cost benefit vs. risk benefit analysis

it is crucial to understand what the difference between these two analytic processes is when looking at recommendations for medical screening devices.

cost benefit: determines if a specific medical expenditure is justifiable by calculating if the amount spent is greater or less than the amount recouped by making that expenditure. for instance, would shifting colonoscopy to 40 years of age (something i have done) cost society more money than it saves. actuaries add up the cost of screening all people between the age of 40 and 50 (the current recommended age for colonoscopy) and then compare that to the cost to society of making the expenditures (or doing the procedure) against the potential loss of productivity and medical costs of all of the people who would have gotten sick and or died of colon cancer in the same age group if not screened. the recommending agency then makes the recommendation depending exclusively on which is more costly.

risk benefit: determines if more people would be saved than potentially harmed by doing a particular procedure. using the same example would more people's lives be saved by doing colonoscopy beginning at 40 than would be harmed by complications of the procedure in the same age group and then making the recommendation based on which course would save more lives: this analysis is blind to cost.

currently in the united states all recommendations are made by cost benefit analysis.

mission statement

on a fairly regular basis the new york times has prominent medical articles both on the front page and in the science times. i find that i am often quite distressed at the content of these articles both because of the subject being directly reported or because of the spin that the times embraces and sometimes both. i am committed to using this blog to post responses and interpretations of these articles as well as general comments regarding medical news and public policy as it relates to medicine.

those of you who know me know that i have fairly strong opinions (understatement) and i can happily say that as they relate to medicine i think they are well thought out. so for anyone interested in my opinions anywhere in this realm please feel free to check in here and hopefully you will find posts that answer some questions and perhaps offer a different slant on medically related news and are maybe even interesting and thought provoking. i welcome any comments and i hope to learn a lot from this process.

opening salvo

check later for my first post about what this blog is for and a discussion about mammograms.