The United States' tradition of quality clinical investigation is jeopardized by government funding cutbacks and managed-care's reluctance to pay for research.
That's the assertion of a series of articles in the July 16 Journal of the American Medical Association. The authors, from Massachusetts General Hospital in Boston, linked higher managed-care penetration to lower clinical-research production.
Medical school researchers in the most competitive markets publish fewer articles in peer-reviewed journals and see more patients than those in less-competitive markets. And if their school is in a highly penetrated managed-care market, it's more likely their share of National Institutes of Health grants is declining.
The American Association of Health Plans, the HMO industry's lobbying group, objected to JAMA's conclusion that managed care is at fault. "The data don't support any conclusion that would point to managed care here," said Susan Pisano, AAHP spokeswoman. "The authors admit that (their research) `does not establish causality and does not address any mechanism by which managed-care penetration may affect the ability of medical schools to compete successfully for NIH research awards.' "
In an editorial, two researchers at the Bowman Gray School of Medicine in Winston-Salem, N.C., call for a national "clinical-research summit" to reverse the decline.
Another editorial, by Kenneth I. Shine, M.D., of the Institute of Medicine, argues in favor of "a new income stream" to replace the patient revenues that formerly supported clinical research.
He suggests a 1% "assessment" on health insurance premiums for four years. It would function like the 10% airline tax for air-traffic control or the gasoline tax for roads. Shine estimates $4 billion to $8 billion of research could be funded this way.
