Financial conflict of interest has become one of the most contentious issues in medicine today. Several decades ago studies disclosed that physicians who had investments in medical facilities were referring patients for more tests and procedures than physicians who had no such investments. More recently, physicians who forego expensive tests and treatments for patients have been accused of skimping on care for personal financial gain. Physicians who emphatically tout certain treatments have been criticized for possessing hidden financial ties to the manufacturer of the products. Some physicians engaged in clinical trials have been suspected of enrolling patients who do not strictly conform to the research protocols so that they can collect fees from contract research organizations. And in the aftermath of deaths and complications in gene therapy experiments, some scientists and their institutions have been criticized for possessing a financial stake in companies that are involved in the studies.

The most publicized finding of the Institute of Medicine (IOM) report is that between 44,000 and 98,000 patients die each year as a result of “adverse events” in medical care. The core concern of the report is to argue that a "systems" approach to medical practice holds out considerable promise for the elimination of the subset of those “adverse events” which are the result of medical error. The report outlines the “systems” approach and proposes various public policies which might encourage the adoption of that approach, enhance its effectiveness and protect it from potentially undermining legal assaults.

Medical error and health care fraud are hot topics these days. Since the Fall 1999 publication of the Institute of Medicine (“IOM”) Report, To Err is Human, medical errors have received a great deal of attention in the popular and academic press. Error reporting bills have been introduced at both the state and federal levels, and industry and government representatives have undertaken a variety of cooperative error-reduction efforts.

Tort “crises” and serious interest among policy-makers in tort reform are inter-related, cyclical phenomena in the United States. In the mid-1970s, and again in the mid-1980s, medical malpractice markets across the country experienced rapid increases in the frequency of claims, rising premiums, and in some places, shrinking options for professional indemnity coverage. A wave of tort reform measures followed, the majority of which were designed to chill the interest of plaintiffs' attorneys in bringing suit.

The pace of medical innovation is quickening, pushed by advances in biotechnology and pulled by growing demand for healthcare. Completion of the Human Genome Project has provided a multitude of data for determining genes and their functions, and stimulated the application of information technology and private capital for the development of new individualized drugs, gene therapies, and biomaterials for tissue and organ regeneration. Concurrently, demand for healthcare continues to grow, expanding the market for medical innovations that are proven in clinical trials to be safe and effective.

The development and application of technologies will arguably be the major driving force for the evolution of world society in the first part of our new century. In medicine, agriculture, material science, communications and a host of other areas, new technologies promise unimaginable changes in our lives. And yet, in the midst of the euphoria surrounding this rush of invention, there is concern. When asked, people often say they are scared of what they do not know and scared of today's pace and power of invention. Putting aside the voice of the modern Luddite, it appears that while few want to stop the rush toward more and better technology, there is apprehension about the potential risks of the new technologies—risks that have not been sufficiently considered.

The Americans with Disabilities Act of 1990 promised to be a “secondgeneration” civil rights statute, comparable in importance and scope to the Civil Rights Act of 1964. The breadth of the act reflected congressional and disability activists' desire to change society in order to enable the disabled to achieve economic autonomy and social equality. Historically, disabled individuals were characterized by their inability to normally function in society, either due to physical obstacles or social myths and stereotypes. Up until 1990, the federal government had taken baby steps to address these issues. Indeed, most federal activity was limited to assisting disabled people in overcoming physical barriers to employment. However, the government did little to change the structure of those barriers, and most certainly did not address the widespread social prejudice against the disabled.

In recent years, complementary and alternative medicine (“CAM”) has grown in both popularity and economic import across all segments of society and is now an established presence in the lives of millions of Americans. It has generated its own field of adherents, practitioners, opponents, lobbyists and counter-lobbyists, case law, and regulations. On one side of the CAM equation stand the advocates of CAM: its practitioners and satisfied patients. On the other stand its detractors: its dissatisfied patients, groups within the established or mainstream medical community, and historically, the American Medical Association (“AMA”). In the aggregate, the two sides engage in large scale scientific and philosophical battles over how best to treat or address the health care needs of patients. On a smaller scale, individuals on each side are essentially lobbying to protect their professions and their jobs. The struggle between the two warring camps fills volumes of medical, legal and popular scholarship. However, it is not the point of this Note to address the validity of the debate between CAM and mainstream medicine.