[extropy-chat] RE: [futuretag] QALY pharmacoeconomics

Hughes, James J. james.hughes at trincoll.edu
Mon Dec 19 01:35:33 UTC 2005


Interesting question, albeit not very coherently stated.

Some observations:

QALYs are a tool for assessing the social utility that can be generated
by alternative investments of public monies. It can certainly be
extended to include the social utility produced by both public
expenditures and regulatory efforts, which are also an investment of
sorts. However your posts seems to assume that public regulation is only
to be judged in terms of how many benefits they deny the public access
to. I'm willing to concede some of that, but I think there is a much
stronger case on the other side: in general, food and drug regulations
keep the public from wasting money on unproven, ineffective and
dangerous drugs, "natural" and otherwise. 

For instance, millions of women took estrogen replacement therapy and
then found out that it increased their risks of cancer and heart
disease. In retrospect, it would have been nice to have required a large
scale double-blind clinical trial of HRT before it was prescribed rather
than after.

As for "natural" therapies, a major study of milk thistle just found it
ineffective in reducing liver disease, and St. Johns wort has been shown
to be ineffective in treating depression. 

The reason that QALY calculations have not included "natural" treatments
hitherto is because once we know, through clinical trials, what efficacy
a treatment actually provides then its not "natural" anymore - its just
medicine. As we've seen with Vioxx and many other drugs, however, even
the process of clinical trsting is very problematic. 

Although the process and science of clinical trials can be much
improved, if anything, public health and QALY maximization would be
improved by more aggressive food and drug regulation, not less.

What keeps the FDA from acting in the public interest is the influence
of the pharmaceutical and health supplements industries, pursuing their
various forms of lobbying and influence, increasingly naked and
unashamed under the Bush administration.

So if your real concern is QALY maximization, let's start with policy
questions such as:

- what QALYs are being produced by investing in the administrative
overhead of 1500 private insurance firms (and the administrative
externaltiies they impose on hospitals and doctors' offices) versus
investment in something like universal health insurance in the US?

------------------------
James Hughes Ph.D.
Executive Director
Institute for Ethics and Emerging Technologies 
http://ieet.org
Williams 229B, Trinity College
300 Summit St., Hartford CT 06106
(office) 860-297-2376 
director at ieet.org



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