On Health Care


November 22, 2004


Research, technology and the cost of health care: cause or cure?

When it comes to health and longevity, we've come a long way since Hippocrates wrote the classic oath.

We need only review recent history to see the progress. At the beginning of the 20th century, the leading causes of death were pneumonia and tuberculosis, and the average life expectancy was 50.

Today, that's considered middle age, and heart disease, cancer and stroke are the biggest killers -- complex diseases that aren't likely to be ameliorated with a single pill. But, their devastating effects are managed and even prevented with increasing success, thanks to early intervention, advanced technology and 21st century drugs. And, in the near future, a new breed of practitioners being trained at institutions like UCSD's School of Medicine and Skaggs School of Pharmacy will tailor therapies for the individual, based on his or her genetic makeup.

Lifestyle, nutrition and environment are key factors in sustaining and enhancing health. But when healthy individuals become patients, they expect to have access to the latest in medicine and technology. And, they want us to continue developing even better treatments and cures.

Discovery leading to improved patient care has a real dollars-and-cents cost. So, when the debate rages on about the affordability of health care, technology and research appear at the top of many lists as a big part of the problem.

In the health care industry, we appreciate the costs of staying abreast of the latest advances more than anyone. As the CEO of a university hospital with the multiple missions of patient care, research and education, maintaining a balance between investment and revenue can be especially challenging.

But we also know that technology is not the problem. It is often the solution, allowing us to improve care, function more efficiently and shorten hospital stays, ultimately bringing down costs. And, technology contributes substantially to our ability to safely and effectively care for our patients.

In my experience, technology has an impact on two broad categories of health care: the "management" of patients and patient information, and the diagnosis and treatment of disease.

In the first category, I include the vitally important role of advanced information systems within our hospitals and clinics.

In its landmark reports on medical errors and patient safety, the Institute of Medicine strongly stated that a top priority for the health care industry is to invest in information technologies for collecting and sharing essential health information, to improve outcomes and reduce the risk of death and injury due to error.

Today's sophisticated and secure technologies allow standardized collection and monitoring of patient data about each and every patient, and ready access to accurate and detailed records by caregivers at any point in the patient care continuum. And, various Web-based reports are now utilizing the aggregated, anonymous data to enable consumers to evaluate and compare hospital performance.

Technologies such as Computerized Physician Order Entry (CPOE) and "paperless" Electronic Medical Records systems that UCSD and others are adopting result in highly efficient and reliable information management, and therefore improved safety, quality and patient satisfaction. Within just a few weeks after installation of CPOE, we have found our efficiency, timeliness and service have all improved dramatically.

The second category, diagnosis and treatment, is directly meaningful to our patients. Consumers today are well-informed and demanding when it comes to their health or that of a loved one. If there is a new imaging technology, or an innovative drug or procedure that might make a difference in their outcome, our patients are likely to know about it coming in the door.

An accusation we often hear in the cost debate is that the health care industry is engaged in a "medical arms race," leading to duplication and unnecessary use of costly technologies. This position ignores the incalculable value of early diagnosis leading to early intervention, with advanced imaging that now can reveal a tumor or a blocked artery in its very earliest stages. The value is measured in better results for patients, and in the reduction of the suffering and costs of managing advanced, disabling illness that has gone undetected.

We have an obligation to use these and other powerful tools as they become available through biomedical research, and expand upon the arsenal of treatments we have to help our patients battle back from injury and disease.

As I walk through UCSD's hospitals and clinics, I see this commitment carried out every day. It applies to the fragile infant who weighs under 2 pounds at birth, growing stronger in our Neonatal Intensive Care Unit, and to the patient with incurable Alzheimer's disease who adds quality years, thanks to new memory-enhancing drugs; to the leukemia patient who has traveled here from out of state to take part in an experimental therapy, and to the stroke victim in a rural hospital in another county, rapidly and therefore successfully treated after long-distance consultation with specialists, utilizing telemedicine technology.

Our patients benefit from these kinds of services because of investments in research and technology. This region is not only a center for superb health care, but is ranked as the nation's No. 1 biotech cluster. New drugs and technologies are being generated right here in our own back yard, making their way into practice for the benefit of patients, often through the collaboration and partnership of health care providers with each other and with the research community.

One example is the UCSD-Sharp Blood and Marrow Transplant program, a joint venture that treats over 150 patients a year, pioneering new advances that have greatly reduced complications so that patients can undergo the procedure with very little risk.

And UCSD and others offer access to hundreds of clinical trials through our participation and leadership in local and national research networks.

Yes, technology costs. But it also saves lives and, in the long run, it saves dollars. It's well worth the upfront investment in every respect. As we continue to seek solutions to spiraling health care costs, we need to focus on how to share in this investment for the benefit of all patients, not on how to reduce it at the expense of progress and improved health.

Liekweg is chief executive officer of UCSD Medical Center, University of California, San Diego.


November 22, 2004