title: Is medical research cost effective? Response to Murphy and Topel.
abstract: The paper explores the relationship between medical innovation and cost of treatment. The methodology used by Murphy and Topel to calculate the statistical value of a life is examined. The authors discuss possible confounding factors, such as the general trend of decreasing mortality, and consider the possibility that non-medical sources, especially the decrease in tobacco use, may explain much of the decrease in mortality rates. The authors suggest an alternative to Murphy and Topel's population-level model for assessing the benefits of medical technology, based on Lewis Thomas' categorization of three levels of technology: non-technology ("caring"), half-way technology (does not reverse or prevent the underlying problem), and high technology (preventative or curative). The categories are applied to the example of type 1 diabetes mellitus, in which quality of life and mortality improvements are clearly the result of technological changes and not behavioral modifications. The authors emphasize the cost-effectiveness of high technology, which is based on medical research advances.
authors.affiliation: MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA. msiegler@medicine.bsd.uchicago.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Siegler
authors.forename: Alix
authors.initials: A
authors.lastname: Weisfeld
authors.forename: David
authors.initials: D
authors.lastname: Cronin
mesh_terms: D035843:Biomedical Research / Q000191:economics*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000628:therapy; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008136:Longevity; D008297:Male; D009026:Mortality / Q000639:trends; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014481:United States