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Biomedical subjects

S O Thier

Publications and source records attributed to S O Thier.

At least 19 recordsLinked to original sources
PubMed1995

The JIM interview. Samuel O. Thier, MD.

Although the public has grown increasingly accustomed to consolidation in the health care industry, the announcement on December 8, 1993, that the Massachusetts General Hospital (MGH) and the Brigham and Women's Hospital would merge merited front page coverage across the nation. These hospitals, long considered the crown jewels of the Harvard Medical School, have a history rich in tradition and a reputation for fierce independence. The merged entity, subsequently named Partners Healthcare System, Inc., has a payroll of 17,500 employees, making it the largest employer in Boston and the third largest in Massachusetts. Shortly after the merger, Boston newspapers reported that the announced plan had circumvented plans for Harvard to merge all five of its major teaching hospitals. The MGH-Brigham merger included no provisions for the other three Harvard-affiliated hospitals, the Massachusetts Deaconess, the Beth Israel, or the Dana Farber Cancer Institute. Speculation that the move was accomplished with little input from Harvard Medical School Dean Daniel Tosteson further accentuated the delicate politics of the merger. To run this powerhouse of health care, teaching, and research, the directors of Partners turned to Dr. Samuel O. Thier. Thier, who had honed his leadership skills as Medicine Chairman at Yale and President of the Institute of Medicine (IOM), has lifelong ties to the MGH. Indeed during his recent tenure as President of Brandeis University, he still made rounds at the hospital. Largely credited with revitalizing the IOM and restoring financial health to Brandeis, Thier must now lead an entity playing in a quickly changing and unpredictable marketplace.(ABSTRACT TRUNCATED AT 250 WORDS)

Boston↗
PubMed1994

Academic medicine's choices in an era of reform.

Academic medicine is once more face-to-face with health care reform, which this time is being seriously debated and will at least be the subject of legislation. There is the possibility that the coming changes could unintentionally injure academic medicine; that is why academic medicine's leaders must be participants and constructive contributors to the discussion rather than simply being critics. The author describes the economic, social, and educational forces that have led to the present reform proposals, indicates the main proposals that are being made to respond to these forces, and states ways that academic medicine can effectively change to meet the coming reforms. For example, curriculum content can change (e.g., revise courses to strengthen the bridge between the basic and clinical sciences); there can be more public health emphasis; the educational structure can change (e.g., continue to modify the sites for clinical education); and academic medicine's philosophy can change (e.g., broadening the acute-care, biologically-based medical approach). The author also discusses risks of the proposed reforms to academic medicine (e.g., stagnant support of basic research; political pressures for the distribution of resources for prevention services research and other reforms; decrease in the support available for hospitals' examination of clinical activities), and emphasizes that academic medicine's traditional inertia is one of the greatest risks in the coming years. In conclusion, the author proposes that the university become the base of the medical school and that the health system become the base of the university hospital; an interactive federated relationship between medical schools and hospitals will allow academic medicine to stay flexible enough to effectively meet the coming changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1992

Preventing the decline of academic medicine.

Academic medicine in North America has been highly successful in many ways in the last 50 years, including being able to resist change while unprecedented and fundamental changes are taking place in the practice, technology, and financing of medicine. This stance places academic medicine at risk of being bypassed by events. To prevent this, what balance between rigidity and flexibility should be sought? The author addresses this question by first reviewing the history of academic medicine and then defining in detail three current problems in medical education and two in biomedical research, two of academic medicine's domains. All these problems have in common some form of harmful dissociation of endeavors: for example, in education, there is a dissociation between both the teaching and academic clinical practice of medicine and the health care needs of the public. The author then proposes solutions to the problems, based on his examination of three major principles that motivate academic medicine. For example, he maintains that the teaching of all the medical sciences should be part of, and equal in quality to, the overall program of sciences in a university, and that the interdependence of medical schools and universities should be nurtured. He also maintains that the narrow conceptual framework of medicine that focuses on mechanisms of disease must be expanded to include rigorous attention to such areas as prevention, technology assessment, and organization of care.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Medicine↗
PubMed1991

Health care reform: who will lead?

The United States is almost alone among industrialized nations in failing to assure access to at least some health care for all of its citizens. Three major obstacles impede the provision of universal access. First is the deeply embedded sense among our citizens and in our health care system that some persons are more deserving than others of care. Second is a focus on costs and reimbursement mechanisms rather than on defining effective and appropriate care. Third and most serious is an absence of leadership in addressing the problems of access and of reform in the U.S. health care system. In choosing among the possible leaders, which include the federal government, the states, the business sector, unions, and physicians, a compelling argument can be made that physicians should lead, particularly in defining effective and appropriate care. Physicians may also lead in redesigning the health care system, but they are likely to be only one interested voice in the debates about financing health care.

Attitude to Health↗
PubMed1986

Anticystinuric effects of glutamine and of dietary sodium restriction.

We studied four patients with cystinuria to assess the effects of glutamine and dietary sodium on the urinary excretion of dibasic amino acids. In Patient 1, at an ad libitum dietary sodium intake of about 300 mmol per day, oral administration of glutamine led to reproducible and marked anticystinuria and antiornithinuria, whereas the excretion of lysine and arginine was not significantly affected. In Patient 2, at an ad libitum dietary sodium intake of about 150 mmol per day, no effect of glutamine could be demonstrated in studies lasting up to three weeks. Since the principal difference between Patients 1 and 2 was their dietary intake of sodium, Patient 3 was studied during dietary sodium intakes of 150 and 300 mmol per day. His cystine excretion was found to be higher at 300 than at 150 mmol per day. Glutamine suppressed his cystine excretion at a sodium intake of 300 mmol per day but had no effect at 150 mmol per day. When the effect of a further reduction in sodium intake alone was studied in a fourth patient, a decrease of 150 to 50 mmol per day was found to reduce cystine excretion markedly within 17 days. The low-sodium diet alone also reduced the excretion of lysine, arginine, and ornithine. We conclude that glutamine may reduce the excretion of dibasic amino acids at a high sodium intake but not at an intake of about 150 mmol per day. However, since a sodium-dependent excretion of the dibasic amino acids occurs at an intake down to about 50 mmol of sodium per day, dietary restriction of sodium can provide a safe approach to the treatment of cystinuria.

Administration, Oral↗