Wednesday, January 17, 2007

CSPCP Conference; Rationing cancer care; & Oh yeah, and is here...

Coming up in late May 2007 is the 4th Annual Advanced Learning in Palliative Medicine conference (brochure here) in balmy Halifax Nova Scotia. It's sponsored by the Canadian Society of Palliative Care Physicians and promises to be a worthwhile event. Full-disclosure: I am going to be speaking at it, at the inhumane hour of 0815 I'll add--a time of day my brain is fit only to direct coffee to my mouth--about blogging and learning how to sip from the fire-hydrant flow of medical information we are constantly under in a (hopefully) clinically meaningful way.

Journal of Clinical Oncology has just published an entire issue on cancer & money/economics. Needless to say, I didn't read the entire thing, but did read the article by Daniel Sulmasy on rationing cancer care and the value of human life. Sulmasy actually makes an appeal to common sense in this, in an argument that is too subtle to summarize here**. Instead I'll note that the article is a contrarian's dream & he uses the discussion to gleefully rip into a lot of modern medicine and policy, including cost-effectiveness analysis, QALY, etc., as well as this:

One used to hear it said often that a particular study result was "statistically significant but clinically unimportant." Such a common sense judgment is rarely heard today. Researchers, their funders, advocacy groups, universities, and for-profit producers of devices and drugs all have a huge stake in touting the success of their research. These (usually unarticulated) self-interested motives blend almost imperceptibly into expressed beliefs in the incremental nature of medical progress and into population-based arguments that small differences (if the condition is sufficiently common) lead to large net gains in public health. Thus nearly every statistically significant improvement, no matter how small, has come to be hailed as a breakthrough. Cardiologists, for instance, regularly laud the results of studies that demonstrate 1% absolute differences in outcome, despite enormous costs, as "breakthroughs."

**The sum of his argument is:
"A common sense approach to resource allocation would argue that when extremely expensive treatments are developed that are statistically superior to their alternatives, but the advantages are clinically unimportant when relating the data to the patient, these treatments can be withheld at the bedside."
He follows this with "
one should
not underestimate the effort that will be involved to restore a universally shared appreciation for common sense among patients and practitioners." I'll append a (!) to that last statement.

3) is here! (the prior post was me panicking today when for 8 hours the entire thing was FUBAR'd).
The good news: it's exactly the same as!
The bad news: it's exactly the same as !
More good news: all of your old links, including links to (and individual posts at pallimed.blogspot) should still work and will be re-routed to
More good news: we are hoping to improve the look and functionality of Pallimed in the near future, but don't hold me to that.
A little bit of bad news: do not to to it doesn't work. You need that www in there (this will hopefully be fixed at some point in the future).

Viva Pallimed & let your friends know!

Pallimed has always been a labor of love, and will continue to be so for as long as we do this. However, we have decided to go 'legit' and pay for our own domain name etc. Because of this, and our aspirations for expansion, I placed a 'donation' button on the sidebar. I want to be on the up and up about this, and to note that it goes without saying that no one in this universe is making any money from blogging about palliative care [do I hear a (!!!)], and that any donations will go towards:
-maintaining (domain name registry, hosting, etc.)
-expanding and improving the blog's layout and functionality
-future projects which may or may not include: Pallimed CME, reader giveaways (of educational material, subscriptions to medical journals, etc.), scholarships, etc. etc. (feel free to suggest projects).


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