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A frontier is a no man’s land between the known and the unknown; it is a place entered in anticipation of new discoveries, through routes both intuitive and non-intuitive. In our age of science, the brave adventurers who enter this new land are expected to return with, and return to, riches of many kinds. For the frontier heroes of medicine – scientists, entrepreneurs, leaders – the frontier therefore becomes a place of residence, as there is always another horizon that cannot be reached, that recedes as we advance. And yet, many of these same individuals believe that just over the horizon of medicine is the well patient – free from pain and suffering, and perhaps even happy. We would argue that only recently have we begun to see glimpses of the keys to the horizon. GMF IV was an attempt to look again, to discover the individuals and ideas which represent the most promising leads in the search for better healthcare. The inhabitants of the frontier know that the key to the horizon is a unique cooperation of fundamental biomedical discoveries and just socioeconomic systems. If the goal of the well-patient is to be reached, the separate spheres must be harmonized, innovation maximized. And yet, in healthcare, there are no impartial guides to lead the way through the frontier; any listing of the many participants in the healthcare debate is taken as a challenge to one group or the other. The result is politics: a battle between the interests, at the end of which the horizon only seems farther away. In an attempt to contribute to the conclusion of this battle, the Global Medical Forum Foundation has positioned itself at the interface of the two un-harmonized realms: biomedicine and socioeconomics. The frontier of modern healthcare
They are the frontiersmen of those times; individuals
in whom the activity of the scientific revolution seemed to converge.
Thus in 1730 Alexander Pope summed up the 18th century view of Sir Isaac’s
achievements as follows: It is highly unlikely that a Newton will now appear to illuminate our way forward in the healthcare debate, to show us how medicine can be both constantly improved and delivered to all inhabitants of the earth. The great creative insight, the great leap in innovation by the solitary scientist, is rare enough in the physical and biological sciences alone. And yet, as the fractious healthcare debate now intensifies, the time has come for an age of healthcare enlightenment. Healthcare calls for its guides. Expectations But that does not mean that we should enter the new frontiers of healthcare expecting nothing more than the old and tired saw-horses of «managed care» etc. or even the heart-racing words of «consumer driven healthcare» or the thrilling notion of «disease-state management.» Equally and fairly in the biomedical and pharmaceutical world, we should expect truly new medicines to treat cardiovascular disease, motor neuron disease, depression, diabetes, and malignancies and not new packaging, isomeric tinkering, or marketing extravaganzas with less than praiseworthy motives. An honest discussion about what’s wrong in healthcare, the greatest pursuit of a civilized society, suggests that most participants have lost their way, and, as the Global Medical Forum has stressed before, must come to understand again the special nature of the business in which they operate. In yet another difficult combination, healthcare must be an elitist pursuit that recruits to its ranks the most meritorious, while at the same time recognizing the importance of egalitarianism and equity. Unfortunately – and this is just one more chimera of the healthcare debate – many unexamined notions, under the guise of equity, have been embraced that have only added to the miasma that surrounds the healthcare debate. Science & cost As Lewis Thomas has pointed out, the «deeper our understanding of a disease mechanism, the greater are our chances of devising direct and decisive measures to prevent disease, or to turn it around before it is too late.» Disease prevention is without doubt the most costeffective way to lower the overall cost of healthcare. Arguably, earlier diagnosis and targeted therapies – à la Ehrlich – are second in line in the cost reduction queue. These facts require social scientists, economists, and politicians to devise ways in which to measure the global cost of an illness or disease and to understand why new discoveries, new therapies, and new technologies are ultimately cost-effective to society as a whole and not simply enormously expensive ways of bolstering the bottom lines of avaricious corporations. It must also always be kept in mind what the relief of pain and suffering is worth to the patient, to say nothing of the value to society of the increase in productivity that health creates. At the same time, it is incumbent upon healthcare regulators not simply to threaten society with the facile notion – a notion that unfortunately now has become the commonly accepted wisdom – that equates a small market size with pricey therapies. Perhaps the therapies will be pricey, but the cost to society and hence to the payors – will ultimately be less. Healthcare leaders must avoid the trap of knowing the price of everything, but the value of nothing. The measurement of the intersection of medicine and cost, of science and socioeconomics, requires a balanced, wise, and honest approach from all participants in the healthcare debate, all of whom must be conscious not only of what they know, but also of what they don’t know. Two hundred leaders joined us at GMF IV to examine this intersection with colleagues from each of the many different battlefronts of healthcare, to step into the frontier and discuss solutions to the healthcare debate.
GMF IV was structured around an opening plenary session, four main plenary sessions, ten round tables, and a closing plenary session. Opening Plenary Session Main Plenary Sessions Round Tables Closing Plenary Session |
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GMF | 2.0
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