My business ethics class recently discussed the case of Cipla Pharmaceuticals, an Indian generic drug manufacturer drawing the ire of big pharma by blithely ignoring international patents or employing workarounds to manufacture low-cost generics in direct violation of the patents. Cipla’s founder, Dr. Yusuf Hamied, stressed that Cipla’s goal wasn’t to steal from the bottom line of the likes of Merck and Eli Lilly, but rather to serve its mission ...

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My father who was a junior doctor in Britain’s National Health Service (NHS) in the seventies would have been grateful for the match scheme, an algorithm that places medical students in residency programs in the U.S. The training in the NHS was unstructured. Physicians carved their own training by joining a patchwork of hospital positions in disparate places. Over a few years we lived in Yorkshire, East Anglia, Wales, East London ...

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Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms. The patient ...

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There is a tremendous amount of handwringing among students, workforce researchers, and medical school deans about the record amount of debt that medical students incur -- more than $175,000, according to the Association of American Medical Colleges. This has unintended consequences, including student selection of more lucrative specialties and placing medical education beyond the reach of low-income and minority students. The average household income for a matriculating medical student is ...

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Earlier this year, I started teaching a course to first year pediatric residents at Stanford. In it, I challenge the trainees to identify the structural contexts in which patients and families make choices that may impact their health and well-being. Termed structural competency, the goal is to enable young physicians to understand and confront stigma and inequality as key determinants of health. We talk about ...

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In his commencement address at Sarah Lawrence College, international affairs journalist and author Fareed Zakaria defended the value of a liberal arts education.  "At its essence," explained Zakaria, "a liberal education is an education to free the mind from dogma, from controls, from constraints.  It is an exercise in freedom."  His speech, I imagine, was well received and much appreciated by the over 400 graduates earning liberal arts degrees that ...

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An intriguing article was recently published in the Proceedings of the National Academy of Sciences -- one of the most prestigious (more on “prestige” later) journals around -- with the provocative title, “Rescuing U.S. Biomedical Research from Its Systemic Flaws.” That this was written by some of our country’s most well-respected scientists provides credibility to this challenging and thought-provoking critique. The piece ...

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As I walked home last night I glanced up at the evening sky of Dominica. Twinkling down at me was what seemed like a surprisingly bright star compared to all the rest. It couldn’t be a plane because planes very rarely fly over this Caribbean island. It seemed to be stationary so it couldn’t be a meteor. Confused, I pulled out the sky map on my iPhone and discovered it was ...

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If you pay close attention to medical education and training, you have surely read something like this as an goal or learning objective: “Manage inflammatory bowel disease and its complications.” However, this is not exactly what our goals should be. One push in the patient-centered care community has been changing the focus from managing the disease to managing the patient who has (or might have) the disease. The difference in wording is subtle, but it gets more ...

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We recently took our last exam as first-year medical students. Sitting in the same library that I used to as a pre-medical student, I thought about what it was, exactly, that changed this year. For me, the point of transition from pre-med to med student really happened over last Thanksgiving break. I had come home from my first term of medical school more ready for my mom’s hugs and homemade banana bread ...

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