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I'm Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine (NLM).
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The inconsistencies between the willingness to fund cost-ineffective clinical treatments versus cost-effective primary prevention services should be more frequently perceived as a medical ethics issue, notes a stimulating perspective recently published in the New England Journal Medicine.
The author Thomas Farley M.D., writes: (and we quote): 'I believe it is time .... to argue on ethical grounds: it simply isn't right for our $3 trillion health system to withhold interventions that can save hundreds of thousands of lives' (end of quote).
Farley suggests there is a paradox within the health care delivery system where effectiveness thresholds generated by established cost analyses frequently are exceeded to treat some diseases and conditions while comparatively cost efficient prevention interventions receive less support.
For example, Farley notes a successful Diabetes Prevention Program, which provides a bargain by well-established cost-effectiveness thresholds, is not supported by Medicare as well as some other health insurance plans.
Similarly, Farley adds therapeutic health prevention programs, such as free nicotine-replacement therapy and mass media smoking cessation campaigns, are infrequently implemented even though they are well within the cost-effectiveness thresholds used to assess prudent health care costs.
Compared to some cost ineffective reimbursements for the treatments of diseases such as lung cancer, Farley writes (and we quote): 'In sharp contrast, primary preventive services are often withheld even if they are highly cost effective' (end of quote).
To provide some context to the paradox identified within the perspective, the author who is a physician in Philadelphia's public health department, writes (and we quote): 'the starkly different standards for treatment and primary prevention stem from the nature of empathy and the financial structures of our health care system' (end of quote).
For instance, Farley explains public health support is subject to fixed annual appropriations that have to compete with budgets for schools, public safety, and other social needs, while health treatment costs are not similarly defined or limited.
Farley adds a better understanding of the chronic underfunding of public health and prevention initiatives might be boosted by framing the problem in terms of social and medical ethics.
He notes (and we quote): 'There has been little written about the ethics of offering beneficial primary preventive services' (end of quote). Farley hopes health care professionals will help the public understand that society needs to be as creative to find ways to support preventive services (and we quote): 'as we have been in finding ways to pay for the penniless woman's lung-cancer treatment' (end of quote).
Meanwhile, helpful links to information about well-established medical ethics issues (such as end of life care and patient rights) are available within the 'summary' section of MedlinePlus.gov's medical ethics health topic page. The National Institute of Environmental Health Sciences provides a timeline of ethical issues raised within medical research in the 'resources' section of MedlinePlus.gov's medical ethics health topic page.
MedlinePlus.gov's medical ethics health topic page additionally provides links to the latest pertinent journal research articles, which are available in the 'journal articles' section. You can sign up to receive updates about medical ethics as they become available on MedlinePlus.gov.
To find MedlinePlus.gov's medical ethics health topic page, please type 'medical ethics' in the search box on MedlinePlus.gov's home page, then, click on 'Medical ethics (National Library of Medicine).'
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