Ezekiel Emanuel On Medicine Today
Ezekiel Emanuel is the Chair of the Department of Bioethics at the Warren G. Magnuson Clinical Center at the National Institutes of Health. Dr. Emanuel is a well-known authority on the ethics of clinical research, end of life care issues, euthanasia and the ethics of managed care.
He has published in the New England Journal of Medicine, The Lancent, JAMA, and many other medical journals. His book The Ends of Human Life: Medical Ethics in a Liberal Polity received an honorable mention for the Rosenhaupt Memorial Book Award by the Woodrow Wilson Foundation. Dr. Emanuel was educated at Amherst College, Oxford University and Harvard University, from which he holds both an MD and PhD in political philosophy. He also served on the ethics section of President Clinton's Health Care Task Force, on the National Bioethics Advisory Committee, and on the bioethics panel of the Pan American Health Organization.
Question: How does the media affect the practice of medicine?
Ezekiel Emanuel: Oh just hugely! I mean what is a problem? How they address problems; how they can sometimes do tremendous job educating people about the complexities of the problem; how sometimes they can do a terrible job because of the shortness . . . that they don’t allow the complexities and the subtleties to get through. In general actually, I think reporters have really been very interested in trying to understand the details. I would say that the second problem with the media is the attention span problem. That’s a general problem in our culture. You gotta say it in 250 words or less; but also once you’ve said it, you know . . . How much coverage do we now have today in July 2007 on pandemic flu? The threat hasn’t gone away. If anything, the threat has gotten worse. And yet, you know, you talk to a reporter, “Well we did that last year.” You know? And that, I think, is a terrible problem. Because some of these problems require a long-term focus on an issue. Healthcare reform is another really big issue, which you’re not gonna solve it in a year. You’re not gonna solve it in the next five years. It’s gonna take a long time to focus on the problem; and yet the media doesn’t have that attention span.
Question: What is the biggest challenge medicine faces?
Ezekiel Emanuel: Well medicine in the United States, I think, faces a real disaster in its delivery system. We know that we’re not delivering care well in that we can’t reliably guarantee Americans will get quality care when they enter the hospital. That in fact it’s almost a 50/50 flip of a coin for people, whether they get the right care or the not right care. That is a disaster. And to change the system to make sure that delivery is better, and that we’re really doing better by people and actually doing it efficiently is a huge challenge at the moment. And I think that, without a doubt, is the biggest challenge facing American medicine. And that’s really gonna, in my view, require comprehensive change of the system. We can’t sort of fix a little here and a little there. I don’t even think getting all Americans ensured is a solution. We actually . . . That’s one small element, but we actually have to control costs. Otherwise in a few years, we’re gonna have uninsured. We also have to improve quality. So that’s a very complicated puzzle. And you just think that American healthcare system costs two trillion dollars – sixteen percent of the GEP – fixing that obviously is a huge, huge challenge. And so I think without a doubt, the medicine, that’s the biggest challenge.
Obviously there are lots of diseases we haven’t solved. Lots of diseases that we don’t even have therapies for. Those are big challenges, but nothing compared to delivering what we know works today efficiently and effectively to all Americans. That is a huge undertaking in management, really.
Recorded on: 7/4/2007 at The Aspen Ideas Festival
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