Science, health, and truth.

The past 2 years have been a strange and difficult time for the world. The COVID-19 pandemic has brought illness, hospitalization, and death near to many people. In the United States, people are divided not only on what they should do but also on what constitutes the facts. Many are seemingly in an alternative world, driven by disinformation, conspiracy theories, and anti-science beliefs. How can health and medical leaders do their jobs while trying to cope with a polarized public? They must be more effective in explaining and persuading the public on matters of science and health. This will require better clarification of two things to the public-the roles of science and politics in public policy decisions, and the means by which scientific truth is established and updated.

Research for North Carolina: The University Cancer Research Fund.

In 2008 an estimated 40,000 North Carolinians will be diagnosed with cancer. This disease is the number one cause of death in our state and will claim more than 17,000 lives this year. North Carolina is swimming against a demographic tide of growth and aging that will bring 80,000 new cancer cases by 2050, despite continued improvements in cancer prevention, early detection, and treatment. By establishing the University Cancer Research Fund, North Carolina has taken a bold, nation-leading step forward toward improving the future health and well-being of its citizens. Research that creates new knowledge, turns that knowledge into advances in treatment, screening, and prevention, and then ensures delivery of those advances across the state-that research is the key that unlocks the doors to a new and better future. The Fund will make that research possible. As has often been the case, North Carolina was ahead of the national curve by creating the UCRF in July 2007. In November 2007, Texas passed a $3 billion bond referendum to provide $300 million annually to support cancer research over the next decade. In 2005, California passed a $3 billion bond referendum to support stem cell research. Perhaps noting the downturn in federal funding for biomedical research, other states are watching these states' investments to see if they improve their citizens' health and make researchers nationally competitive. We will rigorously evaluate the UCRF to show the nation that North Carolina has taken a bold and wise step. The North Carolina General Assembly and the people of North Carolina have presented the University of North Carolina at Chapel Hill, the UNC Lineberger Comprehensive Cancer Center, the North Carolina Cancer Hospital, and UNC Health Care with an astounding opportunity and responsibility. We embrace that opportunity and that responsibility and pledge ourselves to our shared vision of a better future for the citizens of North Carolina.

Improving health care: national policy and local practice.

Attention to quality and patient safety in health care has grown substantially over recent years. From 1982, I have been involved in advocating for efforts to improve quality and safety. Four years ago, I was given the opportunity to lead an academic health system - hospitals, doctors, and a medical school. This article recounts the shift in perspective, from a focus solely on national policy, to one now of changing local practice. Both are important and needed. The past 25 years have seen a large scale shift in the way the public at large and especially the medical community view the state of quality and safety in health care. I have been privileged to participate in this transformation at the national level in several roles, and I would like to describe that evolution. Now, however, I have the job of leading an academic medical enterprise, and am challenged by the task of putting lofty national ideas into practice at the local level. I am very committed to this effort, but am sobered by the challenges we face.

Here we go again--lessons on health reform.

The 2008 election will focus renewed attention on fundamental health care reform. Lessons from past politically driven reform efforts show that although fundamental reforms may make for good politics, a systemic shift in how health care is financed and delivered is unlikely to occur. Calls for fundamental reform over the past twenty-five years have prompted incremental changes that have had a major impact on the U.S. health care system. Many of these changes were driven from outside the political system. The forecast based on past experience is not radical change; it is more of the same.

Health promotion in later life: it's never too late.

The clinical and epidemiological rationale for the health improvement benefits of health promotion in the later years of life are provided in this article. The authors review the emerging scientific consensus concerning the utility of lifestyle interventions for health improvement in the context of a narrowed definition of health promotion. Governmental initiatives for testing health promotion among Medicare beneficiaries are also discussed. Major research findings are reviewed and implications for health promotion practioners are also provided.

Significance of Medicare and Medicaid programs for the practice of medicine.

The 1965 legislation that established Medicare and Medicaid declared that the Federal Government would not interfere in clinical medicine. Despite the original intent, Medicare and Medicaid have had tremendous influence on medical practice. In this article, we focus on four policy areas that illustrate the influence of CMS (and its predecessor agencies) on medical practice. We discuss the implications of the relationship between CMS and clinical medicine and how this relationship has changed over time. We conclude with thoughts about potential future efforts at CMS.

The North Carolina experiment: academia-practice partnerships.

Bringing academia and public health practice closer is a major challenge to the field. The Institute of Medicine's report, The Future of Public Health, emphasizes the need for practice scholarship and closer relationships between schools of public health and the practice arena. However, little has been written on the "how to" of developing these partnerships. This article describes four approaches utilized by the North Carolina Institute for Public Health for sustainable partnerships. Each approach is depicted along with its strengths and weaknesses identified. Characteristics of the approaches are described as well as being depicted by diagrams. A time context for each approach suggests the type of events for which the approach works. Culture and requirements of the respective partners' organization must be taken into consideration in utilizing any of the approaches. Some events in the practice setting cannot wait for an academia calendar. Therefore, all successful partnerships approach must be built on realistic expectation and trust.

AIDS and the role of the HCFA.

KIE: The Administrator of the U.S. Health Care Financing Administration (HCFA) describes HCFA's policies concerning Medicaid and Medicare benefits for patients with AIDS. He also provides a table of estimates of government expenditures for these patients over the next five years. HCFA is funding research related to the financing of AIDS care. The agency opposes paying for AIDS through a special disease-specific program and believes that AIDS financing must be a shared responsibility of the public and private sectors.^ieng