From 1978 to 2009, Ed was head of the U-M Health System Legal Office. In 2009 he moved into the Medical School Department of ObGyn as an Associate Professor to work full-time on issues of sexual rights and reproductive justice. He has teaching appointments in the Medical School, the School of Public Health, the Law School, and LSA Women's Studies. He teaches courses on the legal and ethical aspects of medicine at the Medical School, the rules of human subjects research at the School of Public Health and reproductive justice in LSA and the Law School.. In 2011, Ed went to Ghana and helpe
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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.
Barbara Koenig, PhD
Professor of Medical Anthropology & Bioethics Dept. of Social & Behavioral Sciences
Institute for Health & Aging, UCSF
“Revisiting the “Race” Issue in Genomics”
Summary: Throughout the post-genomic era, efforts to categorize human populations according to geographical ancestry have been contentious. How does genetic variation map on to social categories of difference? How can researchers seeking to understand health disparities—or to interrogate diseases associated with particular genetic variants—pay attention simultaneously to race as social identity, and biological characteristic?
Stephanie Kukora, MD
Neonatal-Perinatal Medicine Fellow
"Choosing Wisely: using past medical decisions in allocating scarce ECMO resources"
This talk will examine the ethical complexities of distributing limited ECMO resources to a growing population of eligible patients across the age spectrum and varying prognosis, describe the ramifications of influenza vaccine refusal among otherwise healthy adults, and explore the moral permissibility of allocating scarce ECMO resources based on previous medical decision-making, such as declining the seasonal influenza vaccine.
Kevin Kerber, MD
Associate Professor of Neurology, Medical School
Director, Dizziness Clinic
Title: Implementation of Evidence-Based Practice for Benign Paroxysmal Positional Vertigo
Summary: A wide gap exists between the evidence-base for processes to diagnose and treat Benign Paroxysmal Positional Vertigo (BPPV) and the use of these processes in real world medicine. The investigators will present their work-in-progress regarding an implementation strategy to increase the use of BPPV processes in emergency department presentations of dizziness.
Jacob Solomon, PhD
CBSSM Postodoctoral Fellow
Designing the information cockpit: The impact of customizable algorithms on computer-supported decision making
Intelligent systems that provide decision support necessitate interaction between a human decision maker and powerful yet complex and often opaque algorithms. I will discuss my research on end-user control of these algorithms and show that designing highly customizable decision aids can make it difficult for decision makers to identify when the system is giving poor advice.
Kayte Spector-Bagdady, JD
CBSSM Postdoctoral Fellow
From the Guatemala STD Experiments to the NPRM for Revisions to the Common Rule: Why We Still Don’t Have Human Subjects Research Ethics Right
While much has been made of scandals, and academics zealously deliberate nuances, we still find ourselves revisiting the most basic of human subjects research ethics questions: What is a research subject? What is informed consent? This talk will address this ongoing debate but also the less often asked question of why—what are the structural pressures that bring us time and again to step one and is human subjects research ethics a zero sum game?
Alcoholic liver disease represents a large and growing portion of the liver disease in the US and worldwide, and the most powerful treatment shown to improve outcomes for patients with ALD is complete abstinence from alcohol. Unfortunately, many patients with ALD continue to drink or relapse to alcohol use, even after their diagnosis, worsening liver-related outcomes and mortality. Jessica Mellinger will be speaking about her K award project to improve outcomes for patients with ALD by developing and testing a pilot intervention designed to increase engagement in alcohol use disorder treatment.