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M. Nuwer, G. Barkley, G. Esper, P. Donofrio, J. Szaflarski, T. Swift (2008)
Invited Article: The US health care systemNeurology, 71
M. Nuwer, G. Esper, P. Donofrio, J. Szaflarski, G. Barkley, T. Swift (2008)
The US health care system: Part 1: Our current system.Neurology, 71 23
Swift TR, Neurology (2008)
Invited article: the US health care system: part 2: proposals for improvement and comparison to other systems., 71
In reply We appreciate Dr Jaffe's thoughts on translational medicine being simply a term describing an attempt to systematize a practice that has been evolving for generations. However, the purpose of our article was less to systematize than to address how the provision of health care is changing and how all stakeholders need to be engaged to make informed decisions. These decisions involve not only which treatment options are available but how to study and identify the best treatment for individuals who do not fit demographic criteria for the implementation of treatment identified as efficacious by “gold standard” randomized controlled trials. Furthermore, we attempt to outline strategies through which access to quality health care can be realized and sustained. As Dr Jaffe points out, we as physicians provide care in a very different and much more complex world than the days of Jenner and Pasteur. We have seen advances in understanding of the pathophysiology and etiology of many more diseases, innovations in diagnosis and treatments that require application to larger populations, and escalating costs complicated by greater difficulty in accessing appropriate quality care. To address these issues and those that emerge in the future, an expansive approach to evaluating health care delivery is necessary. This includes the “bench to bedside” tools but also must include epidemiologic, economic, and clinical efficiency instruments as outlined in phases 2 and 3. No doubt, as scientific and medical knowledge grows, populations evolve, and the health care environment changes, stakeholders will need to be able to use present day tools while developing new methods that can evaluate each phase so as to feed forward to improve health care and feedback to inform innovation in the other phases. Dr Jaffe highlights excellent (and controversial) points regarding the future of medical education, fiscal debt of burgeoning physicians, and health care economics in a changing political landscape. This article was not intended to offer an opinion as to which type of payer system should be favored, nor was it intended to analyze the benefits and risks of different payer systems currently in place in this country and others; this has been done in prior articles.1,2 We hope that we have offered thoughts that must be applied in any payer system, such as the application of clinical trial data for best outcomes in wider populations, improving efficiency of health care delivery, and facilitating use of electronic medical records for patient care. As this evolution in evaluating options in health care continues, the way we teach ourselves, our colleagues, our students, our patients, and our policy makers will enable us to incorporate translational medicine into the way we take care of patients. Correspondence: Dr Helmers, Department of Neurology, Emory University, WMRB 101 Woodruff Circle, Ste 6000, Atlanta, GA 30322 (sandra.helmers@emory.edu). Financial Disclosure: None reported. References 1. Nuwer MREsper GJDonofrio PDSzaflarski JPBarkley GLSwift TR The US health care system part 1: our current system. Neurology 2008;71 (23) 1907- 1913PubMedGoogle ScholarCrossref 2. Nuwer MRBarkley GLEsper GJDonofrio PDSzaflarski JPSwift TR Invited article: the US health care system: part 2: proposals for improvement and comparison to other systems. Neurology 2008;71 (23) 1914- 1920PubMedGoogle ScholarCrossref
Archives of Neurology – American Medical Association
Published: Apr 11, 2011
Keywords: neurology
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