A recent article on CBC.ca's Viewpoint and Analysis section hits on a couple of my personal pet topics. Health reporting needs the QALY treatment shows the lack of context of most of our healthcare-related news, and in doing so, points to Canadians' hypocritical view of our healthcare system.
Stephen Strauss's article starts with the unthinkable question that has to be thought of:
How much is a healthy, happy human life worth to you? How about a year of that good life? A month? A day? An hour?
If this is not a calculus that you ordinarily apply to yourself, then you aren't in tune with the coolly — some might say cruelly — rational way provincial health systems try to decide whether or not to use the public purse to pay for a new drug or a procedure.
The classic unit of measure is a QALY — pronounced Kalee — or Quality Adjusted Life Year. ... If a new drug gives you six months of extra good health, for example, and it costs $50,000 over that time, then it costs $100,000 per QALY.
You don't get it both ways - you can't champion universal health care and believe that every treatment, no matter how costly, no matter what its rate of success, must be funded. A sustainable system of universal health care means making hard decisions about the best use for a finite pot of money. And no matter how much we raise taxes or cut spending, that pot is always going to be finite, and there will always be more screening tests and treatments and procedures out there than money to fund them all.
In the news, we're regularly presented with the people behind the treatments rejected as having unacceptably high QALY scores (not that any hint of a cost-benefit analysis is mentioned). In these instances, the media tend to step out of the role of reporters and into the role of advocates, presenting the human interest story devoid of any context in the hope that an outcry will sway the cold, dead hearts of the decision makers. Never mind that those hearts are governed by brains trying to consider the overall good, while the media is looking for a good story.
Oh, look, here is a man with incurable colorectal cancer who wants to have Avastin. Too bad, said [Dalhousie bioethics professor Nuala] Kenny, the article doesn't tell us the drug only increases survival times by an average of 4.7 months and it costs $7,200 a month.
Oh, there's that woman with breast cancer demanding to get the drug Herceptin. It does work, but benefits cost so much that Derek Machin, chair of the British Medical Association's private practice committee, offered this doubting review: "I am advised you have to spend 500,000 pounds ($1.09 million Cdn.) to get a difference from one patient on Herceptin. If you treat 20 patients it will make a difference in one of them. How much are we actually going to spend to make a difference? Nobody has a solution."
It's insulting that the media think we can't handle the other side of the human interest story. Maybe Canadians would think differently about our health care system if we actually understood it. Maybe we'd see that it's based on a philosophy we actually do support, and look at the hard decisions with new eyes. Or maybe not, and with new understanding we'd be in a better position to support or agitate for meaningful changes that might help the man who wants Avastin, or the woman who wants Herceptin, or even the sufferers of diseases that haven't attracted media attention.
Strauss has a proposal on how to get reporters and therefore the public to consider the overall implications of the health care human interest story:
Every time a health-policy sob story appears without being qualified by a QALY or something like it, I am going to send an e-mail to the reporter and institution he or she works for. It will say: "Very sad, but how much longer would your person live and at what cost. And what does that say about the viability of the system as a whole. Please send me this information."
I guarantee you that when 100 e-mails arrive after each QALYless story, editors will — within short order — tell their reporters that pathos and bathos aren't enough. That their stories need statistical context, if just to keep that annoying QALY patrol away.
I predict that if you use the e-mail power the Internet god has given us, we can make the media treat us like people with brains as well as hearts. At least we can try.
I think he's tilting at windmills - I don't think people want to have their sad stories of the underdog fighting the system tempered with statistics and logic - but I'll take hopeful over cynical any day. I'd like to think we can handle the truth - all of it.