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Durham, N.C. -- Duke University Health System administrators are calling for a "radically new" health system that will transform the delivery of medical care.

In an editorial in the April 25, 2003, issue of Science, the Duke administrators propose a prospective health care system -- bolstered by advances in biotechnology -- as being able to predict and prevent chronic disease by focusing on the health risks and needs of individuals. While Duke has already committed to effecting such a change, the team urges their colleagues elsewhere to join them in implementing the new approach.

Not only would such a health care model improve health, but it would also control health expenditures, the Duke team said.

"A successful model must deliver a realistic promise of improved outcomes combined with sustained payment mechanisms, enhanced patient safety and involvement of individuals in their own care, protection of privacy and insurability, and respect for a diversity of political, religious and ethical viewpoints," wrote R. Sanders Williams, M.D., dean of the Duke University School of Medicine. Ralph Snyderman, M.D., chancellor for health affairs and president and CEO of Duke University Health System, and Huntington F. Willard, Ph.D., director of Duke's Institute for Genome Sciences and Policy (IGSP), coauthored the editorial.

Today's U.S. health care system is fraught with inefficiencies, making change necessary, the Duke leaders wrote.

"Justifiable pride in the advance of scientific knowledge and medical technology cannot disguise the fact that, to a large degree, the delivery of health care in the United States is broken and cannot be sustained in the present form," they wrote.

They cite as evidence of the system's failures rapidly increasing health spending and the millions of uninsured Americans.

"The current system of health care delivery is inherently wasteful and driven more by tradition than by scientific principles," they added.

A successful prospective health care system must rely on current science and respond to new scientific findings to develop more powerful methods to identify those individuals at highest risk for the major chronic diseases -- atherosclerosis, heart failure, cancer, diabetes, neurodegenerative and psychiatric disorders, wrote the Duke administrators.

Such a system requires effective countermeasures to delay progression of these conditions at pre-clinical or early clinical stages, before the underlying pathology becomes irreversible and broader application of measures already known to have beneficial effects.

New discoveries about the underlying causes of disease, made possible by the sequencing of the human genome, continue to strengthen physicians' ability to meet these challenges. However, the Duke team emphasizes that the time for change is now.

Duke has already begun to revamp health care. For example, the health system has already launched a "strategic health plan" study aimed at testing the effectiveness of lifestyle improvements to reduce individuals' risk for heart attack, stroke and diabetes. The Duke Center for Integrative Medicine and the Department of Veterans Affairs' Center for Health Services Research in Primary Care have joined to conduct the research.

The IGSP, launched in 2000, represents Duke's comprehensive response to the Genomic Revolution. A major focus of the institute is the development of sophisticated diagnostic techniques to map in fine detail a person's susceptibility to disease, said Willard.

REFERENCES

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