Rationing healthcare

---

Disease prevention and treatment have been made easier by advancement in medical science. But unproven new techniques of doubtful worth can push up the medical cost. Profit motive guides manufacturers of medical gear and drugs to market new interventions as soon as they become obtainable. One such new modality is lung screening of smokers using low-radiation-dose automated tomography. This imaging improves the likelihood of detection of small non-calcified nodules, an indication of lung cancer at early stage. Conventional chest radiography does not facilitate it. Though there is no evidence that such screening can reduce lung cancer mortality. This technology is marketed to smokers.
PSA test for prostate cancer has become popular despite a lack of evidence of its usefulness. Like other unproven screening approaches, it might have grave side effects. Many patients might have been wrongly diagnosed to have prostate cancer.
The victims of wrong diagnosis never know their real state of their health during their lifetime. Consequent wrong treatment leads unnecessary and endless suffering. Further diagnosis and treatment seldom rectifies the mistakes.
The high sounding evidence-based medicine appeals little to patients and their families, chiefly those facing serious illness or death looking for survival. Cost-effectiveness is more important for the cross section of the population. Only the insured patients can afford costlier treatment. This is why efforts for rationing are very controversial. When the public become aware that the care would be rationed there is a backlash. The ethicists seek rationing processes that are explicit and transparent. Many countries are now under pressure on the issue.

Mohammad Rajja
A member of Nepal Student Society, Dhaka, Bangladesh, the writer can be reached at E-mail : arnold_raza@yahoo.com