NEJM â Collection Updates for Health Policy

SOUNDING BOARD: Comparative Effectiveness and Health Care Spending â Implications for Reform

Milton C. Weinstein, Ph.D., and Jonathan A. Skinner, Ph.D. — Thu, 04Â FebÂ 2010 00:00:00 -05:00

Title VIII of the American Recovery and Reinvestment Act of 2009 authorizes the expenditure of $1.1 billion to conduct research comparing âclinical outcomes, effectiveness, and appropriateness of items, services, and...

PERSPECTIVE: Launching HITECH

Thu, 04Â FebÂ 2010 00:00:00 -05:00

Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Without that system, neither individual physicians nor health care institutions can perform...

PERSPECTIVE: Medicare and Medical Technology â The Growing Demand for Relevant Outcomes

Thu, 04Â FebÂ 2010 00:00:00 -05:00

In deciding whether to pay for new medical technologies, the Centers for Medicare and Medicaid Services (CMS) is becoming more specific about its requirements for evidence of improved health outcomes...

PERSPECTIVE: American Values and Health Care Reform

Thu, 28Â JanÂ 2010 00:00:00 -05:00

With the national debate over health care reform careening between tired, well-rehearsed talking points, on the one hand, and deep-in-the-weeds debates over technical details, initiatives, and financing mechanisms, on the...

PERSPECTIVE: Medicine's Ethical Responsibility for Health Care Reform â The Top Five List

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Early in 2009, members of major health careârelated industries such as insurance companies, pharmaceutical manufacturers, medical device makers, and hospitals all agreed to forgo some future profits to show support...

PERSPECTIVE: Tobacco Control and Free Speech â An American Dilemma

Thu, 28Â JanÂ 2010 00:00:00 -05:00

On June 22, 2009, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act. This landmark legislation, which passed the House by a vote of 307 to 97...

PERSPECTIVE: Nearing Negotiations â Reconciling Key Differences between House and Senate Reform Measures

Thu, 21Â JanÂ 2010 00:00:00 -05:00

With Republicans unanimously opposed to the Democrats' health care reform, the challenge of melding the House and Senate reform bills has fallen to House Speaker Nancy Pelosi (D-CA) and Senate...

PERSPECTIVE: Patient-Centered Medical Homes in Ontario

Thu, 21Â JanÂ 2010 00:00:00 -05:00

As the United States debates health care reform, the concept of âpatient-centered medical homesâ is receiving increasing attention.1 Many experts believe that medical homes with multidisciplinary teams and financial incentives...

PERSPECTIVE: Health Care Reform and the Need for Comparative-Effectiveness Research

Thu, 21Â JanÂ 2010 00:00:00 -05:00

Health care reform will eventually pit the goal of expanding health insurance coverage against strong pressure to reduce the growth in health care costs. If left to measures in the...

PERSPECTIVE: Accelerating the Use of Electronic Health Records in Physician Practices

Thu, 21Â JanÂ 2010 00:00:00 -05:00

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts...

PERSPECTIVE: Senate's Reform Package Wrapped Up in Time for Christmas

Thu, 14Â JanÂ 2010 00:00:00 -05:00

With no votes to spare â because every Republican stood in opposition â the normally fractious Senate Democrats cast aside their differences to pass a landmark health care reform bill...

PERSPECTIVE: Carrots, Sticks, and Health Care Reform â Problems with Wellness Incentives

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Chronic conditions, especially those associated with overweight, are on the rise in the United States (as elsewhere). Employers have used both carrots and sticks to encourage healthier behavior. The current...

PERSPECTIVE: Implementation and Enforcement of Health Care Reform â Federal versus State Government

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Health care reform lurches forward. The House and Senate have both passed reform bills. How well reform works in practice, however, will depend on one key difference between the two...

PERSPECTIVE: Ranking 37th â Measuring the Performance of the U.S. Health Care System

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Evidence that other countries perform better than the United States in ensuring the health of their populations is a sure prod to the reformist impulse. The World Health Report 2000,...

PERSPECTIVE: Uncomfortable Arithmetic â Whom to Cover versus What to Cover

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Much of the current debate about expanding health insurance coverage avoids addressing an uncomfortable trade-off: with a limited budget, making benefits more generous means being able to cover fewer people....

PERSPECTIVE: âPlay-or-Payâ Insurance Reforms for Employers â Confusion and Inequity

Thu, 14Â JanÂ 2010 00:00:00 -05:00

One prominent feature of the current health care reform bills is a âplay-or-payâ rule for employers: workers must receive part of their compensation in the form of employer-sponsored health insurance,...

PERSPECTIVE: Payment Reform â The Need to Harmonize Approaches in Medicare and the Private Sector

Thu, 07Â JanÂ 2010 00:00:00 -05:00

In the midst of heated debate over health care reform, there is an emerging consensus that the way we pay for health care â with our widespread reliance on fee-for-service...

PERSPECTIVE: Ensuring the Fiscal Sustainability of Health Care Reform

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Much of the recent health care reform debate has focused on achieving budget neutrality over a 10-year period, but this goal is less important than the reform's long-run fiscal sustainability....

PERSPECTIVE: Rallying the Caucus â The Democrats' Struggle for Unity on Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Fighting Republicans and a few wary Democrats as he races against the clock, Senate Majority Leader Harry Reid (D-NV) must muster 60 votes to defeat an anticipated series of GOP...

PERSPECTIVE: Ending End-of-Life Phobia â A Prescription for Enlightened Health Care Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Reform is coming to U.S. health care. A sense of urgency regarding the redesign of policies prevailed well before Barack Obama was elected president under the banner of change. A...

PERSPECTIVE: Industry Influence on Comparative-Effectiveness Research Funded through Health Care Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Much attention has been focused on the ongoing efforts in Washington to pass a health care reform bill. Comprehensive health care should reduce the use of ineffective and suboptimal medical...

PERSPECTIVE: Australia's Winter with the 2009 Pandemic Influenza A (H1N1) Virus

Thu, 31Â DecÂ 2009 00:00:00 -05:00

When the World Health Organization declared a âpublic health emergency of international concernâ on April 25, 2009, after the emergence in Mexico of pandemic influenza A (H1N1) virus, Australia activated...

PERSPECTIVE: Abortion Politics and Health Insurance Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

President Barack Obama has made it clear that he does not want abortion politics to sabotage health care reform. In his September 10 speech about health care to a joint...

PERSPECTIVE: Week 1 of the Senate Debate â Amending the Reform Bill

Thu, 24Â DecÂ 2009 00:00:00 -05:00

The Democrats' ambitious health care reform measure escaped its first week of Senate debate unscathed, with the defeat of Republican amendments that would have eliminated Medicare spending cuts and killed...

OTHER POINTS OF VIEW: Act II â Curve Bending

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Health care reform seems to be a two-act play. We are moving toward the conclusion of the first act, universal coverage. The second act will consist of controlling the cost...

EDITORIAL: The Need for Science in the Practice of Public Health

Nicole Lurie, M.D., M.S.P.H. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

When H5N1 avian influenza emerged in 1997, much of the world began planning for an eventual pandemic. Most planners expected the pandemic to begin in Asia and believed the virus...

PERSPECTIVE: Cervical-Cancer Screening â New Guidelines and the Balance between Benefits and Harms

Thu, 24Â DecÂ 2009 00:00:00 -05:00

One of the greatest challenges in developing cancer-screening guidelines is devising strategies that maximize screening benefits and minimize screening harms. The benefits of cancer screening â decreased cancer-related morbidity and...

PERSPECTIVE: Screening Mammography and the âRâ Word

Thu, 24Â DecÂ 2009 00:00:00 -05:00

The new recommendations from the U.S. Preventive Services Task Force on screening for breast cancer1 were front-page news for several consecutive days, and they sent the Obama administration scrambling to...

PERSPECTIVE: On Mammography â More Agreement Than Disagreement

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Breast cancer is the most common cancer in women in the United States, with more than 190,000 women receiving a diagnosis of invasive disease annually1 and more than 40,000 dying...

PERSPECTIVE: Getting the Facts Straight on Health Care Reform

Thu, 24Â DecÂ 2009 00:00:00 -05:00

The United States stands on the verge of the most significant change to our health care system since the 1965 introduction of Medicare. The bill that was passed by the...

PERSPECTIVE: Settling in for a Long Debate

Thu, 17Â DecÂ 2009 00:00:00 -05:00

With virtually all Republicans in opposition and public opinion sharply divided, the Senate opened debate on a Democratic health care reform bill that would greatly expand insurance coverage and, its...

OTHER POINTS OF VIEW: It Is Patients Who Most Need Tort Reform

Thu, 17Â DecÂ 2009 00:00:00 -05:00

There is a poor correlation between competence of care and malpractice lawsuits.1 The arbitrary-seeming nature of malpractice litigation places a dark cloud over all medical practice, encouraging wasteful defensive medical...

SOUNDING BOARD: The Agenda for Continuing Medical Education â Limiting Industry's Influence

Lewis Morris, J.D., and Julie K. Taitsman, M.D., J.D. — Thu, 17Â DecÂ 2009 00:00:00 -05:00

Most physicians must complete accredited continuing medical education (CME) programs to maintain their medical licenses, hospital privileges, and specialty board certifications. Data from the Accreditation Council for Continuing Medical Education...

PERSPECTIVE: Leveling the Field â Ensuring Equity through National Health Care Reform

Thu, 17Â DecÂ 2009 00:00:00 -05:00

The United States is in the midst of a profound demographic transition. By 2050, non-Hispanic whites will account for less than half the U.S. population and members of racial and...

PERSPECTIVE: The Consequences of âNoâ

Thu, 17Â DecÂ 2009 00:00:00 -05:00

In the next few weeks, Congress will determine the fate of health care reform. An early and important objective of the Obama administration, reform once carried an air of inevitability....

PERSPECTIVE: Health Care Reform â A Republican View

Thu, 17Â DecÂ 2009 00:00:00 -05:00

The health care system has serious problems. Costs are rising at three times the inflation rate. Many Americans are uninsured. Millions more fear losing their insurance in a weak economy...

PERSPECTIVE: Forestalling a Filibuster â Senate Reform Bill Cleared for Floor Debate

Thu, 10Â DecÂ 2009 00:00:00 -05:00

Faced with unanimous Republican opposition, Senate Democrats, joined by two independents, closed ranks in a rare Saturday session on November 21 to advance consideration of a vast health care reform...

OTHER POINTS OF VIEW: Taxing âSin Foodsâ â Obesity Prevention and Public Health Policy

Thu, 10Â DecÂ 2009 00:00:00 -05:00

As the United States struggles to combat obesity, some health policy experts have asserted that a tax on sugar-sweetened beverages such as soda would lead to reduced consumption of sodas...

PERSPECTIVE: The Supreme Court, Process Patents, and Medical Innovation

Thu, 10Â DecÂ 2009 00:00:00 -05:00

On November 9, the U.S. Supreme Court heard oral arguments in Bilski v. Kappos, one of the most closely watched cases in the Court's current term. The central question involves...

PERSPECTIVE: Primary Care and Accountable Care â Two Essential Elements of Delivery-System Reform

Thu, 10Â DecÂ 2009 00:00:00 -05:00

With discussions about U.S. health care reform focused heavily on insurance reforms, relatively little attention has been paid to the delivery-system reforms that will be required to improve the quality...

PERSPECTIVE: Lobbying, Campaign Contributions, and Health Care Reform

Thu, 03Â DecÂ 2009 00:00:00 -05:00

With health care reform in the air, interest groups are spending huge sums of money to influence the final legislation and other matters pending in Washington. Since 2006, the health...

OTHER POINTS OF VIEW: Eliminating a Viable Primary Care Workforce â A Primary Care Perspective

Thu, 03Â DecÂ 2009 00:00:00 -05:00

When physicians or health policy experts propose that the United States move to a single-payer health care system, with all doctors on salary,1 I find it disheartening: I am hoping...

PERSPECTIVE: The Emergency Use Authorization of Peramivir for Treatment of 2009 H1N1 Influenza

Thu, 03Â DecÂ 2009 00:00:00 -05:00

On October 23, 2009, Food and Drug Administration (FDA) Commissioner Margaret Hamburg issued an Emergency Use Authorization (EUA) for peramivir for intravenous injection (BioCryst Pharmaceuticals). Peramivir is an unapproved investigational...

PERSPECTIVE: America's Safety Net and Health Care Reform â What Lies Ahead?

Thu, 03Â DecÂ 2009 00:00:00 -05:00

To say that the current U.S. health care âsystemâ is a dysfunctional and costly patchwork of employer-based insurance, private markets, public programs, and special initiatives is, by any measure, an...

PERSPECTIVE: Narrowly Clearing the Next Hurdle â Passage of the House Reform Bill

Thu, 26Â NovÂ 2009 00:00:00 -05:00

With Democrats wielding their sizable majority to fend off strong Republican opposition and survive the defection of 39 members of their own party, the U.S. House of Representatives voted 220...

OTHER POINTS OF VIEW: Dead Souls â Comparing Dartmouth Atlas Benchmarks with CMS Outcomes Data

Thu, 26Â NovÂ 2009 00:00:00 -05:00

The premise, based on the Dartmouth Atlas of Health Care, that geographic variations in end-of-life Medicare spending can be used to identify wasted resources was popularized by Peter Orszag, director...

OTHER POINTS OF VIEW: Looking beyond the Market

Thu, 26Â NovÂ 2009 00:00:00 -05:00

For the most part, the market doesn't work where health care is concerned. It has been particularly ineffective in constraining costs over the past half-century, with stakeholders (insurance companies, organized...

PERSPECTIVE: Controlling U.S. Health Care Spending â Separating Promising from Unpromising Approaches

Thu, 26Â NovÂ 2009 00:00:00 -05:00

High U.S. health care spending has been characterized not only as a barrier to affordable insurance but also as the preeminent long-term threat to the economy and the competitiveness of...

PERSPECTIVE: Getting to the Real Issues in Health Care Reform

Thu, 26Â NovÂ 2009 00:00:00 -05:00

No issue has dominated the health care reform debate as much as whether the U.S. government should offer a health insurance plan to compete with private insurers â the so-called...

PERSPECTIVE: A Difficult Balance â Pain Management, Drug Safety, and the FDA

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Pain is a common medical problem, and relief of pain is an important therapeutic goal. Although nonpharmacologic approaches to treating pain (e.g., behavioral techniques) show promise for certain conditions, pain...

PERSPECTIVE: The American Public and the Next Phase of the Health Care Reform Debate

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Congressional leaders and President Barack Obama are moving ahead to develop a single piece of major health care legislation, which will be debated, voted on by both houses of Congress,...

PERSPECTIVE: Compromises and Controversies â Moving Forward on Reform

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Accelerating progress toward the Democrats' goal of enacting health care reform legislation, House Speaker Nancy Pelosi (D-CA) unveiled a bill on October 29 that would establish a mandate for most...

PERSPECTIVE: Not âSocialized Medicineâ â An Israeli View of Health Care Reform

Thu, 19Â NovÂ 2009 00:00:00 -05:00

In 2007, the United States spent about 15% of its gross domestic product (GDP) on health care, whereas Israel's health care spending was about 8% of its GDP (see graph,...

OTHER POINTS OF VIEW: Cost Expansion versus Cost Control â Lessons from the Canadian System

Thu, 19Â NovÂ 2009 00:00:00 -05:00

The health care reform effort in the United States is driven by the desires for cost control and expanded coverage. However, as Daniel Callahan recently wrote, âcost controls that are...

PERSPECTIVE: Mandatory Vaccination of Health Care Workers

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Mandatory vaccination of health care workers raises important questions about the limits of a state's power to compel individuals to engage in particular activities in order to protect the public....

PERSPECTIVE: Massachusetts Health Care Reform â Near-Universal Coverage at What Cost?

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Massachusetts has long been known for its academic medical centers, biomedical research, high-quality health care, and perhaps not unrelatedly, high health care costs. In 2006, the state captured national attention...

PERSPECTIVE: Medicaid and National Health Care Reform

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Defined by a history of both achievement and controversy, Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health...

PERSPECTIVE: Ensuring Progress in Primary Care â What Can Health Care Reform Realistically Accomplish?

Thu, 12Â NovÂ 2009 00:00:00 -05:00

In the current political environment, forging consensus on health care reform has proven challenging. Yet the value of a strengthened primary care infrastructure is one apparent zone of agreement among...

PERSPECTIVE: Communal Responsibility for Health Care â The Example of Benefit Assessment in Germany

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Many German observers are bewildered over the U.S. health care reform debate. Most Europeans see affordable health insurance for everyone as a fundamental element of a stable and prosperous society...

OTHER POINTS OF VIEW: Which Medicine, Which America?

Michael Fine, M.D. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

Underlying the debate over health care reform are two competing visions of medicine. According to one vision, medicine aims to care for people in their communities and to provide affordable...

PERSPECTIVE: Balancing Innovation, Access, and Profits â Market Exclusivity for Biologics

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Twenty-five years ago, Congress enacted the WaxmanâHatch Act to facilitate the approval by the Food and Drug Administration (FDA) of low-cost generic drugs that are bioequivalent to approved brand-name drugs....

PERSPECTIVE: Physicians' Views of the Massachusetts Health Care Reform Law â A Poll

Thu, 05Â NovÂ 2009 00:00:00 -05:00

In 2006, Massachusetts enacted the country's first law mandating near-universal health care coverage,1 and the state now has the lowest proportion of uninsured residents in the United States. The Massachusetts...

PERSPECTIVE: Reform and the Health Care Workforce â Current Capacity, Future Demand

Thu, 05Â NovÂ 2009 00:00:00 -05:00

As Democrats press to enact health care reform legislation, they have emphasized their commitment to greatly expanding coverage, slowing the growth of medical spending, and more tightly regulating private insurers,...

PERSPECTIVE: Payment Reform for Safety-Net Institutions â Improving Quality and Outcomes

Thu, 05Â NovÂ 2009 00:00:00 -05:00

In the U.S. health care system today, many hospitals have the market power to raise the prices of their services without showing evidence of improvements in the quality of care.1...

PERSPECTIVE: Litigation amidst Reform â The Boston Medical Center Case

Thu, 05Â NovÂ 2009 00:00:00 -05:00

Nearly 175 years ago, Alexis de Tocqueville wrote in Democracy in America, âThere is hardly a political question in the United States which does not sooner or later turn into...

PERSPECTIVE: Doctors, Patients, and the Need for Health Care Reform

Thu, 05Â NovÂ 2009 00:00:00 -05:00

One Montanan wrote to me recently about her father's death. Six months away from qualifying for Medicare coverage, he did not have health insurance or the cash to pay for...

PERSPECTIVE: The Baucus Bill and the Hope for Reform

Thu, 29Â OctÂ 2009 00:00:00 -05:00

After months of wrangling with Republicans over the appropriate role of government in health care, the Senate Finance Committee's 13 Democrats were joined by a lone Republican, Senator Olympia Snowe...

PERSPECTIVE: Implementing Evidence-Based Health Policy in Washington State

Thu, 29Â OctÂ 2009 00:00:00 -05:00

The Obama administration's infusion of stimulus funds into enhanced comparative-effectiveness research (CER) is in keeping with the conclusion of a recent Commonwealth Fund report that, of the top 15 ways...

PERSPECTIVE: Four Health Care Reforms for 2009

Thu, 29Â OctÂ 2009 00:00:00 -05:00

Prospects for the enactment of some reform look good, but comprehensive, sustainable reform of the health care system must wait for another day. Republican support for President Barack Obama's ambitious...

PERSPECTIVE: Lost in Transmission â FDA Drug Information That Never Reaches Clinicians

Thu, 29Â OctÂ 2009 00:00:00 -05:00

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated â and relatively little would be needed â to disseminate...

PERSPECTIVE: How Health Care Reform Can Benefit Children and Adolescents

Thu, 22Â OctÂ 2009 00:00:00 -05:00

Medical and scientific advances have reduced the rates of acute childhood illnesses and childhood mortality and increased the positive outcomes of a wide variety of serious childhood illnesses; nevertheless, children's...

PERSPECTIVE: Group Health Cooperative â One Coverage-and-Delivery Model for Accountable Care

Thu, 22Â OctÂ 2009 00:00:00 -05:00

âOn January 1, 1947, Group Health Cooperative of Puget Sound began delivering a new kind of healthcare. Consumers paid flat monthly dues for comprehensive care. Members elected the board of...

PERSPECTIVE: Poor Substitutes â Why Cooperatives and Triggers Can't Achieve the Goals of a Public Option

Thu, 22Â OctÂ 2009 00:00:00 -05:00

According to a recent survey, a majority of U.S. physicians support health care reform that includes a new national public health insurance plan, which would compete with private plans.1 Polls...

PERSPECTIVE: Senator Kennedy's Legacy to U.S. Health and Health Care

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Edward M. Kennedy, the long-serving senior senator from Massachusetts who died on August 25, 2009, had a major impact on Americans who deliver or receive health care services and left...

PERSPECTIVE: Health Care Reform in Perspective

Thu, 15Â OctÂ 2009 00:00:00 -05:00

President Barack Obama has placed U.S. health care reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills â...

HEALTH POLICY REPORT: The Public Health and Economic Benefits of Taxing Sugar-Sweetened Beverages

Thu, 15Â OctÂ 2009 00:00:00 -05:00

The consumption of sugar-sweetened beverages has been linked to risks for obesity, diabetes, and heart disease123; therefore, a compelling case can be made for the need for reduced consumption of...

PERSPECTIVE: Drug Shortages and Public Health

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Because the public discussion of drugs is dominated by considerations of their safety, effectiveness, and cost, it is easy to forget that medications have to be manufactured from raw materials...

PERSPECTIVE: American Roulette â Contaminated Dietary Supplements

Thu, 15Â OctÂ 2009 00:00:00 -05:00

In one of the most dangerous cities in the United States, one portly police sergeant has more to worry about than crime. His doctor had been encouraging him for years...

PERSPECTIVE: Follow the Money â Controlling Expenditures by Improving Care for Patients Needing Costly Services

Thu, 15Â OctÂ 2009 00:00:00 -05:00

In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications,...

PERSPECTIVE: Baucus's Bill and the Long Road to Reform

Thu, 08Â OctÂ 2009 00:00:00 -05:00

In an effort to attract Republican support, Senator Max Baucus (D-MT), chair of the Senate Finance Committee, stripped his health care reform proposal of some of its most contentious elements...

PERSPECTIVE: Will the Cost Curve Bend, Even without Reform?

Thu, 08Â OctÂ 2009 00:00:00 -05:00

If there is one certainty about the health care sector, it is that its costs increase over time. U.S. health care spending has more than doubled as a share of...

PERSPECTIVE: The Cost of Health Care â Highlights from a Discussion about Economics and Reform

Thu, 08Â OctÂ 2009 00:00:00 -05:00

President Barack Obama has argued that health care reform is essential to the future economic health of the United States. But the economics of both health care and reform are...

PERSPECTIVE: Obama's Vision and the Prospects for Health Care Reform

Thu, 01Â OctÂ 2009 00:00:00 -05:00

In a rare address to Congress, designed to consolidate support among Democrats behind one health care reform plan, reassure people with insurance that they would benefit from reform, and offer...

PERSPECTIVE: Doctors on Coverage â Physicians' Views on a New Public Insurance Option and Medicare Expansion

Thu, 01Â OctÂ 2009 00:00:00 -05:00

In the past few months, a key point of contention in the health care reform debate has been whether a public health insurance option should be included in the final...

PERSPECTIVE: Physicians' Beliefs and U.S. Health Care Reform â A National Survey

Thu, 01Â OctÂ 2009 00:00:00 -05:00

In an address to the American Medical Association on June 15, 2009, President Barack Obama acknowledged that he needed physicians' support on health care reform and offered to work with...

SOUNDING BOARD: Balancing âNo Blameâ with Accountability in Patient Safety

Robert M. Wachter, M.D., and Peter J. Pronovost, M.D., Ph.D. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

This year marks the 10th anniversary of the Institute of Medicine's report To Err Is Human,1 the document that launched the modern patient-safety movement. Although the movement has spawned myriad...

PERSPECTIVE: Putting U.S. Health Care on the Right Track

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Americans do not consistently receive high-value health care. Collectively, our country spends more on health care than any other nation, but our people do not receive the best outcomes, safety,...

PERSPECTIVE: 21st-Century Health Care â The Case for Integrated Delivery Systems

Thu, 01Â OctÂ 2009 00:00:00 -05:00

It was 1933. The United States was in the midst of a severe economic downturn that was to become the Great Depression. Data from 1929 showed that U.S. health care...

PERSPECTIVE: Opportunities and Challenges for the NIH â An Interview with Francis Collins

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Francis Collins, the physician and geneticist who was sworn in as the 16th director of the National Institutes of Health (NIH) in August 2009, anticipates scientific opportunities and budgetary challenges....

PERSPECTIVE: British Lessons on Health Care Reform

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Amid widespread recognition that the U.S. health care system cannot continue its current upward cost spiral, forever widening the life-expectancy gap between rich and poor, Britain's National Health Service (NHS)...

PERSPECTIVE: New, but Not Improved? Incorporating Comparative-Effectiveness Information into FDA Labeling

Thu, 24Â SepÂ 2009 00:00:00 -05:00

New technologies, including prescription drugs and medical devices, are a major driver of increases in U.S. health care expenditures, which have grown by an estimated 71% since 2000.1 The U.S....

PERSPECTIVE: Getting Past Denial â The High Cost of Health Care in the United States

Thu, 24Â SepÂ 2009 00:00:00 -05:00

What seemed to be a golden opportunity to achieve badly needed health care reform now appears to be threatened. Many Americans believe that we simply cannot afford to cover the...

PERSPECTIVE: Doctors as the Key to Health Care Reform

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Experts agree that sustainable health care reform requires reining in rising costs, but few people understand that the control of medical expenditures is largely in the hands of the medical...

HEALTH LAW, ETHICS, AND HUMAN RIGHTS: Good Law from Tragic Facts â Congress, the FDA, and Preemption

George J. Annas, J.D., M.P.H. — Thu, 17Â SepÂ 2009 00:00:00 -05:00

The New York Times heralded âA Win for Injured Patients,â1 while the Wall Street Journal said that the U.S. Supreme Court was âPre-empting Drug Innovation.â2 To the New York Times,...

PERSPECTIVE: Health Insurance Exchanges â Making the Markets Work

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Americans purchase health insurance in various ways. Some buy individual policies. For them, medical underwriting is common, and preexisting conditions can preclude, limit, or dramatically increase the cost of coverage....

PERSPECTIVE: Health Insurers at the Table â Industry Proposals for Regulation and Reform

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Many commentators have noted the dramatic change in approach by the insurance industry during this year's health care reform debate. This position was a deliberate strategic shift that was developed...

PERSPECTIVE: Systemwide Cost Control â The Missing Link in Health Care Reform

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Successful health care reform requires effective control of health care spending â without it, rising costs will continue to strain federal and state budgets, businesses, and families, jeopardizing gains in...

PERSPECTIVE: Poverty, Wealth, and Access to Pandemic Influenza Vaccines

Thu, 17Â SepÂ 2009 00:00:00 -05:00

On June 11, 2009, Margaret Chan, director general of the World Health Organization (WHO), declared that the status of the influenza A (H1N1) pandemic had reached phase 6 â active...

PERSPECTIVE: Setbacks and Fissions â Reconsidering the Scope and Timing of Reform

Thu, 10Â SepÂ 2009 00:00:00 -05:00

Encountering surprisingly strong discontent over Democratic proposals for health care reform, which has been registered at town-hall meetings and has energized the Republican opposition, the Obama administration and its allies...

PERSPECTIVE: Fiscal Responsibility and Health Care Reform

Thu, 10Â SepÂ 2009 00:00:00 -05:00

It has been clear for some time that the primary hurdle to enacting health care reform is figuring out how to pay for it. Virtually all Republicans and some Democrats...

OTHER POINTS OF VIEW: Health Care Reform and Clinical Culture

Thu, 10Â SepÂ 2009 00:00:00 -05:00

It is a tired and cynical cadre of physicians who will implement health care reforms. Yet few published perspectives include the view from the factory floor. The usual platitudes about...

PERSPECTIVE: Reform, Regulation, and Research â An Interview with Gail Wilensky

Thu, 10Â SepÂ 2009 00:00:00 -05:00

John Iglehart: Many Republicans oppose reform proposals put forward by Democrats. Do you consider the pursuit of health care reform an urgent matter?

Gail Wilensky: There is obviously a deep divide...

PERSPECTIVE: The End of Fee-for-Service Medicine? Proposals for Payment Reform in Massachusetts

Thu, 10Â SepÂ 2009 00:00:00 -05:00

Health care reform has multiple goals, including expanding insurance coverage, improving quality and access to care, and controlling costs. Since Massachusetts enacted reforms in 2006, the proportion of residents lacking...

PERSPECTIVE: Building a Bridge from Fragmentation to Accountability â The Prometheus Payment Model

Thu, 10Â SepÂ 2009 00:00:00 -05:00

In the current debate over health care reform, many observers are proposing new delivery structures to move U.S. health care away from fragmentation, poor performance, and dysfunction toward accountability for...

PERSPECTIVE: Weighing Benefits and Risks â The FDA's Review of Prasugrel

Thu, 03Â SepÂ 2009 00:00:00 -05:00

The Food and Drug Administration (FDA) approved prasugrel on July 10, 2009. Developed by Eli Lilly and Daiichi Sankyo, prasugrel is a thienopyridine that inhibits platelet aggregation. It was approved...

PERSPECTIVE: Why Paying for Health Care Reform Is Difficult and Essential â Numbers and Rules

Thu, 03Â SepÂ 2009 00:00:00 -05:00

No health care reform bill can succeed unless Congress finds the money to pay for it. The challenge is brutally simple. The up-front costs of extending coverage are certain and...

PERSPECTIVE: Understanding How Americans View Health Care Reform

Thu, 27Â AugÂ 2009 00:00:00 -05:00

Now that Congress has adjourned and most members are back in their own states or districts, they will be listening to what their constituents have to say about the debate...

SOUNDING BOARD: Disclosure of Financial Relationships to Participants in Clinical Research

Thu, 27Â AugÂ 2009 00:00:00 -05:00

In keeping with previous statements by a number of prominent groups,1234 the Institute of Medicine has recently stressed the need for vigilance in managing conflicts of interest to ensure the...

PERSPECTIVE: H1N1 Influenza, Public Health Preparedness, and Health Care Reform

Thu, 27Â AugÂ 2009 00:00:00 -05:00

In December 2009, the Department of Health and Human Services will present to Congress its first-ever national health security strategy, outlining high-priority activities and areas of investment for strengthening the...

PERSPECTIVE: Urbanization â An Emerging Humanitarian Disaster

Thu, 20Â AugÂ 2009 00:00:00 -05:00

In 2008, the proportion of the world's population living in urban areas crossed the 50% mark. The current rates of urbanization suggest that in China, 870 million people â more...

PERSPECTIVE: Multinational Medicines â Ensuring Drug Quality in an Era of Global Manufacturing

Thu, 20Â AugÂ 2009 00:00:00 -05:00

Rickee Rudowitz, a 56-year-old New Jersey woman with hypertension, believes that a generic version of long-acting metoprolol played havoc with her health last year. Rudowitz said her blood pressure had...

PERSPECTIVE: Cost Control â Time to Get Serious

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Although everyone seems to agree that controlling health care costs is no less critical a need than improving access to health care, the evidence suggests that cost control is not...

EDITORIAL: Health Care Reform 2009 at healthcarereform.nejm.org

Thu, 13Â AugÂ 2009 00:00:00 -05:00

During the past year, the nation has witnessed a remarkable example of the democratic process at work. A national debate on health care in the United States has captured the...

PERSPECTIVE: Managing Drug-Risk Information â What to Do with All Those New Numbers

Thu, 13Â AugÂ 2009 00:00:00 -05:00

In the late 1970s, many pharmacies and governmental and private insurers began electronically recording patient-specific data from filled prescriptions, as physicians, hospitals, and insurers began capturing computerized information on diagnoses,...

PERSPECTIVE: The New Sentinel Network â Improving the Evidence of Medical-Product Safety

Thu, 13Â AugÂ 2009 00:00:00 -05:00

In 2007, Congress directed the Food and Drug Administration (FDA) to create a new postmarketing surveillance system that will, by 2012, be using electronic health data from 100 million people...

PERSPECTIVE: A Time for Revolutions â The Role of Clinicians in Health Care Reform

Thu, 06Â AugÂ 2009 00:00:00 -05:00

William Beveridge, the economist whose 1942 report led to the founding of Britain's National Health Service (NHS), famously said that âa revolutionary moment in the world's history is a time...

PERSPECTIVE: A Bumpy Road for Reform

Thu, 06Â AugÂ 2009 00:00:00 -05:00

The legislative process is one of ebb and flow, particularly when politicians are confronted with issues that demand tough choices and divide the voters who elected them. Both currents were...

SOUNDING BOARD: Health Care Reform â Toward More Freedom, and Responsibility, for Physicians

Harold S. Luft, Ph.D. — Thu, 06Â AugÂ 2009 00:00:00 -05:00

Most discussions about health care reform focus on efforts to expand the number of people who are covered by health insurance. Yet the current system does not work well even...

PERSPECTIVE: Keeping the Patient in the Equation â Humanism and Health Care Reform

Thu, 06Â AugÂ 2009 00:00:00 -05:00

Over the past decade, two major movements have emerged in medicine, both intended to improve patient care. The medical humanism movement seeks to understand the patient as a person, focusing...

PERSPECTIVE: The Shifting Mission of Health Care Delivery Organizations

Thu, 06Â AugÂ 2009 00:00:00 -05:00

An important transition has begun in payment for health care delivery in the United States: organizations that have long been paid for transactions, such as visits or procedures, are beginning...

PERSPECTIVE: The Next Wave of Corporate Medicine â How We All Might Benefit

Thu, 06Â AugÂ 2009 00:00:00 -05:00

The thought of âcorporate medicineâ makes patients and providers panic. Medicine is individualistic; corporations are not. Doctors look out for patients; corporations make money. And yet the current economic situation...

PERSPECTIVE: More Checks Than Balances in the Struggle for Health Care Reform

Thu, 30Â JulÂ 2009 00:00:00 -05:00

The founding fathers would be pleased to know that the checks and balances of U.S. democracy are still working â as demonstrated by current activity surrounding the Democrats' health care...

PERSPECTIVE: âAmerican Valuesâ â A Smoke Screen in the Debate on Health Care Reform

Thu, 30Â JulÂ 2009 00:00:00 -05:00

Amid all the rhetoric about health care reform, one claim has emerged as a trump card designed to preserve the current patchwork of private and public insurance and to stop...

PERSPECTIVE: The Burden of Health Care Costs for Working Families â Implications for Reform

Thu, 30Â JulÂ 2009 00:00:00 -05:00

On June 2, 2009, President Barack Obama's Council of Economic Advisers released a report examining the economic case for health care reform, in which they underscored the importance of cost...

HEALTH POLICY REPORT: Medicare Part D Update â Lessons Learned and Unfinished Business

Patricia Neuman, Sc.D., and Juliette Cubanski, Ph.D. — Thu, 23Â JulÂ 2009 00:00:00 -05:00

Since 2006, more than 40 million elderly and disabled people have had the opportunity to enroll in a Medicare Part D prescription-drug plan, as established under the Medicare Modernization Act...

EDITORIAL: Tobacco, Public Health, and the FDA

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D. — Thu, 23Â JulÂ 2009 00:00:00 -05:00

More than a decade ago, David Kessler, then Commissioner of the Food and Drug Administration (FDA), launched a bold initiative to regulate tobacco. He believed that since nicotine is an...

SPECIAL ARTICLE: Effects of Pay for Performance on the Quality of Primary Care in England

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Background: A pay-for-performance scheme based on meeting targets for the quality of clinical care was introduced to family practice in England in 2004.

Methods: We conducted an interrupted time-series analysis of...

PERSPECTIVE: Comparative Effectiveness â Thinking beyond Medication A versus Medication B

Thu, 23Â JulÂ 2009 00:00:00 -05:00

The American Recovery and Reinvestment Act of 2009 (ARRA), the stimulus package signed into law by President Barack Obama on February 17, 2009, directs $1.1 billion to support âthe development...

PERSPECTIVE: Comparative-Effectiveness Research â Implications of the Federal Coordinating Council's Report

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Despite a plethora of diagnostic and treatment options, practical information that can guide health care choices for an individual patient are often elusive, and the resultant clinical uncertainty is an...

PERSPECTIVE: Prioritizing Comparative-Effectiveness Research â IOM Recommendations

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Directed by Congress to rapidly develop a list of broad-based priorities for the Department of Health and Human Services (DHHS) to consider as it implements a new agenda for comparative-effectiveness...

CORRESPONDENCE: What Went In When Trans Went Out?

Steen Stender, M.D., Arne Astrup, M.D., and JÃ¸rn Dyerberg, M.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

To the Editor: Industrially produced trans fatty acids in popular foods such as fast foods, cookies, cakes, and snacks1 are gradually being replaced in the United States and Western Europe...

PERSPECTIVE: Finding Money for Health Care Reform â Rooting Out Waste, Fraud, and Abuse

Thu, 16Â JulÂ 2009 00:00:00 -05:00

In their quest to enact health care reform legislation, Democrats' major challenge is securing the money to pay for greatly expanded insurance coverage and more government regulation in the face...

HEALTH LAW, ETHICS, AND HUMAN RIGHTS: Protecting Privacy and the Public â Limits on Police Use of Bioidentifiers in Europe

George J. Annas, J.D., M.P.H. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

Since 9/11, police and military around the world have sought to increase their arsenals of bioidentifiers, and privacy advocates have sought to cabin their use. In what may turn out...

EDITORIAL: Gene Therapy â Still a Work in Clinical and Regulatory Progress

Elizabeth L. Hohmann, M.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

In this issue of the Journal, Frank and colleagues present the case history and autopsy results of a widely publicized death in the summer of 2007 of a young woman...

ORIGINAL ARTICLE: Investigation of the Cause of Death in a Gene-Therapy Trial

Thu, 09Â JulÂ 2009 00:00:00 -05:00

We present a case of disseminated histoplasmosis, complicated by retroperitoneal bleeding and leading to death, in a patient who was receiving systemic immunosuppressive therapy for rheumatoid arthritis and who was...

PERSPECTIVE: A Strategy for Health Care Reform â Toward a Value-Based System

Thu, 09Â JulÂ 2009 00:00:00 -05:00

Despite many waves of debate and piecemeal reforms, the U.S. health care system remains largely the same as it was decades ago. We have seen no convincing approach to changing...

PERSPECTIVE: A Higher Bar â Vermont's New Law on Marketing Prescribed Products

Thu, 02Â JulÂ 2009 00:00:00 -05:00

As Congress continues to discuss the reform of physicianâindustry relations, individual states are enacting new laws. In July 2009, regulations on the conduct of pharmaceutical and medical-device manufacturers take effect...

PERSPECTIVE: The Individual Mandate â An Affordable and Fair Approach to Achieving Universal Coverage

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Some of the most prominent shortcomings of the U.S. health insurance market are rooted in the fact that the system is a voluntary one. Outside the state of Massachusetts, which...

SPECIAL ARTICLE: The Effect of Medicare Part D on Drug and Medical Spending

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: It is not known what effect the increased use of prescription drugs by enrollees in Medicare Part D has had on spending for other medical care.

Methods: We compared spending...

PERSPECTIVE: A WinâWin Approach to Financing Health Care Reform

Thu, 02Â JulÂ 2009 00:00:00 -05:00

No hurdle facing health care reform in the United States today is more daunting than the problem of financing universal coverage. There is an inescapable logic of reform that lies...

PERSPECTIVE: The Role of Medical Liability Reform in Federal Health Care Reform

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Although enthusiasm for health care reform is resounding in Washington these days, the specific shape reform will take and the compromises that will have to be made along the way...

PERSPECTIVE: A New Era of For-Profit Hospice Care â The Medicare Benefit

Thu, 25Â JunÂ 2009 00:00:00 -05:00

To ensure that a reluctant medical community would embrace Medicare at its inception in 1965, Congress declared that any willing provider could participate. Since that time, the vast majority of...

PERSPECTIVE: CMS's Landmark Decision on CT Colonography â Examining the Relevant Data

Thu, 25Â JunÂ 2009 00:00:00 -05:00

In an unprecedented endorsement of evidence-based medicine, the Centers for Medicare and Medicaid Services (CMS) recently decided to deny coverage of computed tomographic (CT) colonography for cancer screening, concluding that...

PERSPECTIVE: Easing the Shortage in Adult Primary Care â Is It All about Money?

Thu, 25Â JunÂ 2009 00:00:00 -05:00

As Americans debate health care reform, it is easy to forget that success may depend as much on the availability of primary care physicians for adults as on the specifics...

PERSPECTIVE: A Lifeline for Primary Care

Thu, 25Â JunÂ 2009 00:00:00 -05:00

Primary care in the United States needs a lifeline. In 2009, for the 12th straight year, the number of graduating U.S. medical students choosing primary care residencies reached dismally low...

EDITORIAL: Implications of the Emergence of a Novel H1 Influenza Virus

Robert B. Belshe, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

In this issue of the Journal, there are two reports of recent transmissions of swine influenza viruses in humans. One group of viruses, described by Shinde et al.,1 are triple...

EDITORIAL: H1N1 Influenza A Disease â Information for Health Professionals

Thu, 18Â JunÂ 2009 00:00:00 -05:00

In the first 2 weeks in April, cases of infection with an untypable influenza A virus began to be identified in Mexico and southern California.1 Although the exact sequence of...

PERSPECTIVE: Rescuing the Safety Net

Thu, 18Â JunÂ 2009 00:00:00 -05:00

As the recession deepens, layoffs are swelling the ranks of the uninsured. Despite federal stimulus support for state Medicaid programs, some cash-strapped states have cut Medicaid payments, and others are...

PERSPECTIVE: The Signature Features of Influenza Pandemics â Implications for Policy

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Vast amounts of time and resources are being invested in planning for the next influenza pandemic, and one may indeed have already begun. Data from past pandemics can provide useful...

PERSPECTIVE: Congressional Action on Health Care Reform â An Update

Thu, 18Â JunÂ 2009 00:00:00 -05:00

The pursuit of health care reform continues to gather steam, as Democrats, with a nudge from President Barack Obama, set an ambitious target for action â House and Senate passage...

PERSPECTIVE: Litigation, Regulation, and Education â Protecting the Public's Health through Childhood Immunization

Thu, 11Â JunÂ 2009 00:00:00 -05:00

Recently, three special masters of the U.S. Court of Federal Claims issued carefully reasoned, strongly worded opinions rejecting claims that medical and scientific evidence could demonstrate causal links between thimerosal-containing...

PERSPECTIVE: When Vaccine Injury Claims Go to Court

Thu, 11Â JunÂ 2009 00:00:00 -05:00

In February 2009, the National Vaccine Injury Compensation Program (VICP) released decisions for the first three test cases heard under the program's Omnibus Autism Proceeding. In each of the cases...

PERSPECTIVE: Achieving Health Care Reform â How Physicians Can Help

Thu, 11Â JunÂ 2009 00:00:00 -05:00

This year, we have the best chance in a generation of enacting legislation worthy of being called health care reform and of setting the United States on the path to...

PERSPECTIVE: The FDA as a Public Health Agency

Thu, 11Â JunÂ 2009 00:00:00 -05:00

A little more than a century ago, concerned about the potential dangers of food preservatives such as formaldehyde, Congress passed, and President Theodore Roosevelt signed, the Pure Food and Drug...

CORRESPONDENCE: Insurance-Industry Investments in Tobacco

Thu, 04Â JunÂ 2009 00:00:00 -05:00

To the Editor: The Obama administration is proposing a major overhaul of the U.S. health care system, and the insurance industry is poised to play a major role in the...

PERSPECTIVE: Medicare Nonpayment, Hospital Falls, and Unintended Consequences

Thu, 04Â JunÂ 2009 00:00:00 -05:00

In 2005, in response to disturbing and widely cited findings by the Institute of Medicine about the prevalence of life-threatening conditions acquired by patients in U.S. hospitals, Congress authorized the...

PERSPECTIVE: Ending Extra Payment for âNever Eventsâ â Stronger Incentives for Patients' Safety

Thu, 04Â JunÂ 2009 00:00:00 -05:00

On September 1, 2008, Medicare eliminated a long-standing presumption in its payment rules that, since hospitals were doing everything possible to prevent complications of treatment, taxpayers and patients should primarily...

PERSPECTIVE: Building Momentum as Democrats Forge Health Care Reform

Thu, 04Â JunÂ 2009 00:00:00 -05:00

In the midst of dealing with countless challenges, both foreign and domestic, and a deep ideological divide in Congress, the Obama administration and its Democratic allies have nevertheless made important...

HEALTH LAW, ETHICS, AND HUMAN RIGHTS: Handguns, Health, and the Second Amendment

Leonard H. Glantz, J.D., and George J. Annas, J.D., M.P.H. — Thu, 28Â MayÂ 2009 00:00:00 -05:00

The right to possess firearms by private citizens has been a major political issue in the United States since the founding of the country. James Madison, for example, argued that...

PERSPECTIVE: The Proposed Government Health Insurance Company â No Substitute for Real Reform

Thu, 28Â MayÂ 2009 00:00:00 -05:00

As pressure builds on the White House and Congress to deliver on their promise of health care reform, the idea of a government health insurance company to compete with for-profit...

PERSPECTIVE: Public Health Care and Health Insurance Reform â Varied Preferences, Varied Options

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Health care and health insurance reform will surely require a mixture of public and private efforts for different population groups in different settings. One feature that might help with the...

PERSPECTIVE: Healthy Competition â The Why and How of âPublic-Plan Choiceâ

Thu, 28Â MayÂ 2009 00:00:00 -05:00

The debate over health care reform has increasingly centered on the issue of âpublic-plan choiceâ â whether Americans younger than 65 who lack employment-based coverage should have the choice of...

CORRESPONDENCE: Nickel Allergy in Danish Women before and after Nickel Regulation

Thu, 21Â MayÂ 2009 00:00:00 -05:00

To the Editor: Over the 20th century, the prevalence of nickel allergy increased in Western Europe and the United States1; this increase has been attributed to increased skin exposure to...

EDITORIAL: To Nap or Not to Nap? Residents' Work Hours Revisited

Thu, 21Â MayÂ 2009 00:00:00 -05:00

The medical profession must provide quality, cost-effective care and seek high standards of patient safety. To improve patient safety in our teaching hospitals, a committee of the Institute of Medicine...

SPECIAL ARTICLE: Cost Implications of Reduced Work Hours and Workloads for Resident Physicians

Thu, 21Â MayÂ 2009 00:00:00 -05:00

Background: Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other...

PERSPECTIVE: Controlling Conflict of Interest â Proposals from the Institute of Medicine

Thu, 21Â MayÂ 2009 00:00:00 -05:00

As Congress considers mandating the disclosure of industry gifts and payments to physicians on a searchable federal government Web site,1 others have been developing proposals for reforming physicianâindustry relations, and...

PERSPECTIVE: What Works in Market-Oriented Health Policy?

Thu, 21Â MayÂ 2009 00:00:00 -05:00

There is a widespread belief, embraced by President Barack Obama as well as congressional and industry leaders, that the next round of health care reform should leverage market forces to...

PERSPECTIVE: Globalized Clinical Trials and Informed Consent

Thu, 14Â MayÂ 2009 00:00:00 -05:00

The increasing globalization of clinical research trials calls for more effective ethical and legal rules to protect both research subjects and scientific integrity.1 Some observers noted more than a decade...

PERSPECTIVE: Medicare and HMOs â The Search for Accountability

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Twenty-five years after the introduction of health maintenance organizations (HMOs) as an alternative to fee-for-service Medicare, the promise of these private plans â that competition among them would lead to...

PERSPECTIVE: Picking the Right Poison â Options for Funding Health Care Reform

Thu, 14Â MayÂ 2009 00:00:00 -05:00

The Clinton administration's ill-fated 1993 Health Security Act has at last become a model for health care reform â though not in the way its architects envisioned. The Obama administration...

BOOK REVIEW:

Thu, 07Â MayÂ 2009 00:00:00 -05:00

In Aravind Adiga's novel The White Tiger (New York: Free Press, 2008), the narrator describes his weekly visits to the liquor store. On the wall, in dripping red paint, were...

CORRESPONDENCE: Developing Unbiased Diagnostic and Treatment Guidelines in Psychiatry

Lisa Cosgrove, Ph.D., Harold J. Bursztajn, M.D., and Sheldon Krimsky, Ph.D. — Thu, 07Â MayÂ 2009 00:00:00 -05:00

To the Editor: In 1984, the Journal was one of the first medical journals to establish a policy requiring disclosure of financial interests for all authors of research articles. During...

HEALTH LAW, ETHICS, AND HUMAN RIGHTS: New York City's War on Fat

Michelle M. Mello, J.D., Ph.D. — Thu, 07Â MayÂ 2009 00:00:00 -05:00

In February, a federal appeals court handed public health officials in New York City an important victory in their ongoing war on obesity and chronic disease.1 In the past 3...

SPECIAL ARTICLE: Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases

Thu, 07Â MayÂ 2009 00:00:00 -05:00

Vaccines are among the most effective prevention tools available to clinicians. However, the success of an immunization program depends on high rates of acceptance and coverage. There is evidence of...

PERSPECTIVE: The Neglected Purpose of Comparative-Effectiveness Research

Thu, 07Â MayÂ 2009 00:00:00 -05:00

On February 17, 2009, President Barack Obama signed into law an initiative providing $1.1 billion to support research on the comparative effectiveness of drugs, medical devices, surgical procedures, and other...

PERSPECTIVE: Debate about Funding Comparative-Effectiveness Research

Thu, 07Â MayÂ 2009 00:00:00 -05:00

The proposal to include $1.1 billion for comparative-effectiveness research (CER) in the federal stimulus package encountered a vigorous and well-coordinated backlash. The campaign to gut this funding ultimately failed, but...

PERSPECTIVE: Does Comparative-Effectiveness Research Threaten Personalized Medicine?

Thu, 07Â MayÂ 2009 00:00:00 -05:00

The American Reinvestment and Recovery Act gives comparative-effectiveness research (CER) a large boost in funding over the next 2 years. Despite a consensus that better information about the relative effectiveness...

PERSPECTIVE: Rationing Antiretroviral Therapy in Africa â Treating Too Few, Too Late

Thu, 30Â AprÂ 2009 00:00:00 -05:00

The past 6 years have seen striking advances in access to antiretroviral therapy in Africa. From 2002 onward, the international drive to scale up antiretroviral treatment gained considerable momentum, most...

PERSPECTIVE: Ounces of Prevention â The Public Policy Case for Taxes on Sugared Beverages

Thu, 30Â AprÂ 2009 00:00:00 -05:00

The obesity epidemic has inspired calls for public health measures to prevent diet-related diseases. One controversial idea is now the subject of public debate: food taxes.

Forty states already have small...

SPECIAL ARTICLE: Changes in the Incidence and Duration of Periods without Insurance

David M. Cutler, Ph.D., and Alexander M. Gelber, Ph.D. — Thu, 23Â AprÂ 2009 00:00:00 -05:00

Background: Policymakers have recently proposed ways of providing health care coverage for an increased number of uninsured persons. However, there are few data that show how the incidence and duration...

PERSPECTIVE: The Struggle for Reform â Challenges and Hopes for Comprehensive Health Care Legislation

Thu, 23Â AprÂ 2009 00:00:00 -05:00

Undaunted by a soaring federal deficit, competing legislative priorities, and skeptical Republicans, leading Democrats are relentlessly pursuing health care reform, as they hold hearings, engage key stakeholders, plot strategy, and...

EDITORIAL: Risks of Long-Acting Beta-Agonists in Achieving Asthma Control

Jeffrey M. Drazen, M.D., and Paul M. O'Byrne, M.B. — Thu, 16Â AprÂ 2009 00:00:00 -05:00

In early December 2008, the Food and Drug Administration (FDA) held an unusual joint meeting of the PulmonaryâAllergy Drugs Advisory Committee, the Drug Safety and Risk Management Advisory Committee, and...

SPECIAL ARTICLE: Use of Electronic Health Records in U.S. Hospitals

Thu, 16Â AprÂ 2009 00:00:00 -05:00

Background: Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption...

PERSPECTIVE: Balancing the Benefits and Risks of Inhaled Long-Acting Beta-Agonists â The Influence of Values

Thu, 16Â AprÂ 2009 00:00:00 -05:00

In December 2008, the Food and Drug Administration (FDA) convened a joint meeting of the Pediatric Advisory Committee, the PulmonaryâAllergy Drugs Advisory Committee, and the Drug Safety and Risk Management...

PERSPECTIVE: Care of War Veterans with Mild Traumatic Brain Injury â Flawed Perspectives

Thu, 16Â AprÂ 2009 00:00:00 -05:00

Researchers estimate that more than 300,000 U.S. veterans of the wars in Iraq and Afghanistan (20% of the 1.6 million) have sustained a mild traumatic brain injury (TBI), also known...

BOOK REVIEW: