Title |
How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?
|
---|---|
Published in |
The AMA Journal of Ethic, February 2017
|
DOI | 10.1001/journalofethics.2017.19.2.ecas2-1702 |
Pubmed ID | |
Authors |
Leonard M Fleck, Marion Danis |
Abstract |
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties-medical scientists, reviewing agencies, insurers, and accountable care organizations-can and should contribute to optimizing the development, approval, funding, and prescription of therapies-particularly expensive and marginally beneficial therapies. In aggregate, they should aspire to achieve a pattern of fair, cost-effective therapeutic decisions to ensure a sustainable health care system. Here we offer some suggestions regarding decisions that physicians might pursue to facilitate fair and cost-effective patient care. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 11 | 23% |
Colombia | 4 | 8% |
Canada | 2 | 4% |
Venezuela, Bolivarian Republic of | 1 | 2% |
Kenya | 1 | 2% |
Mexico | 1 | 2% |
Iraq | 1 | 2% |
Brazil | 1 | 2% |
South Africa | 1 | 2% |
Other | 8 | 17% |
Unknown | 17 | 35% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 27 | 56% |
Practitioners (doctors, other healthcare professionals) | 11 | 23% |
Scientists | 6 | 13% |
Science communicators (journalists, bloggers, editors) | 4 | 8% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 25 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 6 | 24% |
Other | 4 | 16% |
Researcher | 3 | 12% |
Student > Ph. D. Student | 3 | 12% |
Student > Bachelor | 2 | 8% |
Other | 1 | 4% |
Unknown | 6 | 24% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 7 | 28% |
Nursing and Health Professions | 4 | 16% |
Philosophy | 1 | 4% |
Environmental Science | 1 | 4% |
Biochemistry, Genetics and Molecular Biology | 1 | 4% |
Other | 6 | 24% |
Unknown | 5 | 20% |