Putting the Pieces Together

  • Robert M. Kaplan

This book has addressed a variety of important medical and healthcare topics. On the surface, the topics may not have been obviously connected to one another. This final chapter suggests how the pieces of the puzzle fit together.

Costs are Out of Control

Healthcare is the largest sector in the economies of most developed countries [1]. We have been unable to control healthcare costs. US healthcare costs grew from 4 percent of the gross domestic product in the 1960 s to nearly 15 percent today [2]. In addition, the increase in healthcare costs contributes to increases in prices for products manufactured by companies that provide health benefits for their employees. General Motors, for example, until recently the world’s largest automobile producer, is currently on the verge of bankruptcy in large part because it has been unable to control expenses. And one of the largest expenses it has failed to control is its health-insurance cost for employees and retirees. Many American industries...


Guideline Development Political Action Committee Guideline Process Commercial Speech Medical Care Establishment 
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  1. 1.
    Anderson GF, Hussey PS, Frogner BK, Waters HR. Health spending in the United States and the rest of the industrialized world. Health Aff (Millwood). 2005;245:903–914.CrossRefGoogle Scholar
  2. 2.
    Smith C, Cowan C, Heffler S, Catlin A. National health spending in 2004: recent slowdown led by prescription drug spending. Health Aff (Millwood). 2006;255:186–196.CrossRefGoogle Scholar
  3. 3.
    Emanuel EJ, Fuchs VR. Who really pays for health care? The myth of “shared responsibility”. JAMA. 2008;2995:1057–1059.CrossRefGoogle Scholar
  4. 4.
    Golomb B, Evans M. Risk factors for rhabdomyolysis with simvastatin and atorvastatin. Drug Saf. 2006;295:1191; author reply – 2.CrossRefGoogle Scholar
  5. 5.
    Lepkifker E, Sverdlik A, Iancu I, Ziv R, Segev S, Kotler M. Renal insufficiency in long-term lithium treatment. J Clin Psychiatry. 2004;655:850–856.CrossRefGoogle Scholar
  6. 6.
    Shah NS, Wright A, Bai GH, et al. Worldwide emergence of extensively drug-resistant tuberculosis. Emerg Infect Dis. 2007;135:380–387.CrossRefGoogle Scholar
  7. 7.
    Zhang J, Ding EL, Song Y. Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events: meta-analysis of randomized trials. JAMA. 2006;2965:1619–32.CrossRefGoogle Scholar
  8. 8.
    Bhatnagar V, Stewart ST, Huynh V, Jorgensen G, Kaplan RM. Estimating the risk of long-term erectile, urinary and bowel symptoms resulting from prostate cancer treatment. Prostate Cancer Prostatic Dis. 2006;95:136–146.CrossRefGoogle Scholar
  9. 9.
    Gellad ZF, Lyles KW. Direct-to-consumer advertising of pharmaceuticals. Am J Med. 2007;1205:475–480.CrossRefGoogle Scholar
  10. 10.
    Frosch DL, Krueger PM, Hornik RC, Cronholm PF, Barg FK. Creating demand for prescription drugs: a content analysis of television direct-to-consumer advertising. Ann Fam Med. 2007;55:6–13.CrossRefGoogle Scholar
  11. 11.
    Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. Am Med Assoc. 2002;2875:612–617.CrossRefGoogle Scholar
  12. 12.
    Hasenfeld R, Shekelle PG. Is the methodological quality of guidelines declining in the US? Comparison of the quality of US Agency for Health Care Policy and Research (AHCPR) guidelines with those published subsequently. Qual Saf Health Care. 2003;125:428–434.CrossRefGoogle Scholar
  13. 13.
    Steinbrook R. Guidance for guidelines. N Engl J Med. 2007;3565:331–333.CrossRefGoogle Scholar
  14. 14.
    Finkelstein JB. Proposed FDA conflict-of-interest guidelines get lukewarm reception. J Natl Cancer Inst. 2007;995:747–788.Google Scholar
  15. 15.
    Steinbrook R. Guidance for guidelines. N Engl J Med. 2007;3565:331–333.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Robert M. Kaplan
    • 1
  1. 1.UCLA School of Public HealthLos AngelesUSA

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