Finding a lasting cure for U.S. health care.

In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.

Biological testing and occupational disease liability.

This paper discusses the economic and legal incentives for using biological monitoring to detect occupational disease. The limitations of workers' compensation statutes and the various theories of liability for occupational disease are described. After a description of the general principles governing liability, the following issues are discussed: the liability that may result when employers fail to biologically monitor their employees; the company physician's personal liability; liability of manufacturers of hazardous substances; and the employer's duty to report known diseases to affected employees.

Cultural characteristics and fatty acid composition of propionibacteria.

The cultural characteristics and cellular fatty acid composition of 40 strains representing 7 species of Propionibacterium and of 9 cultures of anaerobic corynebacteria were studied. The cultures were characterized by means of 23 separate cultural and biochemical tests. Cultures of the two genera differed consistently in only two reactions; the propionibacteria did not produce indole or liquefy gelatin, whereas the anaerobic corynebacteria were consistently positive with these tests. The fatty acids were extracted from whole cells and examined as methyl esters by gas-liquid chromatography. The most abundant acid in the seven Propionibacterium species was a C(15)-saturated branched-chain acid which was present in both the iso-and anteiso-form. Based on a comparison of the relative abundance of these isomers (i-C(15) and a-C(15)), the species were separated into two groups. P. freudenreichii and P. shermanii (group one) were similar and contained the a-C(15) isomer as the predominant acid. The i-C(15) isomer was the most abundant acid in the second group (P. arabinosum, P. jensenii, P. pentosaceum, P. thoenii, and P. zeae). The fatty acid profiles of the anaerobic corynebacteria were somewhat similar to those of the second group of propionibacteria, but were distinct from the profiles of P. freudenreichii and P. shermanii. The addition of branched-chain amino acids (l-leucine and l-isoleucine) to the growth medium increased the synthesis of the specific fatty acid(s) structurally related to the added amino acid.