We need less medical care, not more. We need more preventive services and more patient education, not more high-technology crisis care. Specifically, we need more primary care physicians.

Most informed citizens are aware that in the U.S., per capita expenditures on health care are the highest in the world. Each American spends an average of $8100 per year, representing a substantial proportion of annual income. The total U.S. health care burden of $2.5 trillion (in 2009) is 17.6% of our gross domestic product.

These numbers need to come down, but costs continue to rise. A long-term solution is available, one that doesn't involve structural changes in how health care services are bought and paid for. [Such structural change is critically important, but vested interests continue to severely dominate the U.S. political landscape.] The specific long-term solution involves focusing on primary care.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

If we were not capable of autonomous thought and merely accepted and acted on what others told us, the future prospects of our communities, nations, and race would be bleak indeed. Fortunately, a few humans are capable of independent thinking, creativity, insight, and innovation. Every "benefit" of modern existence is a direct result of independent thinking in the form of scientific activity. Those of us who live in developed nations would be very hard-pressed to get through a day without readily available electricity and running water. Imagine living without automated transportation. Imagine living without television or cinema. Imagine living without a computer.

The study, investigation, and application of mathematics, physics, chemistry, and biology, and their combined disciplines such as engineering, agriculture, and architecture, have given us the world we inhabit. And yet in the United States close to half the population is being trained daily to believe that science is a bad thing.

For example, the theory of evolution (a classical example of the scientific method) has been under attack for several decades. A Gallup Poll conducted two years ago, around the time of the 200th anniversary of Darwin's birth, revealed that only 39% of Americans "believe in the theory of evolution". Twenty-five percent did not believe in the theory and 36% had no opinion.

Of course, in order to be able to assess the value of a scientific theory, even from a high-level view, one has to have the ability to assemble facts and be able to recognize associations and connections among disparate threads and competing explanations. Sadly, it seems that such abilities, formerly mastered in grade school, are no longer accessible to the majority of our fellow citizens.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

“Are you still collecting stories about DTC testing? I've got one for you!” my grad student L.W. e-mailed a few days ago. Little did I know her family's experience would change my mind about direct-to-consumer genetic testing.

L.W. had taken my online course “Genethics” in 2008 for the master’s program at the Alden March Bioethics Institute of Albany Medical College. For one assignment, students choose a DTC testing company, peruse the website, and indicate 3 tests that they would take and 3 that they wouldn't – and why. 

As a class activity, L.W. didn’t really approach the testing seriously. “It's fun cocktail party info. ‘Why, yes, I'd love another mocha cappuccino at 9 pm. No problem... I'm a fast caffeine metabolizer!’” 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Women's reproductive rights are not an issue that concerns only women. A well-documented causal chain connects a woman's access to contraception and abortion services, the fertility rate, women's educational levels in a developing nation, and that nation's gross domestic product.

What do these matters have to do with women's reproductive rights? The key point is choice. No availability of reliable birth control methods directly equates to no choice. And as has been forcefully demonstrated recently, the availability of choice is deemed critical to the health and well-being of men and women in all socioeconomic groups. Witness the Susan G. Komen Foundation debacle.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

For most of the past 20 years I have had the privilege of talking with and learning from medical students in small group discussions. As medical students leave the classrooms of the first and second year and transition into the third year, they confront a new reality: they are now actually encountering patients directly for the first time and are working with physicians in the daily care of patients. The more encounters they have with patients and their families and with their clinical mentors, the more stories they have to tell, which often lead to vexing questions that shed light on many of the problems of our health care system in the United States. 

One of the common themes throughout each year is the growing disenchantment with primary care, for a variety of reasons. Most of the students are assigned at some point to a clinical mentor who is a practicing internist seeing many patients each day in a primary care setting. Students often present cases of patients with complex medical and psychosocial issues that require interaction with and support from the physician. Not infrequently do we hear accounts of how patient non-compliance is a barrier to a constructive outcome. The idea of seeing patients over time with the same medical problems, while not heeding medical advice, strikes many students as a frustrating aspect of primary care. Also the students talk of these same physicians continuing to work into the evening, doing mountains of administrative work because of multiple insurance forms to complete. 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.