Introduction to "Money in Medicine"
The First Installment of NextGen's "Money in Medicine" Series
What does the physician do, in the strict sense?
Does he heal the sick, or does he make money?
And remember, I am now speaking of the true physician.
-Plato, The Republic, Book 1
The issue of money in medicine has been on our minds since antiquity. Today, something appears rather new in the realm of physicians' finances: never before has the power of money loomed so large in determining the direction of research, the shape of health care policy, and the careers of our doctors. Drug ethics scandals, national political battles, physician protests, and billions of dollars in politicized medical research funding are just some of the headline-making issues facing American doctors.
For the undergraduate, it can be frustrating and intimidating to confront the financial side of medicine. In this series, "Money in Medicine," the Next Generation seeks to shed light on many areas where money meets medicine in the lives of modern physicians. Can a physician find financial stability and still work in a field that is meaningful to her? How can the aspiring researcher find the money he needs and the patron who understands his vision? How can an undergraduate understand the current political battles about malpractice liability insurance? What is ethical when it comes to a doctor dealing with money?
Over the course of this series, the Next Generation will explore these issues and seek to find relevancy and applicability for the undergrad and others interested in the financial aspects of medicine.
What is a researcher to make of the labyrinth of philanthropies and institutions which provide the lifeblood of research medicine? The large American centers for research medicine frequently have different missions, methods, and financial means, and thus provide different opportunities for unique research. For example, the National Institutes of Health, with 27 separate institutes and centers and a budget near $30 billion, is the federal government's medical research organization and the single largest source of research money in the country. The Howard Hughes Medical Institute, with an endowment over $11 billion, maintains a special focus on biomedical research, science education, and in-house research by the Institute's 300 full-time investigators. Another major player in the research funding field, the Bill and Melinda Gates Foundation, has spent almost $4 billion in the last decade with a special focus on combating disease in third world countries. The Next Generation will seek to portray the research process at these institutions and others in a way that is accessible and helpful to undergrads and others who are unfamiliar with the way research money is distributed.
An issue that has garnered great attention in states around the country and in the recent presidential campaign is medical malpractice liability insurance. Clinical practical, a future many undergraduates envision for themselves, seems now a future plagued by uncertainty. What is the real status of malpractice insurance? Is there any hope for reform? With the American Medical Association identifying 20 states in full crises, with doctors walking away from their practices and deserting their towns, and with half of medical students claiming liability as a factor in their specialty choice, the issue is one of special importance to the next generation of physicians.
Recent allegations of cover-ups in drug trials, congressional battles about private-public ties within NIH, and the growing influence of drug companies in the examining room has led many to question anew the medical world's commitment to ethical conduct. How is a doctor to act with regard to money? When the director of NIH can tell Congress that "it would be a mistake to ban all compensated activities with outside organizations" for NIH scientists, it is clear that ethical norms are shifting. NextGen will explore the changing definition of "right and wrong" with regards to money and medicine - and why this should matter to undergrads.
We will seek in this series to develop a practical and realistic portrayal of "Money in Medicine." Such an understanding is critical for a student interested in medicine. In the end of his discussion in The Republic, Plato determines that a good physician can deal with finances without betraying the humane spirit of his profession. We wish to help students come to the same conclusion.
Chris Catizone is an Associate Editor of the Next Generation and a member of the Harvard College Class of 2006.