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![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
House of Cards
The Best of Times and the Worst of Times
Another example - pap smears
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Sam Diago, Detroit, MI USA economics
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A very thoughtful analysis on "Technology vs. Fidelity." However the authors expect us to swallow a bitter pill. The premise is grounded on sand. There are too many assumptions that have been proven nonviable. 1. Rational people can't believe we can do a better job of socialism than socialist countries. They have all failed. 2. Are we expected to believe the 45 million uninsured are the same 45 million year after year? 3. How many of the 45 million choose not to have medical insurance? 4. The reference to "moral imperatives & ethics of utilitarianism" get to the heart of the issue...society can not "marshal" (authors' word) resources without coercion and force, (marshal law?) two ideas that MUST NOT be tolerated in a free society. Competing interests: non socialist |
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Mary K Wakefield, Grand Forks, ND, USA Director, Center for Rural Health
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The authors draw a sharp line between the return on investment in technological innovation versus investments in system improvement to ensure that people get timely appropriate care(authors refer to this as fidelity). Without a doubt, many in the public and policymaking arenas have come to equate high quality care with technology improvement, without paying much attention to the care systems on which the application of that technology rests. How do we help to move toward a more appropriate balanced investment? For starters, to the extent health care providers, researchers and others 'turn up the volume' on the importance and value of system functionality that supports appropriate, timely care, the message won't necessarily be lost on important stakeholders. And, as the authors note, public discouragement with health care may also help to catalyze fiscal policy realignment. In fact, some recent federal actions do acknowledge the importance of investing in related improvements and measuring progress against established indicators. Having said that, we nevertheless clearly have a long way to go. In addition to the dynamic so well articulated by the authors describing the fascination with technological breakthroughs and the related lack of adequate thought given to real impact and tradeoffs, another major challenge to moving this discussion forward is the fragmented health care and health policy world in which we live. Our current approaches to health care investment are too often based on slivers of targeted activity rather than more comprehesive assessment and phased-in actions. Instead, we need a 'systematic approach' to critically analyzing health care broadly, including the 'system' features that are essential to ensuring that care is timely and appropriate. Without the bigger picture in focus, tradeoffs that are made are hidden--except for the occasional article, like this one, that illuminates some of them. Competing interests: None declared |
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Ed Miron, Calhoun, GA Family Physician, private practice
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Great article. Another classic example of efficacy vs fidelity is the common use of Thin- Prep paps by physicians who do annual gynecological exams on well patients. This more expensive tchnology is undoubtably more sensitive, but I question whether it has saved any lives from cervical cancer when used in this way. The way to save lives from cervical cancer is to screen women who don't routinely recieve it. Competing interests: None declared |
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