IMBALANCED PRIORITIES: DOING THINGS BETTER VS. DOING BETTER THINGS
EXAMINING THE TRADEOFFS BETWEEN MEDICAL ADVANCES AND IMPROVING HEALTH CARE DELIVERY
In a compelling essay, Woolf and Johnson argue that as a society, we should spend less on technological advances and more on improving systems for delivering care. They make the case, supported by mathematical arguments, that technological advances must yield dramatic, often unrealistic increases in efficacy to do more good than improving fidelity - the systems that ensure the delivery of care to all patients in need. They point out that our society channels most of its resources into the race for new drugs and devices, even though medical advances do less good than closing the gap in the quality of health care delivery. The authors conclude that our huge investment in technological innovations, which only modestly improves efficacy but consumes resources needed for improved delivery of care, may cost more lives than it saves. They assert that the misalignment of priorities is driven partly by special interests (e.g., blockbuster earnings for industry) and by the public's appetite for technological breakthroughs. Ultimately, however, health outcomes suffer. They urge society to confront the price we pay - in human lives - by maintaining a health care system that is not designed to deliver care well while investing vast wealth in technology.

Two accompanying editorials further the debate about the appropriate balance between investing in new technologies vs. devoting resources toward improving systems of care to deliver services already known to be effective. Steven M. Teutsch, M.D., M.P.H., with Merck & Co., Inc. concedes the American health care system fails to deliver the health benefits commensurate with our investment. He agrees that the American free enterprise system has its weakness in channeling resources into innovative technologies that can be successfully marketed a
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Contact: Angela Sharma
asharma@aafp.org
913-906-6253
American Academy of Family Physicians
6-Dec-2005

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