The Institute of Medicine report: too quick to diagnose bias.

The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, claims that medical studies document a systematic causal relationship between race and disparities in health inputs and outcomes among individuals of different races. This article argues that the majority of studies are not powerful enough to establish a causal link, since they do not sufficiently control for differences among patients that happen to correlate with race, and it outlines a powerful audit study that could isolate any effect of race on health care decisions. Even if there are race-based disparities in health inputs, evaluations of welfare and policy prescriptions should be based on health outcomes, since the relationship between care and health is, at least in some cases, weak.

Reforming health insurance: realistic options and hard choices.

The persistently high number of people reporting that they have no health insurance has precipitated a number of new comprehensive proposals to extend coverage to most Americans. Such proposals must find solutions to fundamental problems that have thus far eluded policymakers, including the role of government regulation, how much to spend, and who should pay. The experience of the 1990s suggests that an effective policy would offer more choices of health plans through the private market, limit unnecessary government regulation, and provide appropriate subsidies to individuals.

What do we know about direct-to-consumer advertising of prescription drugs?

Two papers, by Joel Weissman and colleagues and by Robert Dubois, add to our limited knowledge of the effects of direct-to-consumer (DTC) advertising of prescription drugs. Their results reinforce the largely positive findings from consumer surveys, while adding valuable new data and insights. These suggest that DTC ads probably improve patients' health outcomes and do not tend to lead to inappropriate prescribing.

The role of marketing in pharmaceutical research and development.

Pharmaceutical marketing, which is primarily targeted at physicians, has been criticised because it may distort physician prescribing and thus potentially raise costs and/or worsen health. An alternative view, presented in this paper, is that successful marketing of pharmaceuticals can improve consumer welfare by increasing incentives for research and development (R&D) investment and by providing guidance to R&D to make it more consistent with consumer preferences. There are a number of arguments that support this view, despite impediments to pharmaceutical marketing such as the prohibited dissemination of off-label information in the US, difficulties in estimating potential pharmaceutical demand, and the long time lag between demand assessment and the introduction of new drugs.

The increasing necessity for market-based pharmaceutical prices.

In most markets, research and development are driven by expected prices, and those prices are determined mainly by consumer willingness to pay for the potential benefits of new products. In the pharmaceutical market, however, the dominant role of government and tax-induced insurance has tended to create a wedge between expected prices and consumer willingness to pay to cure or prevent disease. This distorts investment decisions, tending to cause underinvestment.

"I will give no deadly drug." Why doctors must not kill.

Is the profession of medicine ethically neutral? If so, whence shall we derive the moral norms or principles to govern its practices? If not, how are the norms of professional conduct related to the rest of what makes medicine a profession?

Implications of population growth on prevalence of diabetes. A look at the future.

The purpose of this study was to present projections of the future population of diabetes patients, to discuss policy implications of these projections, and to suggest ways that these projections might be made more useful to medical professionals. Under the assumption that the incidence of diabetes in four age-groups will remain constant in future years, previous estimates of the incidence of diabetes will be applied to Bureau of the Census population projections to project the number of new cases of diabetes that can be expected in future years in each of these age-groups. The prevalence of diabetes will remain relatively constant at approximately 1 million patients in younger populations (less than 45 yr old) through the middle of the next century.

Future issues in health economics: one view from Washington.

These are comments about how policy issues at the federal level may create a demand for research in several areas of health economics. As background, there is a discussion of the current federal budget situation and the cost-containment pressures this puts on public health programs. The longer-term problem of financing of the Medicare trust fund is also discussed.