Advantages and disadvantages of special hospitals for patients with HIV infection: a report by the New York City Task Force on Single-Disease Hospitals

Article Abstract:

People with human immunodeficiency virus (HIV), the agent associated with AIDS, are concentrated in five states, which have 65 percent of the diagnosed AIDS cases. These states, together with five cities, have 40 percent of the reported cases. Moreover, more than three quarters of the hospital care for AIDS patients is provided by one fifth of the hospitals. Such overwhelming concentration of AIDS care in only a few facilities has led to recommendations for separate care institutions for people with this disease. The positive and negative aspects of such institutions are evaluated in this report by the New York City Task Force on Single-Disease Hospitals. Negative aspects can be seen in reviewing the history of mental hospitals and tuberculosis sanitariums, where patients and staff suffered from geographic and professional isolation. Single-disease institutions may be particularly vulnerable to budget cuts, as was the case for mental hospitals. No clinical aspect of HIV infection can be said to justify hospitals that treat only AIDS patients; in fact, patients may require specialists in many fields. Single-disease hospitals could also result in fewer outpatient services being made available to AIDS patients at a time when the trend in AIDS care is toward more of these services. New York City cannot claim that its hospital problems would be solved by the creation of AIDS hospitals; the ills of that city's health care system extend well beyond AIDS. Major flaws, such as the lack of appropriate lower-level hospitals to which patients can be discharged, and the lack of primary care for poor people, would not be solved by creating 'HIV-only' hospitals. Policy recommendations from the Task Force include a strong position against single-disease hospitals for HIV-infected people, and a positive stance toward inpatient AIDS units in acute care hospitals. Regional HIV hospitals would have more drawbacks than advantages. AIDS patients who need long-term care might be best served in special units within mixed-use nursing homes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Hospitals, HIV infection, HIV infections, AIDS patients

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Institutional conflict of interest

Article Abstract:

Institutional conflicts of interest in the medical research field have not been properly addressed, despite a policy emphasis on the commercialization of government-funded research and the need for research centers to find new sources of revenue. Institutional conflicts arise when a research institution has a potential financial interest in the results of its research. The amount of discretion an institute has over both its findings and financial interest and the potential harm to patients resulting from conflicts are factors that further complicate conflict of interest situations. Disclosure of interests makes the possibility of conflicts known but does not prevent them, and internal regulation of possible conflicts can be seen as just one more potential place for conflicts to arise. External monitoring offers possibly the most objective means of safeguarding against conflicts, despite some cost and time limitations.

Economic aspects, Finance, Research institutes, Prevention, Medical research, Conflict of interests (Agency), Professional standards review organizations (Medicine), Conflicts of interest

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Medical professionalism -- focusing on the real issues

Article Abstract:

Tips for developing professionalism in medicine are provided. One mark of professionalism is putting patients' first. This may be hard for many professional organizations that spend much of their time lobbying on behalf of their own special interests. Professional certification could be a requirement instead of a recommendation. Professional organizations could form alliances with consumer groups to improve health care quality. And professional organizations, medical schools, and hospitals could reduce their dependence on free samples and other gifts from the pharmaceutical industry.

Professional ethics

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