Duke leaders propose overhaul of health care and the practice of medicine

DURHAM, N.C. -- The U.S. health-care system is inefficient, wasteful, expensive, frequently inaccessible and in need of repair. So say leaders of Duke University Medical Center, who in a new article propose a plan for fixing the ailing health-care delivery system by applying the latest scientific tools, know-how and common sense. Their proposal calls for a major redirection of health care from treating disease to effectively preventing or minimizing it.

The revised health-care system should be built on a prospective approach to medicine that emphasizes personal health planning, say co-authors Ralph Snyderman, M.D., president and CEO of the Duke University Health System, and R. Sanders Williams, M.D., dean of the Duke University School of Medicine. Writing in the November 2003 issue of the journal Academic Medicine, they call for the latest medical and genomic technology to be used more strategically to overhaul the U.S. health-care system.

"Emerging scientific fields -- including genomics, proteomics, metabolomics and diagnostic imaging -- can facilitate assessment of each individual's risk for developing disease, as well as early diagnosis and effective prevention and treatment. This is particularly important for the major chronic diseases, such as cancer, cardiovascular disease, diabetes, asthma and musculoskeletal disorders, which account for the greatest burden of human suffering," Snyderman said. "Yet despite vast expenditures for health care, 40 million Americans today lack ready access to health services and effective therapies are inconsistently and ineffectively applied."

Snyderman and Williams call instead for a "prospective health care" model in which physicians would use rapidly evolving tools to determine an individual's specific risk for developing particular diseases. That information would then allow for personal health planning and interventions that would prevent or detect disease in its earliest stages, when treatments gene

Contact: Jeff Molter
Duke University Medical Center

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