Campion, E.W., “Why Unconventional Medicine?,” N. Engl. J. Med., 328 (1993): 282–83, at 282.CrossRefGoogle Scholar

Angell, M., Kassirer, J.R., “Alternative Medicine — The Risks of Untested and Unregulated Remedies,” N. Engl. J. Med., 339 (1998): 839–41, at 841.CrossRefGoogle Scholar

Schneiderman, L.J., “Alternative Medicine or Alternatives to Medicine? A Physician's Perspective,” Cambridge Quarterly of Healthcare Ethics, 9 (2000): 83–97, at 91.CrossRefGoogle Scholar

White House Commission on Complementary and Alternative Medicine Policy, Final Report (March 2002): At Executive Summary, available at <http://www.whccamp.hhs.gov/es.html>..>Google Scholar

Wilk v. American Medical Ass'n, 895 F.2d 352 (7th Cir. 1990), cert. denied, 498 U.S. 982 (1990). Other conventional providers are beginning to provide some forms of CAM themselves, under the heading of “integrative medicine.” See Snyderman, R. and Weil, A.T., “Integrative Medicine: Bringing Medicine Back to its Roots,” Archives of Internal Medicine, 61 (2002): 395–97.Google Scholar

Marcus, D.M. and Grollman, A.R., “Botanical Medicines —The Need for New Regulations,” N. Engl. J. Med., 347 (2002): 2073–76; DeSmet, P.A.G.M., “Herbal Remedies,” N. Engl. J. Med., 347 (2002): 2046–56; Eisenberg, D.M. et al., “Credentialing Complementary and Alternative Medical Providers,” Annals of Internal Medicine, 137 (2002): 965–73.CrossRefGoogle Scholar

Hall, J.B., “Use of the Pulmonary Artery Catheter in Critically Ill Patients: Was Invention the Mother of Necessity?,” JAMA, 283 (2000): 2577–78; Rapoport, J. et al., “Patient Characteristics and ICU Organizational Factors that Influence Frequency of Pulmonary Artery Catheterization,” JAMA, 283 (2000): 2559–67; Bernard, G.R. et al., “Pulmonary Artery Catheterization and Clinical Outcomes: NHLBI and FDA Workshop Report,” JAMA, 283 (2000): 2568–72; Sandham, J.D. et al., “A Randomized, Controlled Trial of the Use of Pulmonary-Artery Catheters in High-Risk Surgical Patients,” N. Engl. J. Med., 348 (2003): 5–14; Parsons, RE, “Progress in Research on Pulmonary-Artery Catheters,” N. Engl. J. Med., 348 (2003): 66–68.CrossRefGoogle Scholar

Dalen, J.E., “‘Conventional’ and ‘Unconventional’ Medicine,” Archives of Internal Medicine, 158 (1998): 2179–81, at 2180. In another example, as of 1988, a national conference on antithrombotic therapy (anticlotting treatments used to prevent stroke, pulmonary embolism, and the like) evaluated the scientific foundation for various recommendations on which physicians based treatment. The American College of Chest Physicians found that only 24 percent of those recommendations were based on appropriately scientific studies, while 55 percent were based on uncontrolled clinical observations. Ten years later, 44 percent of the recommendations were science-based, though this was largely because of Food and Drug Administration requirements for the testing of new drugs. Id. at 2179.CrossRefGoogle Scholar

Gellins, A.C., Rosenberg, N., and Moskowitz, A.J., “Capturing the Unexpected Benefits of Medical Research,” N. Engl. J. Med., 339 (1998): 693–97, at 694. See also Feinstein, A.R., “Clinical Judgment Revisited: The Distraction of Quantitative Methods,” Annals of Internal Medicine, 1230 (1994): 799–805.Google Scholar

Lange, R.A. and Hillis, L.D., “Use and Overuse of Angiography and Revascularization for Acute Coronary Syndromes,” N. Engl. J. Med., 338 (1998): 1838–39. “Although the patients enrolled in the United States were more likely than their Canadian counterparts to undergo coronary angiography (68 percent vs. 35 percent, respectively) and subsequent revascularization (31 percent vs. 12 percent), the incidence of reinfarction and death during more than three years of follow-up was similar…. [E]xcessive use is probably related to the more widespread availability of facilities and trained personnel in the U.S.” Id. at 1839. See also Fisher, E.S. and Welch, H.G., “Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse?,” JAMA, 281 (1999): 446–53.CrossRefGoogle Scholar

Felson, D.T. and Buckwalter, J., “Debridement and Lavage for Osteoarthritis of the Knee,” N. Engl. J. Med., 347 (2002): 132–33.Google Scholar

Moseley, J.B. et al., “A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee,” N. Engl. J. Med., 337 (2002): 81–88.CrossRefGoogle Scholar

Id. at 81.Google Scholar

Kolata, G., Petersen, M., “Hormone Replacement Study a Shock to the Medical System,” New York Times, July 10, 2002.Google Scholar

Kolata, G., “In Public Health, Definitive Data Can Be Elusive,” New York Times, April 23, 2002. See also Grady, D., “Scientists Question Hormone Therapies for Menopause Ills,” New York Times, April 18, 2002; Kolata, and Petersen, , supra note 15; Grady, D., “A 60-Year-Old Woman Trying to Discontinue Hormone Replacement Therapy,” JAMA, 287 (2002): 2130–37.Google Scholar

Kolata, , supra note 16 (quoting Dr. Deborah Grady, a professor of medicine and epidemiology at the University of California in San Francisco).Google Scholar

See ECRI (formerly the Emergency Care Research Institute), High-Dose Chemotherapy with Bone Marrow Transplant for Metastatic Breast Cancer (1996): At Brief Summary, available at <http://www.ecri.org/documents/bctoc1.html#Summary>. See also High-Dose Chemotherapy with Peripheral Stem Cell/Autologous Rescue, Treatment for Breast Cancer, in 2 Hayes Directory of New Medical Technologies’ Status (updated May 1997), available through <http://www.westlaw.com>, Hayes-Med Database..+See+also+High-Dose+Chemotherapy+with+Peripheral+Stem+Cell/Autologous+Rescue,+Treatment+for+Breast+Cancer,+in+2+Hayes+Directory+of+New+Medical+Technologies’+Status+(updated+May+1997),+available+through+,+Hayes-Med+Database.>Google Scholar

Mello, M.M. and Brennan, T.A., “The Controversy over High-Dose Chemotherapy with Autologous Bone Marrow Transplant for Breast Cancer,” Health Affairs, 20, no. 5 (2001): 101–18, at 110.CrossRefGoogle Scholar

Peters, W.P. and Rogers, M.C., “Variation in Approval by Insurance Companies of Coverage for Autologous Bone Marrow Transplantation for Breast Cancer,” N. Engl. J. Med., 330 (1994): 473–77.CrossRefGoogle Scholar

“In 1998, Congress enacted the ‘Women's Health and Cancer Rights Act of 1998,’ amending ERISA. The Act requires all group health plans and health insurance issuers offering coverage for mastectomies to provide reimbursement for reconstructive surgery that is associated with a mastectomy” (citing 29 U.S.C. § 1185(b) (Supp. 1999)). Hoffman, S., “A Proposal for Federal Legislation to Address Health Insurance Coverage for Experimental and Investigational Treatments,” Oregon Law Review, 78, no. 1 (1999): 203–74, at 252. See also Theodos, T.F., “The Patients' Bill of Rights: Women's Rights under Managed Care and ERISA Preemption,” American Journal of Law & Medicine, 26 (2000): 89–108.Google Scholar

The manufacturer of a costly new drug for arthritis is hardly likely, for instance, to do a scientific comparison between its products and copper bracelets. Even a remote possibility of finding such an inexpensive remedy to be effective is enough to discourage such a study from being undertaken. And because copper is so inexpensive, the bracelet manufactures can't make enough profit to justify the expense of the research — particularly since they are not required to do any science as long as they make no health claims. Indeed, science is not merely unlikely in such scenarios. History has shown that sometimes even when high-quality scientific trials have been done, their results may not see the light of day if they are unfavorable to the study's sponsor. See Rennie, D., “Thyroid Storm,” JAMA, 277 (1997): 1238–43.CrossRefGoogle Scholar

Gavras, I., Manolis, A.J., and Gavras, H., “The Economics of Therapeutic Advances: The Paradigm of Sympathetic Suppression in Chronic Heart Failure,” Archives of Internal Medicine, 159 (1999): 2634–36, at 2635. Others have likewise observed that inexpensive, effective therapies tend to be ignored. See Goodwin, J.S. and Goodwin, J.M., “The Tomato Effect: Rejection of Highly Efficacious Therapies,” JAMA, 251 (1984): 2387–90; Goodwin, J.S. and Goodwin, J.M., “Failure to Recognize Efficacious Therapy: The History of Aspirin Treatment for Rheumatoid Arthritis,” Perspectives in Biology and Medicine, 25 (1981): 78–92; Lederle, F.A., Applegate, W.A., and Grimm, R.H. Jr., “Reserpine and the Medical Marketplace,” Archives of Internal Medicine, 153 (1993): 705–06.Google Scholar

Sepsis is a devastating blood infection in which the body's normal inflammatory response to infection goes out of control, threatening major organ systems.Google Scholar

Interestingly, although the drug is the first and only drug approved for the treatment of severe sepsis, several commentators have indicated that they “believe that there is not sufficient evidence at present for it to become the standard of care,” because the performance of the drug was not consistent throughout the trial, leading to a mid-trial change in the protocol. Warren, H. S. et al., “Risks and Benefits of Activated Protein C Treatment for Severe Sepsis,” N. Engl. J. Med., 347 (2002): 1027–30, at 1030. See also Mannis, B.J. et al., “An Economic Evaluation of Activated Protein C Treatment for Severe Sepsis,” N. Engl. J. Med., 347 (2002): 993–1000; Siegel, J.P., “Assessing the Use of Activated Protein C in the Treatment of Severe Sepsis,” N. Engl. J. Med., 347 (2002): 1030–34.CrossRefGoogle Scholar

Burton, T.M., “Why Cheap Drugs that Appear to Halt Fatal Sepsis Go Unused,” Wall Street Journal, May 17, 2002, at A1, A7, at A7.Google Scholar

For a considerably more detailed discussion of these points, see Morreim, E.H., Holding Health Care Accountable: Law and the New Medical Marketplace (New York: Oxford University Press, 2001): At Chapter 5.Google Scholar

Committee on Quality of Health Care in American, Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century (Washington, D.C.: National Academy Press, 2001): At Executive Summary, at 14.Google Scholar

Kolata, G., “Research Suggests More Health Care May Not Be Better,” New York Times, July 21, 2002.Google Scholar

Wennberg, J.E., Fisher, E.S., and Skinner, J.S., “Geography and the Debate Over Medicare Reform,” Health Affairs, at <http://www.healthaffairs.org/WebExclusives/Wennberg_Web_Excl_021302.htm> (posted February 13, 2002).+(posted+February+13,+2002).>Google Scholar

For a broad survey with numerous references, see Morreim, , supra note 29.Google Scholar

Avorn, J. and Solomon, D.H., “Cultural and Economic Factors That (Mis)shape Antibiotic Use: The Nonpharmacologic Basis of Therapeutics,” Annals of Internal Medicine, 133 (2000): 128–35; Gold, H.S. and Moellering, R.C., “Antimicrobial-Drug Resistance,” N. Engl. J. Med., 335 (1996): 1445–53, at 1445–46; Gonzales, R. et al., “Decreasing Antibiotic Use in Ambulatory Practice,” JAMA, 281 (1999): 1512–19; Joshi, N. and Milfred, D., “The Use and Misuse of New Antibiotics,” Archives of Internal Medicine, 155 (1995): 569–77; McKay, D.N., “Treatment of Acute Bronchitis in Adults Without Underlying Lung Disease,” Journal of General Internal Medicine, 11 (1996): 557–62; Hueston, W.J., “Antibiotics: Neither Cost Effective nor ‘Cough’ Effective,” Journal of Family Practice, 44 (1997): 261–65; Fraser, G.L. et al., “Antibiotic Optimization: An Evaluation of Patient Safety and Economic Outcomes,” Archives of Internal Medicine, 157 (1997): 1689–94; Nyquist, A. et al., “Antibiotic Prescribing for Children with Colds, Upper Respiratory Tract Infections, and Bronchitis,” JAMA, 279 (1998): 875–77; Schwartz, B., Mainous, A.G., and Marcy, S.M., “Why Do Physicians Prescribe Antibiotics for Children with Upper Respiratory Tract Infections?,” JAMA, 279 (1998): 881–82; Chassin, and Galvin, , supra note 34; Gonzales, R., Steiner, J.F., and Sande, M.A., “Antibiotic Prescribing for Adults with Colds, Upper Respiratory Tract Infections, and Bronchitis by Ambulatory Care Physicians,” JAMA, 278 (1997): 901–04; Culpepper, L. and Sisk, J., “The Development of Practice Guidelines: A Case Study of Otitis Media with Effusion,” in Boyle, PH, ed., Getting Doctors to Listen: Ethics and Outcomes Data in Context (Washington, D.C.: Georgetown University Press, 1998): At 77–85; Dowell, S.F. et al., “Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections,” Pediatrics, 101, suppl. (1998): 163–65; Dowell, S.F. et al., “Otitis Media — Principles of Judicious Use of Antimicrobial Agents,” Pediatrics, 101, suppl. (1998): 165–71; Fix, A.D., Strickland, G.T., and Grant, J., “Tick Bites and Lyme Disease in an Endemic Setting,” JAMA, 279 (1998): 206–10.CrossRefGoogle Scholar

Ewigman, B.G. et al., “Radius Study Group. Effect of Prenatal Ultrasound Screening on Perinatal Outcome,” N. Engl. J. Med., 329 (1993): 821–27; Berkowitz, R.L., “Should Every Pregnant Woman Undergo Ultrasonography?,” N. Engl. J. Med., 329 (1993): 874–75.CrossRefGoogle Scholar

Krumholz, H.M. et al., “Thrombolytic Therapy for Eligible Elderly Patients with Acute Myocardial Infarction,” JAMA, 277 (1997): 1683–88; Pashos, C.L. et al., “Trends in the Use of Drug Therapies in Patients with Acute Myocardial Infarction: 1988 to 1992” Journal of the American College of Cardiology, 23 (1994): 1023–30; Frances, D.C. et al., “Outcome Following Acute Myocardial Infarction,” Archives of Internal Medicine, 159 (1999): 1429–36.CrossRefGoogle Scholar

Legorreta, A.R. et al., “Compliance with National Asthma Management Guidelines and Specialty Care,” Archives of Internal Medicine, 158 (1998): 457–64; Harten, T.V. et al., “Inadequate Outpatient Medical Therapy for Patient with Asthma Admitted to Two Urban Hospitals,” American Journal of Medicine, 100 (1996): 386–94; Havranek, D.P. et al., “Process and Outcome of Output Management of Heart Failure: A Comparison of Cardiologists and Primary Care Providers,” American Journal of Managed Care, 2, suppl. (1996): S6–S12, at S10. See also Donohoe, , supra note 39, at 1599.CrossRefGoogle Scholar

Weiner, J.P. et al., “Variation in Office-Based Quality: A Claims-Based Profile of Care Provided to Medicare Patients with Diabetes,” JAMA, 273 (1995): 1503–08; Leape, L.L., “Translating Medical Science into Medical Practice: Do We Need a National Medical Standards Board?,” JAMA, 273 (1995): 1534–37; Harris, H.M., “Disease Management: New Wine in New Bottles?,” Annals of Internal Medicine, 124 (1996): 838–42; Newcomer, supra note 39; Epstein, R.S. and Sherwood, L.M., “From Outcomes Research to Disease Management: A Guide for the Perplexed,” Annals of Internal Medicine, 124 (1996): 832–37; Donohoe, , supra note 39, at 1600; Burton, , supra note 39.CrossRefGoogle Scholar

Donohoe, , supra note 39.Google Scholar

At the beginning of the study, “handwashing compliance before and after defined events was 9% and 22% for health care workers in the medical ICU and 3% and 13% for health care workers in the cardiac surgery ICU, respectively. After the education/feedback intervention program, handwashing compliance changed little….” Of note, after an alcohol-based waterless handwashing antiseptic was made easily available by each bed, handwashing compliance improved to 48 percent. Still, that is less than half the desirable level. Bischoff, W.E. et al, “Handwashing Compliance by Health Care Workers: The Impact of Introducing an Accessible, Alcohol-Based Hand Antiseptic,” Archives of Internal Medicine, 160 (2000): 1017–21, at 1017.CrossRefGoogle Scholar

Newcomer, L.N., “Medicare Pharmacy Coverage: Ensuring Safety Before Funding,” Health Affairs, 19, no. 2 (2000): 59–62, at 60 (citations omitted).CrossRefGoogle Scholar

McGlynn, E.A. and Brook, R.H., “Keeping Quality on the Policy Agenda,” Health Affairs, 20, no. 3 (2001): 82–90, at 83.Google Scholar

“[A]ll residents we tested had great difficulty in identifying 12 commonly encountered and important events. Residents were incorrect 4 of 5 times, improved little with year of training, and were not more accurate than a group of medical students. Indeed, trainees in both residencies were less accurate than students [for certain kinds of heart sounds]…. [W]e found minimal gains, if any, as a result of residency training. Deficiencies of this type will probably persist even after residents enter practice. Indeed, increasing evidence in the literature seems to suggest that errors in physical diagnosis are commonly encountered among generalists. These errors may even lead to greater utilization of resources and a higher cost of care.” Mangione, S. and Nieman, L. Z., “Cardiac Auscultatory Skills of Internal Medicine and Family Practice Trainees: A Comparison of Diagnostic Proficiency,” JAMA, 278 (1997): 717–22, at 721.CrossRefGoogle Scholar

The chief brand names are Celebrex and Vioxx.Google Scholar

Juni, P., Rutjes, A.W.S., and Dieppe, P.A., “Are Selective COX 2 Inhibitors Superior to Traditional Non-Steroidal Anti-Inflammatory Drugs?,” BMJ, 324 (2002): 1287–88; Francis, K.L. et al., “Celecoxib versus Diclofenac and Omeprazole in Reducing the Risk of Recurrent Ulcer Bleeding in Patients with Arthritis,” N. Engl. J. Med., 347 (2002): 2104–10; Graham, D.Y., “NSAIDs, Helicobacter pylori, and Pandora's Box,” N. Engl. J. Med., 347 (2002): 2162–64.CrossRefGoogle Scholar

Avorn, J., Chen, M., and Hartley, R., “Scientific versus Commercial Sources of Influence on the Prescribing Behavior of Physicians,” American Journal of Medicine, 73 (1982): 4–8; Schwartz, R.K., Soumerai, S.B., and Avorn, J., “Physician Motivations for Nonscientific Drug Prescribing,” Social Science and Medicine, 28, no. 6 (1989): 577–82.Google Scholar

Orlowski, J.P. and Wateska, L., “The Effect of Pharmaceutical Firm Enticements on Physician Prescribing Patterns,” Chest, 102, no. 1 (1992): 270–73.CrossRefGoogle Scholar

Feinstein, A.R., “System, Supervision, Standards, and the ‘Epidemic’ of Negligent Medical Errors,” Archives of Internal Medicine, 157 (1997): 1285–89, at 1286. Feinstein goes on to note: “The combination of shortened durations of time for both the patient in [the] hospital and the house officer on a service has reduced the house officer's sense of continuity of care within the hospital… and has increased the difficulties of maintaining rigorous patterns of supervision and discussion.” Id. at 1287.Google Scholar

Lantos, J.D. and Frader, J., “Extracorporeal Membrane Oxygenation and the Ethics of Clinical Research in Pediatrics,” N. Engl. J. Med., 323 (1990): 409–13.CrossRefGoogle Scholar

DeBusk, et al., supra note 56, at 2740.Google Scholar

Jong, P. et al., “Prognosis and Determinants of Survival in Patients Newly Hospitalized for Heart Failure,” Archives of Internal Medicine, 162 (2002): 1689–94, at 1692. Mainly these research subjects were white male populations with a mean age of about 60 and few comorbidities.CrossRefGoogle Scholar

Id. at 1692.Google Scholar

Leape, , supra note 41; Woolf, S.H., “Practice Guidelines: A New Reality in Medicine. III. Impact on Patient Care,” Archives of Internal Medicine, 153 (1993): 2646–55, at 2646; Power, E.J., “Identifying Health Technologies That Work,” JAMA, 274 (1995): 205; Feinstein, , supra note 10.Google Scholar

Friedman, et al., supra note 55, at 1729.Google Scholar

Delbanco, T.L., “Bitter Herbs: Mainstream, Magic, and Menace,” Annals of Internal Medicine, 121 (1994): 803–04; Gordon, D.W. et al., “Chaparral Ingestion: The Broadening Spectrum of Liver Injury Caused by Herbal Medications,” JAMA, 273 (1995): 489–90; Koff, R.S., “Herbal Hepatotoxicity: Revisiting a Dangerous Alternative,” JAMA, 273 (1995): 502.CrossRefGoogle Scholar

Meeker, W.C. and Haldeman, S., “Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine,” Annals of Internal Medicine, 136 (2002): 216–27, at 222. But see Smith, W.S. et al., “Spinal Manipulative Therapy Is an Independent Risk Factor for Vertebral Artery Dissection,” Neurology, 60 (2003): 1424–28.CrossRefGoogle Scholar

Kohn, L., Corrigan, J., and Donaldson, M., eds., Committee on Quality of Health Care in America, Institute of Medicine, To Err Is Human: Building a Safer Health System (Washington, D.C.: National Academy Press, 1999): At 1, 26.Google Scholar

Quality Interagency Coordination Task Force, Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact, Report to the President (February 2000): At 29 (citing Kohn, L., Corrigan, J., and Donaldson, M., eds., supra note 64). See also Leape, L.L., “Foreword: Preventing Medical Accidents: Is ‘Systems Analysis’ the Answer?,” American Journal of Law & Medicine, 27, nos. 2 and 3 (2001): 145–48; Krizek, T.J., “Surgical Error: Ethical Issues of Adverse Events,” Archives of Surgery, 135 (2000): 1359–66.Google Scholar

Lazarou, J., Pomeranz, B.H., and Corey, P.N., “Incidence of Adverse Drug Reactions in Hospitalized Patients. A Meta-Analysis of Prospective Studies,” JAMA, 279 (1998): 1200–05, at 1203.Google Scholar

Landro, L., “The Informed Patient: Deadly Errors Dog Procedures at Doctors' Offices and Clinics,” Wall Street Journal, August 29, 2002.Google Scholar

“[P]atients have wasted their time, money, and efforts receiving treatments that were not what they were represented to be or were harmful.” Schneiderman, supra note 3, at 91.Google Scholar

Eisenberg, D.M. et al., “Unconventional Medicine in the United States,” N. Engl. J. Med., 328 (1993): 246–52, at 250.CrossRefGoogle Scholar

Id. at 248–49.Google Scholar

Modalities showing the greatest increase in use were herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. Eisenberg, D.M. et al., “Trends in Alternative Medicine Use in the United States, 1990–1997,” JAMA, 280 (1998): 1569–75.CrossRefGoogle Scholar

Moseley, et al., supra note 13, at 81.Google Scholar

Id. at 87. See also Felson, and Buckwalter, , supra note 12; Horng, S. and Miller, F.G., “Is Placebo Surgery Unethical?,” N. Engl. J. Med., 347 (2002): 137–39.Google Scholar

McGlynn, and Brook, , supra note 45, at 83.Google Scholar

Mello, and Brennan, , supra note 19, at 110. “Although the cost has decreased somewhat in the past several years, it remains in the neighborhood of $80,000.” Id. See also Kolata, and Eichenwald, , supra note 22.Google Scholar

Peters, and Rogers, , supra note 20. See also Ferguson, J.H., Dubinsky, M., and Kirsch, P.J., “Court-Ordered Reimbursement for Unproven Medical Technology: Circumventing Technology Assessment,” JAMA, 269 (1993): 2116–21.Google Scholar

Hoffman, , supra note 21.Google Scholar

Another example is cerebral revascularization featuring superficial anastomosis of temporal to middle cerebral artery. See Cohen, P.J., “The Placebo Is Not Dead: Three Historical Vignettes,” IRB, 20, nos. 2–3 (1998): 6–8.Google Scholar

Tausk, F.A., “Alternative Medicine: Is It All in Your Mind?,” Archives of Dermatology, 134 (1998): 1422–25, at 1423 (citing Roberts, A. H. et al., “The Power of Nonspecific Effects in Healing: Implications for Psychosocial and Biological Treatments,” Clinical Psychology Review, 13 (1993): 375–91).Google Scholar

Wennberg, J.E., ed., The Dartmouth Atlas of Health Care in the United States (Chicago: American Hospital Publishing, 1996); Wennberg, J.E., “Understanding Geographic Variations in Health Care Delivery,” N. Engl. J. Med., 340 (1999): 52–53.Google Scholar

Wennberg, J.E., “Which Rate Is Right?,” N. Engl. J. Med., 314 (1986): 310–11, at 310.CrossRefGoogle Scholar

Wennberg, , Fisher, , and Skinner, , supra note 33.Google Scholar

Morreim, E.H., “Defined Contribution: From Managed Care to Patient-Managed Care,” Cato Journal, 22, no. 1 (2002): 103–20.Google Scholar

Portions of this discussion rely on an earlier publication. See id.Google Scholar

Gabel, J. et al., “Job-Based Health Benefits in 2002: Some Important Trends,” Health Affairs, 21, no. 5 (2002): 143–51.CrossRefGoogle Scholar

Winslow, R. and McGinley, L., “Back on the Front Burner,” Wall Street Journal, February 21, 2001, at R3; Parrish, M., “A New Day Dawns… When Patients Buy Their Own Health Care,” Medical Economics, 78, no. 5 (2001): 95–111; Blumenthal, D., “Controlling Health Care Expenditures,” N. Engl. J. Med., 344 (2001): 766–69; Jacobi, J.V. and Huberfeld, N., “Quality Control, Enterprise Liability, and Disintermediation in Managed Care,” Journal of Law, Medicine & Ethics, 29, nos. 3 and 4 (2001): 305–22, at 309–12; Galvin, R. and Milstein, A., “Large Employers' New Strategies in Health Care,” N. Engl. J. Med., 347 (2002): 939–42.Google Scholar

See Wye River Group on Healthcare et al., An Employer's Guide to Consumer-Directed Healthcare Benefits (2001), available at <http://www.ncpa.org/extra/health/wye_full.pdf>. See also Martin, K.E., Shifting Responsibilities: Models of Defined Contribution (Washington, D.C.: Academy for Health Services Research and Health Policy, 2002), available at <http://hcfo.net/pdf/definedcontribution.pdf>; Robinson, J., “The End of Managed Care,” JAMA, 285 (2001): 2622–28; Freudenheim, M., “H.M.O. Costs Spur Employers to Shift Plans,” New York Times, September 6, 2000; Parrish, , supra note 86; Winslow, R. and Gentry, C., “Health-Benefits Trend: Give Workers Money, Let Them Buy a Plan,” Wall Street Journal, February 8, 2000, at A1, A12; Shaw, G., “The Defined Contribution Solution,” Managed Healthcare News, February 2001, at 1.Google Scholar

See, e.g., HealthMarket, at <www.healthmarket.com>; Lumenos, , at <www.lumenos.com>; Vivius, , at <www.vivius.com>; Definity Health, at <www.definityhealth.com>; myhealthbank, at <www.myhealthbank.com>; HealthAllies, at <www.healthallies.com>.;+Lumenos,+,+at+;+Vivius,+,+at+;+Definity+Health,+at+;+myhealthbank,+at+;+HealthAllies,+at+.>Google Scholar

Health reimbursement arrangements (HRAs) can be rolled over from one year to the next. This guidance was released on July 15, 2002, and applies to Section 105 and 106 of the Internal Revenue Code. See Rev. Rul. 2002–41, 2002–28 I.R.B., available at <http://www.unclefed.com/Tax-Bulls/2002/rr02-41.pdf> (“Holding: Employer-provided coverage and medical care expense reimbursements made under the reimbursement arrangement that allows unused amounts to be carried forward … are excludable from gross income under §§ 106 and 105….”).+(“Holding:+Employer-provided+coverage+and+medical+care+expense+reimbursements+made+under+the+reimbursement+arrangement+that+allows+unused+amounts+to+be+carried+forward+…+are+excludable+from+gross+income+under+§§+106+and+105….”).>Google Scholar

Editorial, “Consumer-First Health Care,” Wall Street Journal, July 21, 1994, at A12.CrossRefGoogle Scholar

Berk, M.L. and Monheit, A.C., “The Concentration of Health Care Expenditures, Revisited,” Health Affairs, 20, no. 2 (2001): 9–18, at 12.CrossRefGoogle Scholar

For further discussion, see Morreim, , supra note 83.Google Scholar

Gabel, et al., supra note 85.Google Scholar

Eisenberg, et al., supra note 69.Google Scholar