Shattuck Lecture - the health care industry: where is it taking us

Article Abstract:

Eleven years ago the author published some comments about the direction in which the medical profession seemed to be headed. At that time, he described a medical-industrial complex that would administer health care while reaping profits. Now it seems appropriate to review the changes that have occurred in the last decade in the commercial and business-like aspects of medicine. Predictions of the expansion of entrepreneurial hospitals have not been borne out. In 1980, about 1,000 hospitals were owned by investors; by 1990 this number had increased to only 1,400. (The total number of US hospitals is roughly 5,000.) The failure of investor-owned hospitals to grow substantially in number is largely due to the fact that it is far more difficult now to operate a hospital profitably. Rapid growth has, however, occurred in another segment of the health care industry. Free-standing organizations have been developed to provide specialized services and have grown. These centers may provide a variety of services, including acute care, ambulatory surgery and radiographic procedures, such as X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). Health maintenance organizations (HMOs) have also grown in recent years, and many provide a full range of services from home nursing care, outpatient care, and inpatient care. Some of the larger HMOs have begun to offer health insurance as well. The total national expenditure for health care is about $700 billion. Revenues of investor-owned organizations are thought to account for about $150 billion of this amount. A development that was not foreseen a decade ago was the response of voluntary hospitals to economic pressures. While investor-owned hospitals have not grown as much as anticipated, voluntary hospitals have begun to behave in a more business-like fashion. Although these hospitals are not owned by investors and do not distribute profits, they have begun to view themselves as competitors for health-care dollars, and are themselves, therefore, part of the medical-industrial complex. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Finance, Physicians, Medical professions

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Shattuck Lecture - misconduct in medical research

Article Abstract:

The problem of scientific misconduct needs to be addressed. The public has a strong faith in scientific research and scientific discoveries are widely published. Funding for research has increased since the 1980s and scientific research is used frequently by regulatory agencies. Scientific fraud betrays the basic principle on which science is based: the search for truth. The incidence of scientific misconduct may be increasing, but scientists may simply ignore this behavior in their colleagues, criticizing the US House Subcommittee on Oversight and Investigation and other groups for investigating research fraud. Several cases of scientific misconduct have been widely publicized. Robert Gallo, a internationally recognized AIDS researcher, is being investigated for his involvement in questionable activities associated with his research. This case is particularly disturbing because of Gallo's prominence in the scientific community. He is also the head of one of the most important laboratories in the world.

Investigations, Medical research, Fraud in science, Science fraud, United States. Congress. House. Subcommittee on Oversight and Investigations

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Shattuck Lecture -- hidden barriers to improvement in the quality of care

Article Abstract:

Many problems must be solved before doctors can improve the US health care system. They include obsolete data from research studies, research subjects who are not representative of the general population, effects of institutions and providers, variable interpretations of data, and the misuse, underuse, and overuse of medical technology.

United States, Quality management, Medical care quality

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