August 9, 2012
Saving Lives on a Budget
By Austin Carter
What is the value of a human life? 1 million pounds? 2 million pounds? It just doesn’t seem right placing a monetary value on a life. Yet, when allocating money for medicine, there are times when the people in charge must make financial decisions that directly affect mortality numbers.
In one of our lectures we learned about a long study done in Africa researching the benefits of including routine CD4 count check-ups in the treatment of HIV patients in Sub-Saharan Africa. Contrary to what one might expect, her findings led to the conclusion that more lives could be saved by removing routine CD4 counts check-ups from treatment protocol. This arises from the fact that the difference in lives saved when routine check-ups were not included was so small that the resources used on check-ups could be allocated elsewhere. When you boil it down to pure numbers and resources, more people would live if the resources formally used on routine check-ups were instead used to provide first line treatment for more Africans.
This example brings to light the greater conflict between the formation of public health policy and a physician’s personal treatment of patients. It is much easier to make a decision about patient care from a distance, using numbers and data, where the actual effects of the decision are not seen first-hand. When a doctor must actually carry out these decisions, the results are much harder to digest. In the example of HIV treatment, the best possible thing a doctor could do for her individual patients might actually conflict with what is best for the people as a whole (because of relatively unnecessary expenditures). Keeping perspective as a physician must be difficult when even the slightest changes in patient care can have direct effects on individual patients.
Austin Carter holding an antique porcelain plate once used to cultivate penicillium mold. Photo by Gabby Yee
We are living in a time in history where there is more technology and data than ever before to make informed decisions about health. As with all changes, there is always a resistance to abandon old ways. But in the case of medicine, a doctor’s inability to quickly adapt can have terrible adverse effects on patient health.
I hope that progress can be made to streamline the dissemination of research results which might decrease mortality on the macro scale. While my views may not be completely developed or informed, I believe that the administration of medicine in resource-poor areas should be completely numbers driven, aiming to save as many lives as possible. I realize that there are ethical issues in not providing the best care possible for individual patients, but unfortunately the current disparity in wealth throughout the world does not allow for equality of treatment worldwide. Difficult decisions must be made in order to protect the greater population as a whole.
Austin is a sophomore double majoring in Global Health and Economics from Beaverton, Oregon. He hopes to one day be President of the World Bank.