None of the solutions put forth in the current healthcare debate take into account the rapid advances in basic medical knowledge or the need to translate this revolutionary new knowledge into hands on clinical practice. The disagreements on other grounds are intense, but upon the science, both sides might agree.
The term translational medicine refers to a newly created bio-medical specialty that attempts to develop practical clinical tools out of the genetic and molecular discoveries now flooding the scientific literature.
Duke University and the U of Pennsylvania medical schools now sponsor an Institute of Translational Medicine. Two new peer reviewed scientific journals trace the progress of translational medicine.[1] Translating new knowledge into clinical advances challenges the ability for researchers to communicate practical applications to clinicians. These efforts clearly fill a widely recognized practical and critical need. Europe is ahead of us in this research and in the collection of necessary bio-medical databases. [2]
The legislative solutions proposed on all sides contain a dangerous element of standardization, which would tend to delay change, adaptation to environmental factors, individual patients and the implementation of new knowledge. Standards of care set by insurance companies, influenced by drug companies, or even central planners such as NIH would tend to smother the very innovation it attempts to communicate. The task is too big for central control. There are vast individual and regional differences in patient need and in patients themselves.
Medical education and an academic approach to research and clinical care offer the only viable solution to our healthcare dilemma. The government should fund medical schools with the challenge of providing the uninsured with low cost medical care. This option will require satellite clinics; many medical schools provide them now. Combining VA clinics and covering Workman’s Comp. could mean savings for the taxpayer and for employers. The system is in place. The economics of basing the public option on an existing infrastructure is obvious. An academic based public system will generate a biomedical database of the patient population, which would facilitate both the research and the translation of discovery into clinical tools and education for the participating providers. Diversity between regional medical centers will better accommodate the vast regional differences in medical problems and population. Multiple regional initiatives will foster a variety of economic strategies. Multiple initiatives will likewise both: spread the risk of unworkable solutions, and increase the probability of desirable results. Responsibility would fall to the highest levels of scientific medical leadership; it would be a nationwide effort. Salaried or semi salaried providers could better focus on quality more than quantity. There might be some shelter from frivolous lawsuits as medical school / state employees. Politically this public option could prove to be non-political -- attractive to both sides.
Do what you can to curtail the abuses of drug and insurance companies. However, an educational and medical school centered public option will better serve the future of US medicine. Health is an issue of national security. If we do not fix the problems, we risk loosing both patients and medical doctors to a more advanced and humanitarian medical delivery system. Patients are going to Europe and Asia now for lower cost surgical care. Medicine is just one more sphere of US technological leadership we risk loosing due to selfish laissez-faire short-term choices when long-term choices in the national interest are required. Translational medicine is the tool for the US to maintain a leading role in the science of medicine and the care of patients – our vital human resource.
Whatever healthcare solution we seek, must accommodate the rapidly changing science of medicine ---funding both medical research and a close connection between that research and our front line clinicians. This translational medicine strategy must prevail.
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[1] Science vol 326, 9 Oct ‘09, p205
[2] Nature vol 461, 24 Sep ’09 p448
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