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Physicians Group: Weigh Costs In Treating Patients


There's a lot of debate these days about the cost of medical care, and the risks. Is a drug for breast cancer patients worth the $100,000 price tag if it only adds a few months to a woman's life? Or should men routinely get blood tests for prostate cancer when the exam could cause more suffering than it prevents?

Well, today, a major medical group issued new ethical guidelines on whether doctors should consider costs when deciding how to treat patients. As NPR's Rob Stein reports, the group takes a provocative position.

ROB STEIN, BYLINE: The American College of Physicians represents 132,000 internists across the country, and they're wading back into this debate over cost and quality of care.

VIRGINIA HOOD: The cost of health care in the United States is twice that of every other industrialized country. We're not providing care to as many people as they do in other places, and we don't even have as good outcomes.

STEIN: That's Virginia Hood, the president of the American College of Physicians. Hood argues that one way to get better outcomes is for individual doctors to think harder about the tests and treatments they use.

HOOD: Every time you prescribe something for a patient or subject them to some kind of investigation, there's a risk of harm. So the concept of doing less is actually a really good concept.

STEIN: That's the reason the new ethics guidelines urge doctors to use the latest cost-effectiveness research to guide their care. That, Hood says, would help all patients.

HOOD: While concentrating on our own patients and what they need, we also have to think on this bigger level - both for their benefit, and for the well-being of the community at large.

STEIN: The new ethics manual is being published in this week's issue of the "Annals of Internal Medicine." In an editorial in the journal, Ezekiel Emanuel, of the University of Pennsylvania, praises the idea of cost-effective care. He's advocated this thinking for a long time.

But even experts who agree with this idea have a problem with the new ethics manual. The manual uses the phrase "parsimonious care." And Scott Gottlieb, of the American Enterprise Institute, says that's alarming.

SCOTT GOTTLIEB: Saying that the use of resources should be parsimonious - that implies a whole lot more. I mean, that really implies that care should be withheld.

STEIN: And Gottlieb says that phrase raises fears of doctors withholding care without even telling patients what they're doing.

GOTTLIEB: Parsimonious, to me, implies an element of stinginess, and stinginess implies an element of subterfuge.

STEIN: But Virginia Hood, of the American College of Physicians, argues the manual simply says that efficient care is good care.

HOOD: Parsimonious is a good word, in the sense that it means you use only what's necessary.

STEIN: Daniel Callahan is a bioethicist at the Hastings Center. He agrees that's the way to go, but Callahan says that whenever you begin talking about costs, you raise the specter of rationing.

DANIEL CALLAHAN: If you say certain things will not be cost-effective, they are not worth the money - now, well, that's rationing. That's where it all becomes a real viper's pit, I might say, in one sense.

STEIN: And among the vipers in this pit is the question of whether individual doctors are going to follow the ethics manual's guidance. They're the ones making the tough choices, especially when patients demand that extra test, drug or procedure that they think may save their lives.

Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.

Rob Stein is a correspondent and senior editor on NPR's science desk.