Darin B. Zahuranec, M.D, M.S., (Residency 2005, School of Public Health 2009), is an associate professor of neurology in the University of Michigan Medical School. Dr. Zahuranec received his bachelor's degree, summa cum laude, from Case Western Reserve University in Cleveland, Ohio, in 1997, and earned his medical degree from Case Western Reserve in 2001. He completed an internship at University Hospitals of Cleveland; residency in the Department of Neurology at the U-M, where he served as chief resident in 2004-05; and a fellowship in vascular neurology here.
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Kathryn Moseley served as one of the judges at "The Big Ethical Question Slam 5" hosted by a2ethics.org. In addition, Naomi Laventhal, Michele Gornick, Christian Vercler, Lauren Smith, and Lauren Wancata served as judges at the "Michigan Highschool Ethics Bowl 2."
Thanks to all the CBSSM folks who contributed their time!
For more information about these events and other great ethics-related activites, go to a2ethics.org.
A short video about the Highschool Ethics Bowl can be found here.
Christian Vercler is a Clinical Associate Professor of Pediatric Plastic Surgery at the University of Michigan C.S. Mott Children’s Hospital. He is a service chief of the Clinical Ethics Service in the Center for Bioethics and Social Sciences in Medicine (CBSSM). Dr. Vercler has a special interest in ethics in surgery and he holds master's degrees in both Theology and Bioethics. He has a passion for teaching medical students and residents and has won teaching awards from Emory University Medical School, Harvard Medical School, and the University of Michigan.
Geoff Barnes is a cardiologist and vascular medicine specialist at the University of Michigan Health System. He completed his undergraduate degree in biomedical engineering at Washington University in St. Louis (2003) followed by medical school at the University of Michigan (2007). He then completed a residency (2010), chief residency (2011) in internal medicine, cardiology fellowship (2014) and vascular medicine fellowship (2014) at the University of Michigan. His areas of research interest include anticoagulation, venous thromboembolism, quality improvement and shared decision making.
Raymond De Vries PhD is Associate Director at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and is a Professor in the Department of Learning Health Sciences and the Department of Obstetrics and Gynecology. He is also visiting professor at CAPHRI School for Public Health and Primary Care, University of Maastricht, the Netherlands.
Susan Dorr Goold, M.D., M.H.S.A., M.A., studies the allocation of scarce healthcare resources, especially the perspectives of patients and the public. Results from projects using the CHAT (Choosing Healthplans All Together) allocation game have been published and presented in national and international venues. CHAT won the 2003 Paul Ellwood Award and Dr. Goold is listed in the Foundation for Accountability's database of Innovators and Visionaries. Dr.
Dr. Fagerlin served as Co-Director of CBSSM from 2010-2015. She is currently Chair of the Department of Population Health Sciences at University of Utah School of Medicine and Research Scientist, Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS)
Do you think that your life is worth more than the amount that the government usually uses as the maximum to spend to provide one year of life?
Imagine that you are a member of a government panel that is trying to decide how cost-effective a medical treatment must be in order for the government to cover the costs of the treatment. Suppose that a certain treatment could provide one additional year of life to an otherwise healthy person. What is the highest amount the government should be willing to pay per person for this treatment?
How do your answers compare?
For the past twenty years, the figure most often used as the maximum amount to spend to provide one year of life has been $50,000. This figure was originally proposed since it was the cost of a year of kidney dialysis, a lifesaving treatment that the U.S. government funds in Medicare.
Should the number be higher or lower than the current standard?
Conventional wisdom would suggest that the number be higher to take into account the inflation that has occurred in the years since the standard was developed. Current practices such as annual Pap smear screening for women with low risk for cervical cancer, which has a cost of $700,000 per year of life gained, also suggest that society is willing to pay more than the current standard for a year of life. The authors of the cited article recommend, based on current treatment practices and surveys of the general public, that the cost-effectiveness threshold should be revised to be around $200,000.
Should the number increase, decrease, or stay the same over time?
Again, it seems that the threshold amount should increase over time due to inflation. However, other factors come in to play that affect the value.
Since new technologies are emerging all the time, some of which will be deemed cost-effective, there will be more and more treatments to be offered in the future. Also, the rate of use of treatments is an important consideration, because even if a new treatment is more cost-effective than an old one, if it is used more often it will end up costing more to society overall. With more treatments becoming available and more people being given treatments, the threshold cost will probably have to decrease so that insurance companies and the government can keep up with the increasing availability and demand.
Why is this important?
Insurance companies and government health care entities face a continuing struggle when trying to determine which medical treatments to cover. Health care costs are increasing rapidly, so these groups will be facing even tougher decisions in the future. Establishing cost-effectiveness guidelines would be extremely helpful as an aid to making the decisions about treatment coverage. Evidence shows that the current threshold is probably not an accurate reflection of the desires of society or actual prescribing practices. It needs to be adjusted to become useful once again, and must be reevaluated periodically to make sure the value keeps up with trends in the health care market, rather than being left alone without question for two decades as is the current situation.
For more information see:
Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn't it increase at the rate of inflation? Archives of Internal Medicine. 163:1637-1641, 2003.