US clinical research under threat

BMJ 1997; 315 doi: (Published 19 July 1997) Cite this as: BMJ 1997;315:143
  1. Janice Hopkins Tanne
  1. New York

    Clinical research in the United States is facing a crisis largely due to the growth in managed care, the Institute of Medicine and the American Medical Association warned last week.

    “The real problem is that American society is trying to control healthcare costs. Managed care organisations are the mechanism through which this is expressed,” said Dr Kenneth Shine, president of the Institute of Medicine, part of the National Academy of Sciences. Academic medical centres, whose costs are 15-30% higher because of research and education, are forced to compete with community hospitals.

    The Institute of Medicine organised a two day meeting in Washington, DC, to highlight these concerns; it coincided with a special issue of JAMA. The biggest single problem, Dr Shine said, is that clinical researchers are losing time to do research as their hospitals press them to see more patients. Basic science researchers usually hold a PhD qualification and so cannot be redirected to the care …

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