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(Circulation. 1996;93:1-3.)
© 1996 American Heart Association, Inc.

Articles

Building Shelters

Safeguards in Public Disclosure of Outcomes Data

Denton A. Cooley, MD

From the Department of Cardiovascular Surgery, Texas Heart Institute, Houston.

Correspondence to Denton A. Cooley, MD, Texas Heart Institute, PO Box 20345, Houston, TX 77225-0345.

Key Words: editorials • risk factors • mortality

	Introduction

 
The individuals which are best fitted for the complex, and, in the course of ages, changing conditions to which they are exposed, generally survive. . .

Charles Darwin

Nothing can escape the effects of evolution. Since the earth was formed, evolution has overpowered the strong, outrun the swift, and outwitted the wise. Every creature, from dinosaurs to human beings, has felt its influence. However, while other species have languished and disappeared, ours has flourished and endured. The secret to this success is not luck or circumstance but rather our ability to adapt to an ever-changing environment.

In this time of sweeping change, the medical profession must take the lessons of human evolution to heart. On the surface, the healthcare system in the United States seems to be "the best . . . in the world."¹ With only 5% of the world's population, we have received almost half of the Nobel prizes in medicine.² We also lead the world in medical innovation, training, and technology. However, while our system remains at the forefront in medical innovation, it lags behind the rest of the world in affordability.¹ To continue the tradition of excellence in American medicine, we must adapt to the changing medical climate. Health care must evolve.

Fortunately, we seem to be up to the challenge. Despite the failure of the Clinton plan, physicians have begun to work with insurers on necessary reform measures. This time, however, the movement toward reform is not driven by political rhetoric but rather by economic . . . [Full Text of this Article]

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