One of the classes I teach is ethics. I am continually telling my students that
the health policy implications are important from an ethical point of view. One
could argue that treating a patient with an ineffective treatment is a harm, a
violation of the duty of non-maleficience, to both the patient and society. But
when we talk about LBP for example there is no compelling evidence that one
particular treatment is best. If we look at meta-analyses on the topic depending
on when and the method used the results are all over the board. Thus, given
there is a lack of robust evidence of effectiveness for any treatment should the
public policy be to pay for no treatments at all? I think pragmatism says that
while the state of knowledge is equivocal one pays for treatments that have a
reasonable body of evidence for a reasonable time. I say to patients let's try
a trial course of treatment for two weeks and then re-evaluate your situation
then.
"Greener, Jenny" wrote:
> How about refocussing the question away from the level of the individual
> patient - if there is no robust evidence of effectiveness for a particular
> service, should public money continue to pay for it?- perhaps a question of
> particular relevance in the UK NHS context.
>
> Jenny
>
> ---
_____________________________________________________________________
Stephen M. Perle, D.C.
Associate Professor of Clinical Sciences
University of Bridgeport College of Chiropractic
Bridgeport, CT 06601
www.bridgeport.edu/~perle
_____________________________________________________________________
Ignorance more frequently begets confidence than does knowledge:
it is those who know little, and not those who know much,
who so positively assert that this or that problem will never
be solved by science. Charles Darwin
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