Archive | health care

Stop researching: We know what works for healthcare.



“Research ethics and health care reform”, a stunning letter written by James Kahn, a professor in Health Policy and Epidemiology University of California, and Paul Hofmann, president of the Hofmann Health Group with a Ph.D. in Public Health, was published in the June 19th issue of Science.

Bottom line of the letter- it is unethical to research and write on partial fixes to the multi-payer system of health care in the USA when we already have plenty of compelling evidence that single payer health care systems improve patient outcomes, serve more people, and do it more economically than multi-payer systems.

Kahn and Hofmann wrote the letter in response to a Policy Forum essay by Amy Finkelstein and Sarah Taubman published in Science in February, 2015. “Randomize evaluations to improve health care delivery” made the point that too few randomized control trials for U.S. health care reform research means there is not enough solid research to base policy on. Kahn and Hofmann do not disagree with this, but say it is a secondary problem to a “major ethical breach.”

The ethical breach defined by Kahn and Hofmann is based on the “principle of equipoise,” which says that deviations from the standard of care are allowable in research with humans only if there is real uncertainty about which intervention is better. Because there is enough research to conclude that single payer healthcare works better, further experiments and trials to define the better system are unethical.

“To ignore this compelling evidence risks lives in the United States as we experiment with partial fixes to the multi-payer system. This experimentation would be rejected by any responsible university institutional review board as violating the principle of equipoise and causing unacceptable patient harm.”

Strong words- and hopefully, they will be spoken by more scientists, physicians, researchers, and academics. The development of drugs and vaccines, research on surgeries and devices, basic work on cell physiology, applied genomics research to target individuals health problems, social and psychological health interventions- all are funneled in the USA through the health care system. And in this system, where money can purchase excellent care for some, while others must hold bake sales and run crowd sourcing campaigns on line to pay for medicine, not all people will benefit from your research.

Most people don’t go into medicine or research to impact only the lives of people who can afford good health insurance. Single payer health care will mean that more people can be served by your work.








Cold Spring Harbor Laboratory, research subjects, and lack of universal health care in the USA.


The headline: “Research Partnership Will Seek Human Subjects for Cancer Work.” (Hartocollis, Anemone, The New York Times, Friday, April 3, 2015, p A16-17.)

The happy content: The basic researcher at Cold Spring Harbor Laboratory (CSHL) on Long Island are collaborating with North Shore-L.I.J. to access human subjects. What’s not to like?

It is hard to say why this is a news article, as there are already many medical centers that combine basic and clinical research, including Memorial Sloan Kettering in Manhattan. As the article points out, this is exciting especially for the CSHL scientists who are excited to be involved in work that is closer to achieving an actual cure in patients, and to be dealing with patients who are not necessarily white and affluent.

But perhaps it is that the patients are not affluent (translation- may not have health insurance) that this supposedly exciting news is disturbing. And the following sentence from the article says it all:

“Although the researchers will not know the identities of the patients who have given tissue samples, if a breakthrough discovery were made, it would be possible to retrace the identity of the donor and perhaps apply the new knowledge to that person’s treatment.”

This is not good enough. “Perhaps” is not good enough.

People donate their time and their health for the idea of cures, and generally will not receive any personal return. Altruism and wanting to make a difference are wonderful traits, and don’t need a reward. But this is happening in a system in which industries and personal fortunes and jobs are build on the basis of clinical trials, and in which many people do not have good health care. Really, do we want to make the most vulnerable- those sick and without the funds to explore experimental treatments- the only folks in the system who will see no benefit for their sacrifice?

Having a universal health care system where all folks receive health care is the start to ensuring all people will see the benefits of research. Patient information, which is now bought and sold and protected and hoarded as its analysis can potentially yield more insights than experimental manipulation, might also be more readily contributed if everyone had access to emergent treatments.