grand discussion; thanks.
after working in the US, canadian, and UK health care systems, i've asked
(but not answered!) 2 questions about NNTs and health policy:
1. didn't rationing begin as soon as the first stone age shaman trephined
the skull of the first schizophrenic in an attempt to let out the bad
spirits (surely there were lots more schizophrenics than flint trephines
or shamans), and haven't we been rationing ever since?
2. if rationing decisions are made democratically and at a local level,
don't variations in disease frequency and severity force NNTs to vary from
place to place, and shouldn't (indeed, mustn't) there be differential
"health care by postal code" on this basis, even when other elements of
the decision (eg, values and preferences) are similar?
erudite answers to these naive questions would be appreciated (but not
necessarily understood).
cheers,
dls
............................................................................
Prof David L. Sackett
Director, NHS R&D Centre for Evidence-Based Medicine
Consultant in Medicine Editor, Evidence-Based Medicine
Nuffield Department of Medicine, University of Oxford
Level 5, John Radcliffe Hospital, Oxford OX3 9DU, England
Phone: +44-(0)1865-221320 Fax: +44-(0)1865 222901
Email: [log in to unmask] WWW: http://cebm.jr2.ox.ac.uk
As of 1 June 1999: The Kilgore Trout Research, Chainsaw Management,
and Conference Centre at Irish Lake,
RR #1, Markdale, Ontario, Canada N0C 1H0
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