Chapter 08: Financing Clinical Research
Files
Loading...
Description
In this chapter, Dr. Goepfert describes the difficult finances of clinical research in an environment where academic clinicians compete with private practitioners for patients. He broadens his focus and speaks about the country’s need for a “social network” system that covers all individuals, noting that Scandinavia and many European nations have “socialized medicine” systems and the highest rates of satisfaction with their health care systems. He notes that though MD Anderson offers some of the best health care, that level of are is not necessarily available to the general community. He notes that rising health care costs effect cancer care and also the viability of research. He observe that in the journal, Head and Neck, fewer and fewer innovative articles are published by American researchers; more authors come from Asia and Europe.
Identifier
GeopfertH_01_20120827_C08
Publication Date
8-27-2012
City
Houston, Texas
Interview Session
Helmuth Goepfert, MD, Oral History Interview, August 27, 2012
Topics Covered
The Interview Subject's Story - Overview; The Business of MD Anderson; Business of Research; Fiscal Realities in Healthcare; Character, Values, Beliefs, Talents
Transcript
Tacey Ann Rosolowski, PhD:
So that particular study has kind of been one that people look to as a model.
Helmuth Goepfert, MD:
Yeah, looked for as a model, but it has been— Clinical research in general has been very difficult in this country, and it has to do predominantly because physicians don’t like to lose control of their patients. The otolaryngologists particularly feel quite strongly that they don’t want to give up the management of a patient when there is something that they would gain—and it has to be said—financially if they take care of the patient. That’s the reality out in the community, and it is the reality in modern financing of departments within the United States of America. Academic medicine—clinical departments are hurting, and they’re hurting because they have to compete with the physician outside and at the same time do other things.
Tacey Ann Rosolowski, PhD:
Does that influence that lack of esprit de corps you were referring to?
Helmuth Goepfert, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
Do you see a way out of that? What observations would you have to start chipping away at that problem?
Helmuth Goepfert, MD:
I would say that one of the tragic events in the United States is that we do not have a social network—or social net—to capture the people who need it. I mean, I have my Medicare, and I have a supplement of Blue Cross Blue Shield. Basically, I’m pretty well off. But there are fifty million people out there that don’t have it. Now, everybody screams bloody murder when the word socialized medicine comes about, but socialized medicine, in addition to other social-oriented safety nets, is what is available in Canada, and yes we in the United States tend to poo-poo it as a bad system. It was created in England when they came out of the ruins of World War II and had nothing available. It evolved in Germany as a result of the post-World War II era. It is prevalent in France. It may or may not be very good, but it allows us to treat everybody. It is available in many parts of the world. Now, is it the best system? There is something to be said if countries like Denmark, Norway, Sweden, even Germany and England are relatively happy with their system. And, dammit, we claim to be—and I include myself because I’m an immigrant but I’m a naturalized citizen—we think we have the best system in the world, but it isn’t. That is sort of very, very sad. As I say, it is sad because it shouldn’t be that way. It should not be that way, and it is going to get worse. God almighty, already seventeen percent of our gross national product is healthcare. Where is that going? Soon we’re going to be twenty-five percent. God almighty, I hope I’m dead before then. But it’s going that way, and we’re not doing anything to improve it. Yes, we think we have the best healthcare. Here at MD Anderson for cancer, at least we hope, but out in the community—now that I work for PN—Physician Network—I get to see a little bit more how people are treated out there—it is not often a happy story.
Tacey Ann Rosolowski, PhD:
What do you think that—? If the nation were to go more in the direction of a “socialized medicine system” as the Scandinavian countries have or Canada or France, how do you think that would affect academic medicine and the ease of doing studies of the kind that would really advance cancer care?
Helmuth Goepfert, MD:
It is already affecting it. It is already affecting it because all the cutbacks that have occurred have significantly impaired the ability of departments to cost shift anything for the purpose of doing something else. Right now, physicians who opt to go into academics have to basically compete for the patients out there against the private practitioners that have to make a living, but the private practitioners, especially if they are shrewd enough in business, don’t have to deal with education of somebody and certainly don’t have to deal with the issue of research, which are two added things. Now, research, there used to be some funding available. It’s becoming less and less and less, and education is something that is hard to come by if you obey all the new rules that are being implemented as far as the eighty-hour week, the fact that the faculty member has to be always present to sign off on a patient. It’s very hard to teach these kids some responsibility in a sense of being able to handle something with the proper background on what they have received. It is difficult. I know that because my youngest son is now a resident in otolaryngology at UCSF, and he has daily this problem that he is on call and the next day at noon he has to leave. If he is on a big case, learning something, he has to leave. He is out—absolutely out. They have to keep track of it very carefully; otherwise, the department gets slapped on the hand. I observe, for example—another example along with this—as you know, I was the second editor of Head and Neck. When I look at the articles that are published nowadays in Head and Neck, the minority, by far, come from the United States. The majority come from other countries with a large influx from Asian countries, particularly China, Taiwan, some from Japan, and some of the more interesting research is done in departments in these countries. You see more articles coming out of Europe as well. But really interesting and groundbreaking sort of ground-shaking research coming out of the United States departments is less and less and less because they have to fight for their living first. Publications are last. So, as I say, how that can be corrected is hard to tell, but it sure is hurting all over the place. And it’s not getting any better.
Recommended Citation
Goepfert, Helmuth MD and Rosolowski, Tacey A. PhD, "Chapter 08: Financing Clinical Research" (2012). Interview Chapters. 1007.
https://openworks.mdanderson.org/mchv_interviewchapters/1007
Conditions Governing Access
Open
