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In January 1976, 79 persons in Jamaica were acutely poisoned by the organophosphorus insecticide parathion. Seventeen died. Cases occurred in three episodes at separate locations, but all patients had consumed wheat flour from a single lot consisting of 5264 cotton bags. Parathion in concentrations of less than 1 to 9900 ppm was identified in flour from six bags in this lot; three had splash marks. The flour had been milled in Western Europe from European wheat, carried in trucks to a dockside warehouse, and loaded aboard ship after 2-5 days' storage. In Jamaica, the flour had moved from quayside to outbreak locations along separate routes through two import houses. Site inspections and review of shipping records suggested that the likely point of contamination was the European port, where foodstuffs and insecticides were stored in the same warehouse.
Academic physicians pride themselves on their intelligent use of medical technology, their innovativeness, and their ability to market their excellence to the public. Although this pride is extraordinarily justified in the areas of clinical medicine, biomedical research, and health sciences education, academic physicians have less reason to be proud of their accomplishments in the area of information management. In years past, a lack of attention to coherent information management had few consequences so long as there were foci of excellence in clinical disciplines, libraries, core research laboratories, and selected training programs. But the widespread adoption of network-based communications has changed both the priorities of faculty and the information infrastructure necessary to maintain a competitive advantage. In the arena of health care information technology, many medical centers have chosen indiscriminate consumption over focused leadership. This essay speculates on how technologies based on the World Wide Web (WWW) may affect academic medicine through both the greater penetration of the Internet and a wider use of internal "intranets." The Internet is transforming the landscape of biomedical publishing, biomedical education, and the hospital library. The intranet is becoming a vital means of providing documents to support the administration of academic medicine and, in many circumstances, the delivery of patient-specific information. Although there is great potential for transformation, many academic medical centers have not yet fully demonstrated either the wisdom to advance a great information-technology vision or the will necessary to turn a vision into a coherent plan of action.
The value system of an organization is important, and the chief executive officer has a responsibility to ensure that it takes root. This nine-point program can serve as a useful guide to the CEO who wants his or her organization to be accountable in today's competitive health care environment.
In this paper I look at the financial implications of genetic testing, particularly in the employment and pensions fields. I have generally not covered life insurance, as that is covered in other papers in this Discussion Meeting. However, the issues are similar, although the emphasis is different. Inevitably there is an element of speculation involved; genetic testing is in its infancy and so we cannot predict either what information we will be able to obtain through genetic testing, nor the uses that may be devised for this information.
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"Natural measures of quantity, such as fathoms, cubits, inches, taken from the proportion of the human body, were once in use with every nation," taught Adam Smith in his lecture "Money as the measure of value and medium of exchange," delivered in 1763. "But by a little observation," he continued, "they found that one man's arm was longer or shorter than another's, and that one was not to be compared with the other; and therefore wise men who attended to these things would endeavour to fix upon some more accurate measure, that equal quantities might be of equal values. Their method became absolutely necessary when people came to deal in many commodities, and in great quantities of them." Smith's comments and the rationale underpinning them became increasingly urgent toward the end of the eighteenth century.
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This article highlights the role played by commercial life insurance companies in determining the response to tuberculosis in Britain between 1865 and 1920. Late-Victorian life offices hired two sorts of physicians to help them screen out high-risk proposals: provincial medical examiners, who collected fees for examining candidates; and salaried medical advisors, who developed guidelines for the medical examination and interpreted the examiners' findings for the head office. The latter set of physicians, many of whom worked at specialist consumption hospitals in London, established an orthodoxy among life offices that privileged hereditarian explanations for the cause of tuberculosis. The provincial examiners resisted that orthodoxy, arguing that advances in public health and treatment rendered irrelevant any apparent correlation between family history and tuberculosis. In adjudicating this internal dispute, life offices stood by their salaried advisors, but in the process pushed them away from viewing disease in terms of specific causes and toward viewing disease in terms of statistical correlation. This victory of statistics over etiology preserved, at least for the rest of the twentieth century, the institutional prominence of insurance as a technique for coping with medical uncertainty.
BACKGROUND: Health care is being changed dramatically by the marriage of computers and telecommunications. Implications for hospitals and physicians already have received extensive media attention, but comparatively little has been said about the impact of information technology on dentistry. This article illustrates how the digital transformation will likely affect dentists and their patients. CONCLUSIONS: Based on recent experiences of hospitals and medical practices, dentists can expect to encounter revolutionary changes as a result of the digital transformation. The Internet, the World Wide Web and other developments of the information revolution will redefine patient care, referral relationships, practice management, quality, professional organizations and competition. PRACTICE IMPLICATIONS: To respond proactively to the digital transformation of oral health care, dentists must become familiar with its technologies and concepts. They must learn what new information technology can do for them and their patients and then develop creative applications that promote the profession and their approaches to care.
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