Saturday, December 18, 2010

At What Cost Is The Right to Know?

Gina Kolata writes in the New York Times that new tests have raised an ethical dilemma for physicians: Should they notify patients who do not have Alzheimer's that they are at risk for the disease?

Ms Kolata's article implies another dilemma as well: Should the tests be performed at all?  Should we be spending hundreds of thousands of dollars on procedures and tests for a condition that has no cure, that can eventually be diagnosed without the tests, and when not everyone who receives them descends into Alzheimer's? Americans and their physicians have become addicted to the latest diagnostic technology, and yet our healthy quality of life is no better -- and in many cases worse -- than the citizens of other wealthy economies. Our costs, though, are staggering -- nearly double those of some of the same countries.

Moreover, whether by design or economic imperative, the United States has chosen to invest in secondary and tertiary care at the expense of primary care and public health. At some point, dollars spent on specialty care negatively impact the savings and improved health from the preventive medicine made possible by primary care and public health policy. Is the detection of a predisposition to early Alzheimer's worth that?

That patients should live with uncertainty is a frightening thing. But so are the crushing health and economic burdens of overtreatment and inadequate investments in primary care and public health.

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