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Mike Newdow wrote........
"We need to know the probabilities that admitting a generally
well-appearing patient with a given pleiocytosis will save bad things, and
then simply see if the cost of admission is below or above the cut-off."
 
You sound like you are a proponent of  a "nationalized" health care system,
much like our neighbours up north, where the government decides and rations
health care, based on available tax revenues. It sounds great but when you
start assigning probabilities to "badness" and determine "cut-offs",  you
also have to attach a $$ equivalent to every health state outcome, to do an
appropriate cost effective analysis.
 
To do that, the common method used is QALY's (quality of life years gained
per intervention), a very subjective scoring system. There are going to
huge soceital disagreements on what constitutes the most appropriate
quality of life for a child who often cannot state his or her choice. The
other problem is having the appropriate data from the literature to assign
probabilities for each outcome. Very often this data is lacking.
 
To me the only way is to individualize each case, present the facts and
probabilities as best you can to the parents and let them make an informed
choice. That is what I meant by the "art" of medicine. Moreover, I don't
think Dr. Kates was thinking of $$ saved when he was making the decision in
the trenches.
 
I commend Dr. Kates for being bold enough to present this case so  that
"arm chair" critics like myself could criticize the eventual management.
Things are always harder in the trenches!!  Would it be possible for you to
share the final results of the CSF culture with us and how the child
eventually did??
 
Thanks
 
Jay
 
Jay Pershad
"We care for wee folks"
 
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