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December 23, 2020

A Medical and Scientific New Year’s Wish List

Author Affiliations
  • 1Editor in Chief, JAMA
JAMA. 2021;325(1):29-30. doi:10.1001/jama.2020.23346

The last 4 years have been difficult for science and medicine. The relentless attack by members of the executive and legislative branches of government on science and federal agencies that conduct science has shaken the fundamental pillars of great US institutions such as the Centers for Disease Control and Prevention, Food and Drug Administration, Environmental Protection Agency, and in some regards the National Institutes of Health (NIH). Although the 2020 NIH budget increased to almost $42 billion, more individuals are uninsured, and although health care costs have not increased substantially over the past 4 years, the financial health of most states is in shambles because of the Great Pandemic of 2020, threatening the commitment to Medicaid, which consumes almost 30% of many state budgets. In addition to Medicaid costs, states are responsible for the health care costs of their employees, and in some states many of their retirees. Moreover, the morbidity, mortality, and ubiquitous nature of COVID-19 have created unprecedented challenges for clinicians, health care systems, and public health, while some political leaders have erroneously minimized the extent, severity, and seriousness of the pandemic.

In addition, physicians and other clinicians remain frustrated at the relentless increase in administrative tasks, highlighted, for example, by the largely nonproductive contribution and lack of added value that current requirements for prior authorization make in health care. Patients are frustrated and concerned because of surprise medical bills and the high cost of drugs. Despite a national investment of more than $100 billion in electronic health records (EHRs) and health information technology in general, many EHRs remain limited, offer little in decision support, and do not allow the ability to “talk” to one another.

An increasingly important question is whether, in a country in which “profit” dominates, it will be possible to have a fair and equitable health care system. Has profit, self-interest, and greed come to dominate the landscape of US medicine? And as the Great Pandemic of 2020 has demonstrated, health care disparities remain a fundamental problem in the US health care system.

Below is a medical and scientific wish list for the coming year. These goals are not meant to be exhaustive, but reflect the clinical, scientific, and political aspects of medicine that have been discussed in the pages of JAMA over the past few years.

  • Respect for science, the individuals who pursue scientific discovery, and the federal agencies that support and conduct scientific research.

  • A comprehensive, coordinated, and effective national response to the COVID-19 pandemic, driven by science and evidence, and based on solid clinical and public health principles, including prevention and widespread vaccination.

  • A true national commitment to health care as a right and not a privilege.

  • A national debate about a single-payer (Medicare for All), universal health plan that includes private insurers, a public option, further expansion of Medicaid, and lowering the age of Medicare to 60 years.

  • A true commitment to interoperability of EHRs that will likely require federal legislation.

  • Reducing administrative costs and eliminating barriers to health care access to ensure that millions of individuals can be insured without increasing overall health care costs.

  • A national campaign to identify and treat every individual with hypertension in the US.

  • Broad agreement on a limited number of high-priority national outcome measures based on the recommendation of the US Preventive Services Task Force and professional societies that would be the focus of every clinician and health care system in the US.

  • A greater appreciation that simply creating more knowledge (and science) does not necessarily improve health outcomes and may exacerbate health care inequities.

  • That the US returns to a time of civility, healthy debate, and respect for the opinions of others.

Why is this list not longer? First, many of these goals encompass many other important issues. Second, a longer list (eg, of 50 goals) would only reduce the likelihood of success. Focus is not an attribute of the US health care system and it might be time for a change. Third, why an emphasis on hypertension (and perhaps a few other quality measures)? A recent report that detailed the decline in the appropriate treatment of patients with hypertension in recent years in the US is a profound indictment of the health care system.1 Hypertension is associated with many health outcomes, including cardiovascular disease, kidney disease, COVID-19, and dementia; the diagnosis and treatment of hypertension reside firmly within medicine; and treatment is relatively inexpensive.2,3 Yet, the US health care system has failed the task of identifying and treating patients with this disorder, with substantial differences between groups, again, highlighting important health care inequities. Fourth, the list reflects the opinion of one individual; others may have included different goals.

It is not clear that any of the above will happen in 2021. For the last 4 years, the Trump administration has offered little in the way of health care reform, except to support legal challenges to the Affordable Care Act. Health care reform is challenging, messy, and controversial. President-elect Biden must commit to a plan that ensures that all individuals in the US have health insurance. What form that coverage takes must involve a responsible, evidence-based national debate that considers, among other factors, economic implications and sustainability.

This list is my hope for 2021 and beyond: a respect for science, scientists, and public health officials, healthy and civil debate, and a fundamental commitment that no individual in the US should be without health insurance.

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Article Information

Corresponding Author: Howard Bauchner, MD, JAMA (Howard.Bauchner@jamanetwork.org).

Published Online: December 23, 2020. doi:10.1001/jama.2020.23346

Conflict of Interest Disclosures: None reported.

Muntner  P, Hardy  ST, Fine  LJ,  et al.  Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018.   JAMA. 2020;324(12):1190-1200. doi:10.1001/jama.2020.14545PubMedGoogle ScholarCrossref
Curfman  G, Bauchner  H, Greenland  P.  Treatment and control of hypertension in 2020: the need for substantial improvement.   JAMA. 2020;324(12):1166-1167. doi:10.1001/jama.2020.13322PubMedGoogle ScholarCrossref
Adams  JM, Wright  JS.  A national commitment to improve the care of patients with hypertension in the US.   JAMA. 2020;324(18):1825–1826. doi:10.1001/jama.2020.20356PubMedGoogle ScholarCrossref
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    4 Comments for this article
    Wishful Thinking
    Wesam Saghir, Bachelors, Masters | None
    A beautiful list, but one not likely to ever materialize. As much as we want to blame government, I believe the biggest obstacle in the way of achieving these wishes is our educational system. Simply put, our educational system, from childhood to adulthood, does not emphasize in any way what's necessary physically and academically, what it means to be healthy.
    Wish List - Add “Primary Care Providers”
    Donald Kollisch, MD | Geisel School of Medicine at Dartmouth
    We know that every person in the US should have a well-trained primary care provider. How can we even hope to address some of Dr. Bauchner’s items - such as adequate treatment of hypertension and broad equitable implementation of agreed-upon preventive strategies - unless every person in the US has a primary care provider looking out for them? It might be useful to think of a primary care provider as a Mom or Dad, someone who looks out for the well-being of their family. We can reserve for another time the discussion of what the “right” credentials should be - MD vs. APRN vs. PA - but we should agree that the distribution of specialties in the US is upside down. Our pyramid is standing on its peak, with only 30-35% of doctors being nominally primary care, and many of them do not provide full-scope services. Instead, we have many organ-system specialists (especially Emergency Medicine clinicians) who are forced to provide all acute, chronic and preventive services because the systems they are in do not have enough primary care providers. Let us please establish a national priority to seriously address this imbalance, and recognize the costs in power, prestige and money that a redress of our specialty-top-heavy system will necessitate.
    From "Wish List" to implementation
    Anatoly Zhirkov, Professor | Saint Petersburg State University
    Undoubtedly the position of the editor of JAMA allows the author to conduct a deep analysis of the state of medical science and practice. Even though the article examines the problems of science and practice through the prism of their importance to American society, many provisions are of international importance. I would like to draw special attention to the problem of arterial hypertension. In the past years, JAMA gave importance to this topic, but not all issues have been solved scientifically at the international level (1,2). I would like to wish JAMA to continue discussing the problem of arterial hypertension in the new year.


    1. McEvoy JW, Daya N, Rahman F, et al. Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline with Incident Cardiovascular Outcomes. JAMA. 2020;323(4):329–338. doi:10.1001/jama.2019.21402

    2. Zhirkov A. Is it possible to reach consensus regarding target systolic blood pressure readings in various evidence-based guidelines? DOI: 10.13140/RG.2.2.33579.18721
    A Wish List for a COVID-19 New Year
    Michael McAleer, PhD (Econometrics), Queen's | Asia University, Taiwan
    A wish list is a combination of needs and aspirations, without which the future can be even more confusing and disturbing than it already is.

    The reassuring and carefully considered editorial wish list that is presented might consider:

    (1) Adding mental healthcare;

    (2) Evaluating long-haul symptoms of patients who have purportedly recovered from COVID-19 infection;

    (3) Diagnosing the short- and long-term effects of the various mutations of COVID-19 that are being discovered globally;

    (4) Evaluating how private and public hospital and health care insurance might be financed;

    (5) Balancing care for COVID-19 patients with existing comorbidities;
    /> (6) Strengthening news and social media contributions from the medical fraternity;

    (7) Greater inclusivity in encouraging non-medical specialists and academics from the social science disciplines to contribute to broad medical and healthcare goals;

    (8) Improving the healthcare protection of those who are most vulnerable during COVID-19, especially front line healthcare workers, the young, the aged, and those with preexisting medical conditions;

    (9) Evaluating the numerous alternative vaccines that are available in terms of their safety, effectiveness, durability, affordability, and availability;

    (10) Strengthening the authority of the leading medical and academic institutions, and emphasizing science as the major source of public policy decision making.