly what are we getting for these prodigious sums? Not very much. Infant mortality, for example, is a key marker of how wisely a nation is spending its health care dollars. The U.S. ranks a dismal 41st. These statistics tell a very sad tale. Despite spending huge amounts of ever-scarcer personal dollars on health care, the key metrics for U.S. residents continue to demonstrate how badly America is underperforming.  Where are the U.S. monies actually going, if not toward developing and providing effective means of health care delivery?

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.