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...cost of a measure called the "quality-adjusted life year" [QALY]. A QALY scores your health on a scale from zero to one: zero if you're dead and one if you're in perfect health. You find out as a result of a treatment where a patient would move up the scale. If you do a hip replacement, the patient might start at .5 and go up to .7, improving by .2. You can assume patients live for an average of 15 years following hip replacements. And .2 times 15 equals three quality-adjusted life years...
...NICE is forcing pharmaceuticals to play ball by offering special discounts to Britain. How do you manage that? Our list price is used as a reference price in other countries, so drug companies believe that a no from NICE is damaging globally. So they set up what we call "patient-access schemes." Drug companies may either give away certain portions of treatment [such as the last few doses of a course] or reimburse the NHS for those patients who don't respond, which has the effect of reducing the price of the drug and lowering the cost per QALY - even...
Using information technology to figure out which treatments are most effective seems eminently sensible. Certain heart patients, for example, do just as well with clot-busting drugs as they would with angioplasty procedures, which typically cost thousands more. Crunching huge amounts of data from a wide cross section of patients could help us do better research than we are doing now. But what will happen when the new computerized research turns up a treatment that works a little better but costs a lot more? Will the government-sponsored researchers tell us? What happens to the patient whose particular circumstances argue...
Doctors and patients live in a world of painful, pressing questions. The great physicians I've known seek answers through personal commitment to each patient and judgment born of practical experience - neither of which I have found in a machine...
...outlook for a patient depends in part on acting fast: call 911 or drive the victim to the hospital; do not wait to reach your own doctor. The rest turns on the type of injury. Richardson died of an epidural hematoma, an accumulation of blood between the skull and dura, the tough tissue covering the brain. A subdural hematoma is blood between the dura and brain. Both injuries have a mortality rate of about 50%. Intracerebral bleeding, which occurs within the brain, is even more serious. "Patients get redlined to surgery in 15 to 30 minutes" if they have...