Nature Eds.: It is worrying that US government departments are unable to divulge basic data on research projects involving human subjects. Such data should be publicly available to ensure volunteers’ safety
Nature Eds.: It is worrying that US government departments are unable to divulge basic data on research projects involving human subjects. Such data should be publicly available to ensure volunteers’ safety
“Your safety is our priority.” It’s difficult to visit a sports stadium, travel on an aircraft or even head to the cinema these days without being told that someone, somewhere, is watching out for you. So why do some systems that are set up to protect the volunteers who participate in scientific research seem so inadequate?
It’s not as if we haven’t been warned about what can happen when supervision and scrutiny are lax. In 2010, the US Presidential Commission for the Study of Bioethical Issues was tasked with a sobering mission. A series of horrifying medical experiments on Guatemalan citizens — some intentionally infected with syphilis — in the 1940s had recently come to light. President Barack Obama asked the commission to determine whether such an atrocity could still happen today, and to evaluate the protections in place for all who participate in human-subject research funded by the US government.
The commission soon ran into a problem: a portrait of the current system was difficult to paint. Some government departments did not have ready access to essential data for identifying and tallying federally funded projects involving human subjects. More than six months after the commission asked for them, some departments were still unable to provide basic information, such as a list of all such projects, the number of participants involved and the location of the work.
Dr. Heidi Schmidt cannot practice medicine. The problem is not that she lost her license or was named in too many malpractice lawsuits. To the contrary, she has never held a license to practice medicine. Yet she has earned not only an M.D. but also master’s degrees in public health and pharmacy, passed all the licensing exams required of medical students
Dr. Heidi Schmidt cannot practice medicine. The problem is not that she lost her license or was named in too many malpractice lawsuits. To the contrary, she has never held a license to practice medicine. Yet she has earned not only an M.D. but also master’s degrees in public health and pharmacy, passed all the licensing exams required of medical students
And she is not alone – many medical school graduates like her cannot obtain a license. Last year, 52,860 U.S. and international medical graduates applied for residency positions in the U.S., yet only 26,252 actually matched into a program.
The painful irony is that the U.S. now faces a substantial shortage of physicians, which is on track to worsen in the decades to come. Increased demand for physicians is driven by advances in medical science and technology, population growth and an aging population that uses more medical care. A study by the Association of American Medical College predicts that by 2025, the U.S. will face a shortfall of between 46,000 and 90,000 physicians.
The situation is growing worse by the year, because U.S. medical schools have increased enrollments by nearly 30 percent in recent years, while the number of residency positions has increased to a much smaller degree.
By Ezekiel Emanuel & Justin Bekelman: Death in America is frequently compared unfavorably with death in other countries, where people may not be as focused on extending life with every possible intervention…But is it actually true that end-of-life care in America is more invasive and expensive than in other countries?
By Ezekiel Emanuel & Justin Bekelman: Death in America is frequently compared unfavorably with death in other countries, where people may not be as focused on extending life with every possible intervention…But is it actually true that end-of-life care in America is more invasive and expensive than in other countries?
We frequently hear complaints about how people near the end of life are treated in America. Patients are attached to tubes and machines and subjected to too many invasive procedures. Death occurs too frequently in the hospital, rather than at home, where they can be surrounded by loved ones. And it is way too expensive. Each year, the care of dying seniors consumes over 25 percent of Medicare’s expenditures.
Death in America is frequently compared unfavorably with death in other countries, where people may not be as focused on extending life with every possible intervention. As Ian Morrison, the former president of the Institute for the Future, once wrote: “The Scots see death as imminent. Canadians see death as inevitable. And Californians see death as optional.” He added, “Americans and the American health care system are uncomfortable with the inevitability of mortality.”
But is it actually true that end-of-life care in America is more invasive and expensive than in other countries?
The effort will be led by vice-president Joe Biden, whose son Beau died of brain cancer last year. US president also touts his climate-policy achievements as he begins his final year in office.
The effort will be led by vice-president Joe Biden, whose son Beau died of brain cancer last year. US president also touts his climate-policy achievements as he begins his final year in office.
“For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all,” Obama said in a soaring speech that otherwise offered few new proposals. Instead, the president spent most of the address looking back at his accomplishments over roughly seven years in office.
The details of the cancer moonshot are still fuzzy. Biden says that he has consulted with nearly 200 physicians, researchers and philanthropists in the past few months and plans to continue to seek such input. Thus far, he has pledged to increase the resources available to combat the disease, and to find ways for the cancer community to work together and share information. The goal is to double the rate of progress against cancer, achieving in five years what otherwise would have taken ten.
A growing number of primary care doctors, spurred by frustration with insurance requirements, are bringing “health care for billionaires” to the masses, including people on Medicare and Medicaid, and state employees
A growing number of primary care doctors, spurred by frustration with insurance requirements, are bringing “health care for billionaires” to the masses, including people on Medicare and Medicaid, and state employees
It’s called direct primary care, modeled after “concierge” medical practices that have gained prominence in the past two decades. In those, doctors typically don’t take insurance, instead promising personalized care while charging a flat fee on a monthly or yearly basis. Patients can shell out thousands to tens of thousands of dollars annually, getting care with an air of exclusivity.
Direct primary care is much less pricey. Patients pay $100 a month or less directly to the physician for comprehensive primary care, including basic medication, lab tests and follow-up visits in person, over email and by phone. The idea is that doctors can focus on treating patients, since they no longer have to wade through heaps of insurance paperwork. They spend less on overhead, driving costs down. And physicians say they can give care that’s more personal and convenient than in traditional practices.
The voices of people with medical debt. Our article on Americans’ struggles with medical debt generated thousands of reader comments. More than 1,200 readers wrote us to answer our question: “How have medical bills changed your life?”
The voices of people with medical debt. Our article on Americans’ struggles with medical debt generated thousands of reader comments. More than 1,200 readers wrote us to answer our question: “How have medical bills changed your life?”
The article explored a large new survey of Americans who struggle with their medical bills. It found that while people with no health insurance are particularly vulnerable to financial distress, about 20 percent of Americans with health insurance were still experiencing difficulties paying for health care.
Readers responded with their own experiences of medical debt. Here are some of their answers, edited lightly. If you’d like to share your own story of medical debt, you can do so here.
Almost exactly one year after US President Barack Obama announced the Precision Medicine Initiative, China is finalizing plans for its own, much larger project. But as universities and sequencing companies line up to gather and analyse the data, some observers worry that problems with the nation’s health-care infrastructure — in particular a dearth of doctors — threaten the effort’s ultimate goal of improving patient care.
Precision medicine harnesses huge amounts of clinical data, from genome sequences to health records, to determine how drugs affect people in different ways. By enabling physicians to target drugs only to those who will benefit, such knowledge can cut waste, improve health outcomes using existing treatments, and inform drug development. For example, it is now clear that individuals with a certain mutation (which is mostly found in Asian people) respond better to the lung-cancer drug Tarceva (erlotinib; W. Paoet al. Proc. Natl Acad. Sci. USA 101, 13306–13311; 2004), and the discovery of a mutation that causes 4% of US cystic fibrosis cases led to the development of the drug Kalydeco (ivacaftor).