Part I: Could You Just Die Already?

Ah, the demons of cost -effectiveness have reared their snake-writhing heads again. Now don’t get me wrong – Doc

A 'No Smoking' sign
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Gurley has actually done some cost-effectiveness research in her day: here and here. That experience taught her that people who do this type of research for a living (not all of them, but most) are capable of sitting in dimmed rooms while staring at massive, god-like PowerPoint images that lay out the advantages of numeric values for fates-worse-than-death. What do I mean by that? If zero is death and 1.0 is perfect health, then, well, hmm, should we give agonizing spinal pain a minus 0.2? Or, should we give ceaseless retching until something tears inside a minus 0.4? Smothering? Anyone got a number for smothering to death? How about paralysis – is that between one and zero, or below zero? And is the person assigning the number paralyzed or not?

We’re talking numbers used as an actual tool to quantify the value of human life. Which begs the question: what number would Stephen Hawking get – plus? minus?

I think the one experience that tipped me over the edge (and sent me scurrying from the battlefield of dollars-per-organ, dollars-per-death, and dollars-per-quality-adjusted-life-year – which, I might point out, assumes that at least one person somewhere actually lives a quality-adjusted life), was when a fellow researcher earnestly explained to me the cost benefits of discouraging smoking cessation in patients after they’ve smoked for about twenty years. Why? See, if you quit while you’re young, you can save money and prevent the consequences of smoking. But if you stop after you’ve smoked a few decades, you’re likely to continue living – but with a smoking-related impairment like emphysema – which is clearly expensive (and possibly, to cost-effectiveness researchers, rude). The best option, once you’ve smoked for twenty years, is to keep smoking (hopefully heavily) and drop dead. Numerous cost-effectiveness models show that dropping dead is surprisingly cheap.

Which brings us back to the emerging Medusa heads of cost-effectiveness. This week has seen earnest discussions take place (under the guise of healthcare reform and the economic crisis) about how expensive smokers are to us as a nation. This Huffington Post serious article (really, there’s not even a touch of irony to it) reveals widespread political discussions about the costs of smoking to America: specifically, about why having more smokers is better for us as a nation because non-smokers suck up costs (frankly inhaling costs at the butt-ends of their lives) by daring (daring I tell you!) to perversely live years longer than smokers, thereby dragging deep to get at the last unfiltered Medicare and Social Security dollars. How selfish can you get?

After reading this article, I had to go lay down and recover from my PTCD (Post Traumatic Cost Disorder) flashback. I then decided there’s only one appropriate response. What else? A cost effectiveness model! Tune in tomorrow for the Doc Gurley Cost-Analysis Ultimate Proposal. I warn you – I’m not being overly modest by saying that this is the one proposal (data-driven!) that will end all of America’s problems. And in a very cost-effective way…

Tell all your friends! The answer to all our political, health and economic problems will be HERE tomorrow!

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