Trouble With the Translation

Biomedical researchers are flying these days, high on the success of the Human Genome Project and countless other advances. But unless we overhaul the health care system, those breakthroughs will never make it into the clinic, says neuropharmacologist and physician Floyd Bloom.

Q: You've written that "the U.S. health system is failing in front of our eyes." What is going wrong?

A: The numbers of physicians are declining, the numbers of applicants to medical schools are declining, the numbers of nurses in our hospitals are already at panic levels--a million or more below what should be part of the current health system staffing.

Doctors have much less time to spend with their patients because of Medicare and other health management paperwork that they're forced to do to receive payment for the services they render. The medical management systems are making the choices as to what tests doctors can do, what medications they can prescribe, what procedures the patients will be allowed. It makes it a very unsatisfactory arrangement both for the doctors and for the patients.

Q: How does the health care crisis affect our aging and elderly population?

A: The elderly tend to have many treatable disorders … so they're going to be particularly sensitive to any shortages in attention from their doctors or their paraprofessionals, who are the intermediaries between them and the doctors. People are living longer, but the last few years of that life are often complicated by a variety of common [problems]--osteoporosis, arthritis, falls.

People who are not dependent on Social Security and have private health insurance may or may not still be entitled to the kinds of coverage they had when they were young and didn't need it so much. Many policies are capped: You can get so much per year, but if you spend more than that, it's got to come out of your pocket.

For people on Medicare, there are only certain medications that the system will pay for. [Insurers] take one member of every class of medication--usually the cheapest--and make the assumption that all drugs in that category are the same. The special needs of individuals are overlooked.

Q: With the human genome sequence completed and funding for biomedical research at an all-time high, some say that we stand on the brink of a golden age of medicine, an era in which we will prevent and treat disease better by using genetic tests and new insights into disease to create medications tailored to a person's genetic makeup. Yet you've stated that unless the current health care crisis is turned around, these scientific advances won't make it to the clinic. Why not?

A: [HMOs and other medical management systems] resist allowing new medications now. They are going to be even more resistant to putting into play medication that might be tailored to only a very small number of people with specific genetic problems.

They [also] don’t like to approve expensive tests. As we find new ways to image the blood vessels or the heart or the liver--or image the brain and assess the effects of medications--more and more physicians will want to use them. They can’t do that if nobody pays for it. And the cost per test is very high.

Q: What can we do to help translate today's discoveries into improved health care for patients in the future?

A: I think it's a straightforward business problem. I don’t think there's a straightforward solution. [Companies' health care] expenses are just going to continue to rise. At some point, even the best companies are not going to be able to tolerate that kind of increase because it's going to eat up all the profit. I think business has to step to the forefront and demand that ways be found to identify their employees' health problems before they become problems, and keep them healthy.

I think the best way would be if health insurance companies saw the need for this translation as a way for them to reduce their ultimate payout. They're the ones who are making the profits now. They should be the sponsors--they and the corporations that are paying the insurance companies on behalf of their employees. It will make for happier, healthier workers; lower retraining costs; fewer days missed from the job; and probably better performance on the job.

Medical schools are [also] going to have to step up to the plate. They're going to have to establish new curricula for training a kind of person who would not be a bench scientist per se and would not be someone who spends [his or her] life in the hospital. [The person] would be working in this very important domain between discoveries about how genes can lead to enhanced susceptibility to disease and ways of using that information to devise new ways of treating or preventing disease.

If we only focus on being ill, we're never going to solve this problem. We have to utilize genetic information that says you're going to be vulnerable to being obese or to having arthritis or to having diabetes and deal with those issues before they become health-threatening problems.

People have to begin to take responsibility for their own health early in their lives, and we have to give them some incentive to do so. Perhaps a tax benefit for staying healthy; perhaps an entitlement to health coverage if you maintain health standards for yourself. Maybe we ought to treat people the way we treat new cars. The warranty's only good if you bring it in for service at the right time.

Dan Ferber is an Urbana, Illinois–based journalist who's checking to see if his warranty's still good.