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First, an admission. I have done research on flu shots. I have helped a student of mine write a dissertation on the timing of flu shots. However, neither I nor anyone in my family has ever had a flu shot. Why was that our health economic decision? We have never thought that the risk was all that large and we have never felt that the time costs were sufficiently low (even with minimal monetary costs) to warrant getting flu shots.
Now, to share an interesting piece of information. In yesterday's Johns Hopkins Bloomberg School of Public Health news feed there was a link to a piece about a report on flu shot effectiveness. The report that the blog had written about concluded that there was surprisingly little randomized trial evidence (the gold standard) of the effectiveness of flu shots--for almost any population and even for preventing excess transmission in hospital settings when hospital workers get vaccinated. The blog points out the history of how we ended up with influenza vaccination being recommended for the older adult population and how difficult it would be to ever go back and rethink policy. In short, the Surgeon General in 1960 made the recommendation and ever since then it has been considered unethical to withhold a recommended vaccine. The author of the linked blog entry calls flu shots a sales job.
Here is where economics and ethics may come together. Maybe if we could realize how many resources we may be over-utilizing, we could ask how it could be ethical to continue to use the resources without asking if it is efficient. In other words, is a known inefficiency unethical? Is a potential inefficiency unethical? Is acting like a supposition is fact without high quality data on the facts unethical? In any case, this would require some consultation with bioethicists and likely a new cost-effectiveness study based on the latest report showing the lack of data on the effectiveness of flu shots. Then we could use that to motivate a new study.
It is not a common use of a cost-effectiveness study but it would be extremely useful in this case.
Now, to share an interesting piece of information. In yesterday's Johns Hopkins Bloomberg School of Public Health news feed there was a link to a piece about a report on flu shot effectiveness. The report that the blog had written about concluded that there was surprisingly little randomized trial evidence (the gold standard) of the effectiveness of flu shots--for almost any population and even for preventing excess transmission in hospital settings when hospital workers get vaccinated. The blog points out the history of how we ended up with influenza vaccination being recommended for the older adult population and how difficult it would be to ever go back and rethink policy. In short, the Surgeon General in 1960 made the recommendation and ever since then it has been considered unethical to withhold a recommended vaccine. The author of the linked blog entry calls flu shots a sales job.
Here is where economics and ethics may come together. Maybe if we could realize how many resources we may be over-utilizing, we could ask how it could be ethical to continue to use the resources without asking if it is efficient. In other words, is a known inefficiency unethical? Is a potential inefficiency unethical? Is acting like a supposition is fact without high quality data on the facts unethical? In any case, this would require some consultation with bioethicists and likely a new cost-effectiveness study based on the latest report showing the lack of data on the effectiveness of flu shots. Then we could use that to motivate a new study.
It is not a common use of a cost-effectiveness study but it would be extremely useful in this case.
Seems to me that the recent experience with the change in USPSTF mammography guidelines provides some indication of the difficulty of revising recommendations like these. There seems to be such inertia in recommended care that even fairly compelling evidence of inefficiency/potential harm can be outweighed by path dependence.
ReplyDeleteAgreed. It is very hard to bring about change. And there is not only a lot of "knowledge inertia" but also a lot of money and that will be the subject of the next blog entry.
ReplyDeletethanks for sharing...
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