Arthur Caplan is a well-respected bioethicist from the Center for Bioethics at the University of Pennsylvania. His opinions are typical of "mainstream" bioethics ideology. A May 20, 2011 article he penned for the Journal of Clinical Oncology, "Will Evidence Ever Be Sufficient to Resolve the Challenge of Cost Containment?," prompted this LIBERTARIAN BIOETHICS BLOG post.
The first nugget to be mined from Caplan's article is his admission that evidence-based medicine is not, as the statists argue, a rationalist philosophy of utilizing objective scientific data to inform medical decision making. Instead, evidence-based medicine is a statist "tool for reigning in the escalating costs of cancer diagnosis and treatment." No shit, Artie.
The second nugget is Caplan's smackdown of statists who assert that "cost containment requires nothing more than a long hard look at the evidence to forge consensus about what to cover." He cites two examples (the 2010 US Preventive Services Task Force recommendation against routine screening mammograms for women > 40 years old and the 2010 Medicare decision to pay for the Provenge advanced prostate cancer vaccine), which he states are scenarios in which "evidence regarding cancer has yielded to politics, money, and emotion." Memo to Artie: you are not the first person to recognize the subjective nature of value.
The third nugget is Caplan's attempt to rehabilitate the concept of evidence-based medicine (an ideology he mocked in earlier paragraphs) by proposing 4 "shifts in thinking about the ethics of health care" that must be adopted so his statist pals can more easily ration health care. SHIFT #1: statists must recognize the subjective nature of value. LIBERTARIAN BIOETHICS BLOG RETORT #1: no chance Artie because statists refuse to accept the existence of objective economic truth. SHIFT #2: doctors must begin to offer "an opinion informed by evidence" rather than merely "offer all possible options to the patient ... ." LIBERTARIAN BIOETHICS BLOG RETORT #2: clearly this is news to you Artie but high-quality physicians, such as me, commonly describe multiple options to the patient AND ALSO deliver a recommendation for one of the options based on the available evidence (phase 3 studies, phase 2 studies, phase 1 studies, retrospective reviews, case-control studies, anecdotal data otherwise known as personal experience, etc.). SHIFT #3: doctors must jettison the old-fashioned notion that their job is to act as advocates for the "personal best interest" of individual patients and instead adopt the modern notion that "a good and virtuous doctor must make recommendations about care as an advocate for the patient, as an honest source of evidence, and as a steward of society's medical resources." LIBERTARIAN BIOETHICS BLOG RETORT #3: like his pals Artie is an evil statist asshole. SHIFT #4: pragmatically rich people should get access to experimental treatments first. LIBERTARIAN BIOETHICS BLOG RETORT #4: also true Artie but your statist pals will never ever under any circumstance permit the existence of a free or freed market in health care.
Per usual, please peruse Caplan's article. I make this as a medical recommendation. Even the ancients knew laughter is the best medicine.
The first nugget to be mined from Caplan's article is his admission that evidence-based medicine is not, as the statists argue, a rationalist philosophy of utilizing objective scientific data to inform medical decision making. Instead, evidence-based medicine is a statist "tool for reigning in the escalating costs of cancer diagnosis and treatment." No shit, Artie.
The second nugget is Caplan's smackdown of statists who assert that "cost containment requires nothing more than a long hard look at the evidence to forge consensus about what to cover." He cites two examples (the 2010 US Preventive Services Task Force recommendation against routine screening mammograms for women > 40 years old and the 2010 Medicare decision to pay for the Provenge advanced prostate cancer vaccine), which he states are scenarios in which "evidence regarding cancer has yielded to politics, money, and emotion." Memo to Artie: you are not the first person to recognize the subjective nature of value.
The third nugget is Caplan's attempt to rehabilitate the concept of evidence-based medicine (an ideology he mocked in earlier paragraphs) by proposing 4 "shifts in thinking about the ethics of health care" that must be adopted so his statist pals can more easily ration health care. SHIFT #1: statists must recognize the subjective nature of value. LIBERTARIAN BIOETHICS BLOG RETORT #1: no chance Artie because statists refuse to accept the existence of objective economic truth. SHIFT #2: doctors must begin to offer "an opinion informed by evidence" rather than merely "offer all possible options to the patient ... ." LIBERTARIAN BIOETHICS BLOG RETORT #2: clearly this is news to you Artie but high-quality physicians, such as me, commonly describe multiple options to the patient AND ALSO deliver a recommendation for one of the options based on the available evidence (phase 3 studies, phase 2 studies, phase 1 studies, retrospective reviews, case-control studies, anecdotal data otherwise known as personal experience, etc.). SHIFT #3: doctors must jettison the old-fashioned notion that their job is to act as advocates for the "personal best interest" of individual patients and instead adopt the modern notion that "a good and virtuous doctor must make recommendations about care as an advocate for the patient, as an honest source of evidence, and as a steward of society's medical resources." LIBERTARIAN BIOETHICS BLOG RETORT #3: like his pals Artie is an evil statist asshole. SHIFT #4: pragmatically rich people should get access to experimental treatments first. LIBERTARIAN BIOETHICS BLOG RETORT #4: also true Artie but your statist pals will never ever under any circumstance permit the existence of a free or freed market in health care.
Per usual, please peruse Caplan's article. I make this as a medical recommendation. Even the ancients knew laughter is the best medicine.
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