German Lang. Media: Medicine at the limit
Is it worth an expensive surgery?
In Germany it is an obligation to have health insurance. The premiums follow income and everyone gets all the treatments or surgeries he or she needs… well… in theory. The reality is less simple: To counteract rising health care costs politicians cap the budgets for clinics, surgeries or pills. Thus physicians are forced to think economically, to ask whether a surgery is “necessary” or “worth it”. But who should make these decisions? And who provides the scientific data to prove that a surgery is not necessary?
Harro Albrecht (a former physician) addresses these issues of health economics and its ethical and medical implications in his piece for (last week’s) Die Zeit. And he accuses German health politicians as well as scientists for avoiding necessary discussion about “prioritizing”, which means to make medical as well as economically sound decisions. In Albrecht’s view prioritizing is “the basis for a just distribution of the resource medicine”.
His chief witness is a German-Swedish physician, who worked in Germany for years but leads a Swedish clinic now. In Sweden prioritizing is already a routine for him, whereas in Germany it is still a taboo to even talk about surgeries, which are “obviously” unnecessary or not worthwhile. Intracardiac catheters, e.g., are used much more often in Germany compared to Sweden. Not because there is a difference between cardiac patients, but because the capped budget in Germany allows (and encourages) the clinic to do more catheter surgeries. No one thinks about the necessity of the individual catheter surgery as long as the budget allows it. This may not be a major problem now, says Albrecht, but in the future (older) society prioritizing will be crucial, because expensive life saving surgeries won’t be accessible for every patient. Rationing will be the rule, not the exception.
But attempts to establish ethical and medical rules for rationing are not heard in Germany. The cost sensible guideline for cardiologist, developed with the help of the Federal Research Administration, was rejected by politicians as well as physicians. No one wants to discuss, whether it is really worth to spend 50000 Euro for the treatment of a special lung cancer if the patients gain 1.2 months by mean. Albrecht quotes the study of the US National Cancer Institute, that the US spend $440 billion each year for “such therapies”, and that oncologists should think about, what beneficial means.
But who should decide what a worthwhile therapy is or is not? The physician alone? Or an independent institution? Both the “IQWiG” and the “Gemeinsame Bundesausschuss” are institutions in Germany, who should judge about the usefulness of therapies. But until know they don’t see their assignment in prioritizing but to find “efficiency reserves” – which means to compare the prize of pills and point to the cheaper one. Only (politically) weak instruments like the National Ethics Council are currently thinking about prioritizing. Is this “Political cowardize”, quotes Albrecht a social law expert from Bochum? Might be, because it looks like political suicide for a politician if he tells Germans, that they may not get an expensive surgery, that doesn’t save a substantial amount of lifetime. This is hard to communicate in a nation, which had the luxury to be able to think that economics and health care have nothing to do with each other. Good, that Albrecht tried to do it anyway – although the reader’s reactions do not differ from the voter’s.
Also: Swine Flu a hoax?
As much as I liked Albrecht’s article, I cannot understand why the Online edition of Die Zeit republished an awful health politics article from the Berlin Tagesspiegel (Tagesspiegel and Zeit belong to the same publisher Holtzbrinck and exchange articles from time to time), which lacks all the basic principles of journalism. The author heavily quotes a German politician, who thinks, that the worldwide actions against the swine flu pandemic is a hoax, “the biggest scandal of medicine of the millennium”. Of course this is news, because the politician acts as chief of an influential European health commission, so that the European Community will have to deal with his theory of a plot of the pharma industry and the WHO: Because the WHO is not under the control of parliaments, the governments should demand consequences, the politician is quoted. “The definition of a pandemic couldn’t be in the hands of an organisation, which is obviously influenced by salesmen of the pharma industry”, the author cites the politician, a former physician. So far so interesting, but the problem is, that no further proof for the politician’s, say, “idea” is presented. And one won’t find any critical comment of the Robert-Koch-Institute or the Paul-Ehrlich-Institute or any other German infectious disease research institution full of “real” swine flu experts.
This is the kind of reporting that spurs confusion and suspicion and doesn’t deal with scientific problems of predicting pandemics or with the difficulties of organizing a worldwide reaction to a health threat with a variable probability of incidence. Instead of making things convincing, the politician gives no proof for his theory. The article closes with the hint, that a comparable inquisition by the European Council finally lead to the discovery of illegal CIA jails in Europe.
- Sascha Karberg
