Ethics of treating the many for the benefit of the few?
November 22, 2011 6:08 PM   Subscribe

Where can I find interesting papers, discussions, blog posts, etc. about the disparity between benefits to personal health and population health when it comes to medical interventions and the ethical implications therein?

For example, browsing through TheNNT, you'll find that statins don't benefit most people who take them, but on a population level, but many bad outcomes are prevented if enough people take them. By the same token, those who are most likely to benefit from statins don't comprise the vast majority of people who are actually going to have heart attacks and die, simply because there's a much larger population at low risk than there is at high risk.

I'd like to find a discussion of, specifically, the ethics involved in approaching these matters from a clinician's point of view. Any pointers would be helpful!
posted by greatgefilte to Health & Fitness (2 answers total) 9 users marked this as a favorite

This is just a google news search link, but it sounds like you'd be interested in the discussion therein concerning recent changes to the guidelines for prostate cancer screening. This NY Times article gives a little overview, and also talks about recent (equally controversial) changes to the screening guidelines for breast and cervical cancer. All of these guideline changes are based on new evidence that increased screening not only doesn't help patients on average, but may even be harmful (e.g. due to surgeries that might not be needed, increased radiation exposure from imaging studies, or even just financial cost vs. benefit). The backlash has come because there are people whose cancer was caught early due to these tests, people who attribute their current survival to the screenings. And there are people whose cancers were caught late because they ignored screening guidelines, and they or their surviving family members are also vocal about the need for early detection.

I'm not going to weigh in on the debate, but you will certainly find a lot of "How many people does this really help?" vs. "Isn't helping one person enough?" debate surrounding these changes in the screening guidelines.
posted by vytae at 5:44 AM on November 23, 2011

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