There is more to this issue than life and death

The recent NEJM Perspectives piece by Pamela Hartzband and Jerome Groopman is about how to interpret expert judgement regarding the PSA test, as well as the methods upon which it is based. It is superb and ungated. Go read the whole thing.

It ends,

Basing decisions on the outcome of death ignores vital dimensions of life that are not easily quantified. There are real complexities and uncertainties that we all, patients and physicians alike, confront in weighing risk and benefit. Wrestling with these uncertainties requires nuanced and individualized judgment. It is neither ignorant nor irrational to question the wisdom of expert recommendations that are sweeping and generic. There is more to life than death.

Agreed. But health care services of (expert-decreed) uncertain value don’t grow on trees any more than do unambiguously valuable ones. Who will pay for them?

@afrakt

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