AAMC Reporter, December 2000: Speakers Address 'Making a Difference' in Health Care and Beyond

VOLUME 10, NUMBER 3

JORDAN J. COHEN, M.D., PRESIDENT

DECEMBER 2000

Speakers Address 'Making a Difference' in Health Care and Beyond

By Jennifer Proctor

Headline speakers at the AAMC's 111th Annual Meeting included
Gen. Colin Powell (Ret.), Ruth Rothstein of the Cook County
Bureau of Health Services, and Princeton University's Uwe Reinhardt, Ph.D.

The message from the AAMC's 111th Annual Meeting's headline speakers was clear: Medical schools and teaching hospitals are facing unprecedented challenges and assuming new responsibilities, whether it's maintaining fiscal solvency, caring for the uninsured, or managing conflicts of interest.

Outgoing AAMC Chair Ralph W. Muller emphasized the need to "renew the public's confidence in us and sustain its support for our good works." To achieve this goal, academic medical centers must secure additional government backing, continue to provide superior quality care, and keep a closer eye on costs.

Medical schools and teaching hospitals also need to better communicate their roles to the public, said Muller, president and CEO of the University of Chicago Hospitals and Health System. The three-legged stool often used as a metaphor to convey academic medicine's missions of patient care, research, and education fails to reflect medical schools and teaching hospitals' increasingly complex roles. Instead, Muller proposed a new model: the four-chambered heart, which adds community service to the traditional three missions.

AAMC President Jordan J. Cohen, M.D., also highlighted the importance of public trust and support in a speech on financial conflicts of interest. "Our ability to continue to pursue the venerated mission of clinical research depends entirely on our willingness to merit public trust.

"We risk great peril if we fail to respond to the growing perception that financial conflicts of interest have gotten out of control," Dr. Cohen said. He urged academic medical centers to take action on two fronts. First, academic medical centers must "better educate the public about how, with proper safeguards, limited financial incentives in the conduct of clinical research can work to the benefit of everyone."

Second, Dr. Cohen said, academic medicine needs to develop special, targeted safeguards that address financial conflicts of interest. He announced the formation of a new AAMC task force, chaired by William Danforth, M.D., chancellor emeritus of Washington University, that will be charged with formulating these safeguards.

Children were the subject of Gen. Colin Powell's keynote address. Powell focused on the "third phase" of his life, which is dedicated to children through his work as chair of America's Promise: The Alliance for Youth. "It is essential that no child be left behind," he said, emphasizing the need to provide young people with access to health care, immunizations, and proper nutrition.

Uwe Reinhardt, Ph.D., may not be a soldier, but in his speech at the Annual Meeting's plenary session, he warned that "academic medicine is under fiscal siege." Dr. Reinhardt, a professor of political science and economics at Princeton University and the meeting's Robert G. Petersdorf lecturer, said that academic medicine must become as cost effective as possible.

Dr. Reinhardt also said that academic medical centers, like all businesses, should be able to account for their costs and expenditures. Specifically, he suggested that medical schools should be independent of their teaching hospitals, and he questioned the costs of graduate medical education.

"Residents pay for themselves and contribute to their own education," he maintained. Dr. Reinhardt also cast doubt on academic medicine's mission to provide health care to the uninsured. "While this is a controversial view, maybe [not providing care to the uninsured] is what it takes to get universal coverage."

In contrast, Ruth Rothstein, chief of the Cook County Bureau of Health Services, urged medical centers to expand their efforts to care for the poor and uninsured. Rothstein, the meeting's John A.D. Cooper lecturer, suggested that medical schools and teaching hospitals have assumed a new role - that of "social advocate." Medical centers are now "major stakeholders in decisions that affect our communities and have an obligation to ensure services meet the needs of communities," she stressed.

"America has not yet accepted the principle that health care is a right, not a privilege," said Rothstein, who maintained that universal health coverage is the only humane option for providing quality care to the nation's 44 million uninsured. She also urged educators to remind doctors in training that their responsibilities include advocating for those who need it most. "When you improve the health status of the poorest, you improve the health status of everyone."

Annual Meeting's Stem Cell Session A Big Draw
"Scientists and religion can embark together on a common search for the truth," said the Most Rev. Edward Egan, the archbishop of New York and one of the speakers at the AAMC Annual Meeting's special focus session on stem cell research. The Rev. Egan did acknowledge the potential benefits of stem cell research and stressed that the use of stem cells from adults is not objectionable to the Catholic Church. However, the agreement among speakers ended when Rev. Egan said that the Catholic Church opposes stem cell research that involves cells cultivated from embryos. "We are not free to use one human being for the benefit of another," he told the audience of more than 400. In sharp contrast, Irving L. Weissman, M.D., said, "It's a tragedy if we don't do this research." A professor of pathology and developmental biology at the Stanford University School of Medicine, Dr. Weissman outlined how stem cells may be used to treat cancers and initiate the regeneration of organs and tissue. Offering the institutional perspective, University of Nebraska President L. Dennis Smith, Ph.D., discussed the stem cell controversy that erupted over his university's research in the field. "The use of stem cells elicits debate that is not going to go away," Dr. Smith said.

Revised: 06 December 2000