Fall 2008 Issue

In early October 2007, physicians, biomedical researchers, and alternative medicine practitioners, including chiropractors and Rolfers, who practice deep-tissue manipulation, gathered in Boston to discuss their shared organ of interest – fascia, the soft part of the connective tissue system. Although it was initially approached with skepticism, the conference ended with enthusiasm and in anticipation of another because it was one of the first attempts at dialogue between professionals who are usually never in the same room together. ^1^ Indeed, attendees encountered some “language” barriers, but these became less problematic once physicians and biomedical researchers realized they would be able to learn from alternative medicine practitioners, and vice versa. ^2^ To extend an invitation to alternative practitioners to the fascia conference is telling of the increasing visibility of alternative and complementary medicine (CAM) in healthcare. The National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health (NIH), reported that at least 36% of Americans have used some form of CAM in 2004 in addition to or in place of conventional treatments. ^3^ CAM therapies include meditation, diet-based therapies, and those that require visits to licensed practitioners of fields including acupuncture, chiropractic care, and massage therapy. On the Tufts Medford/Somerville campus, Bodyworks is a sports massage class offered every semester through the Physical Education Department. The course is taught by a licensed clinical massage therapist, Lawrence E. Warnock, who was interviewed by TuftScope to highlight one portion of the emerging dialogue as an active practitioner of CAM. This interview does not provide a comprehensive overview of massage therapy or CAM, but rather is designed to stimulate discussion on the increasing interactions between CAM and contemporary Western medicine within the healthcare system. Professor Warnock raises interesting points about what it would take for CAM to become integrated into conventional medicine, and why there may be an emphasis on healing rather than curing in CAM. *Editors Note:* _Parentheses indicate an addendum to the transcript post-interview from the interviewee._

Psychosocial needs of the Asian and Pacific Islander (API) population in New York City inhibit their access to primary healthcare. This study analyzes the disparities in API healthcare, and makes suggestions for reaching this underserved population. Six qualitative interviews were conducted with staff in the pediatric department of an urban, public hospital that sees underserved API immigrants with low socioeconomic status from the larger New York City area. Interviews examined care provider awareness of and ability to accommodate for API patients’ psychosocial needs and barriers to care. Literature and interviews confirm that basic needs such as food and housing are often prioritized over health needs, determining health behavior and greatly inhibiting access to care. Health professionals do not have information on community resources or time to confront psychosocial issues. Community-based, culturally competent infrastructure providing information to connect patients, caregivers and services should be integrated into healthcare settings to improve overall health of API individuals.

In this new section, TuftScope presents two contrasting commentaries on a controversial issue: pharmaceutical patent laws. Article I, Section 8, Clause 8 of the U.S. Constitution states, “The Congress Shall Have Power... To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries....” The practical result of this stipulation is that creators of drugs have exclusive rights to produce and sell their products for 20 years. This effective monopoly, in theory, serves as an incentive to create new drugs. It also allows drug companies to recuperate the considerable costs associated with developing and testing a new drug or therapy. The problem, however, is that drugs are sold at a higher cost during this 20-year period than they would be as generics. This higher price puts new, life-saving medications out of the reach of many who cannot afford them. The two articles below describe further the two main “Opposing Viewpoints” on this vital issue.

Pay for performance (P4P) programs aim to align providers’ payment incentives with quality of care. It is no surprise that many providers have reservations about the design and goals of P4P programs which may impact their income. Provider opposition to P4P is rooted in three major areas of concern: the impact of P4P programs on their pocketbooks, professionalism, and patients. Policy makers at all levels who want to include P4P programs in their efforts to raise quality and lower costs must anticipate and respond to provider opposition along these lines. This paper will examine three case studies and analyze how P4P initiatives in California, state Medicaid programs and the United Kingdom have been designed to accommodate these concerns. It will conclude with a discussion of whether and how current efforts to introduce P4P to Medicare are applying these lessons.

HIV presents one of the greatest global health problems of the late 20th and early 21st centuries. No cure or vaccine for HIV exists, though antiretroviral drugs (ARVs) can be provided for infected individuals. ARVs inhibit the replication of the virus within infected cells, slowing the deterioration of the immune system and the spread of the virus. The development of new ARVs, however, requires years of research and clinical trials by major pharmaceutical corporations. As a result, the drugs are often priced at unaffordable rates for individuals in developing countries. A complex ethical debate exists over the right of developing countries to provide generic ARVs in order to produce low-cost treatments and the rights of pharmaceutical corporations to hold a patent to cover research and development costs. This paper will focus on the debate about generic ARV produc- tion by local pharmaceutical industries in India and implications and challenges with regards to other developing countries.