{"id":3697,"date":"2020-02-26T12:14:13","date_gmt":"2020-02-26T11:14:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3697"},"modified":"2020-02-26T12:15:39","modified_gmt":"2020-02-26T11:15:39","slug":"why-care-about-severity","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/02\/26\/why-care-about-severity\/","title":{"rendered":"Why care about severity?"},"content":{"rendered":"<p>By <a href=\"https:\/\/www.researchgate.net\/profile\/Mathias_Barra2\">Mathias Barra<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/marbr97\">Mari Broqvist<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/erigu18\">Erik Gustavsson<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/marhe38\">Martin Henriksson<\/a>, <a href=\"https:\/\/staff.ki.se\/people\/nikjut?_ga=2.203644304.1831865.1581943800-1793220187.1549368849\">Niklas Juth<\/a>, <a href=\"https:\/\/www.researchgate.net\/profile\/Lars_Sandman\">Lars Sandman<\/a>, and <a href=\"https:\/\/www.researchgate.net\/profile\/Carl_Tollef_Solberg\">Carl Tollef Solberg<\/a><\/p>\n<p>In an ideal world, everyone one of us would receive medical treatments in a timely manner, in the best possible way. There would be an unlimited number of organs available for transplantation. There would be enough health workers everywhere, and they would have sufficient time and knowledge to take care of each and every one of us. We would all live long and meaningful lives, and inequity in the distribution of health would be non-existent. This is not the world we find ourselves in. No resource is unlimited, and no effect is granted. Even in the world\u2019s wealthiest countries, we need to prioritize.<\/p>\n<p>As a starting point, any intervention should at least have some positive health effects. During the later years, so-called flat-of-the-curve medicine and overtreatment have received increasing attention. However, effective medicine also comes at a cost, and there is broad consensus in public health care systems that the relationship between effects and costs should be reasonable, inducing a cost-effectiveness criterion for practical priority setting guidelines. Specific willingness to pay thresholds are highly controversial. Yet, most scholars acknowledge \u00a0that at least some weight must be placed on the relationship between costs and benefits (this includes ourselves and Daniel Hausman). So far, so good.<\/p>\n<p>The critical question is: Is cost-effectiveness everything that matters? Here in Scandinavia, public authorities have on several occasions said no to new cancer treatments, citing that it is too expensive in relation to the effect one can realistically hope for. At the same time, some new cancer drugs are offered, although the drugs will most likely displace less expensive and more effective treatments. Overall, we can say that there is (at least) one major controversy in the Scandinavian priority setting debate, and that is <em>severity<\/em>. It is stipulated in our laws that, in addition to the expected cost-effectiveness, we must also take into account the <em>severity<\/em> of the target condition. In colloquial terms, this means that we are willing to offer less cost-effective treatment than we really think society can afford if those who receive the treatment suffer a sufficiently severe condition.<\/p>\n<p>Prioritizing severity, however, is somewhat a truism. Severity refers to something very bad, unpleasant, and serious. We say things like \u201cthey were all shocked by the severity of her injuries,\u201d and \u201che did not understand the severity of his situation.\u201d The very intent is to underline that there was something extraordinary going on. And, indeed, extraordinary situations should receive extraordinary attention. But do we agree on what qualifies as severe?<\/p>\n<p>Another problem with the concept of severity arises when people mean <em>almost<\/em> the same thing. An apparent agreement on severity as a priority setting criterion can lead to conflict in specific cases without properly acknowledging why we disagree.<\/p>\n<p>Daniel Hausman has argued (in the <a href=\"https:\/\/jme.bmj.com\/content\/45\/8\/545\">JME<\/a>) that academics like ourselves should give up the severity criterion in priority setting. We disagree (e.g., in our <a href=\"https:\/\/jme.bmj.com\/content\/early\/2020\/02\/25\/medethics-2019-105870\">JME response<\/a>, and more indirectly in <a href=\"https:\/\/link.springer.com\/article\/10.1007\/s10728-019-00371-z\">this article<\/a>). We have recently been granted funding from the Norwegian Research Council for the research project S<em>everity and priority setting in health care (<\/em><a href=\"https:\/\/www.researchgate.net\/project\/SEVPRI-Severity-and-Priority-Setting-in-Health-care\"><em>SEVPRI<\/em><\/a><em>).<\/em> The aim of SEVPRI is to help improve the public\u2019s understanding of what ordinary people think about severity in general, and in conjunction with priority setting in particular. We also want to examine how close today\u2019s standard health-economic models come to representing Tom, Dick, and Harry\u2019s views on the equitable distribution of health resources. Through SEVPRI, our hypothesis is that severity will prove ethically significant and that Hausman is wrong in his statement that we should give up severity altogether. So, do not despair about severity \u2013\u00a0yet!<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Paper title<\/strong>: <a href=\"https:\/\/jme.bmj.com\/content\/early\/2020\/02\/25\/medethics-2019-105870\">Do not despair from severity \u2013\u00a0yet!<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Author:<\/strong><\/p>\n<p><a href=\"https:\/\/www.researchgate.net\/profile\/Mathias_Barra2\">Mathias Barra<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/marbr97\">Mari Broqvist<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/erigu18\">Erik Gustavsson<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/marhe38\">Martin Henriksson<\/a>, <a href=\"https:\/\/staff.ki.se\/people\/nikjut?_ga=2.203644304.1831865.1581943800-1793220187.1549368849\">Niklas Juth<\/a>, <a href=\"https:\/\/www.researchgate.net\/profile\/Lars_Sandman\">Lars Sandman<\/a>, and <a href=\"https:\/\/www.researchgate.net\/profile\/Carl_Tollef_Solberg\">Carl Tollef Solberg<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Affiliations<\/strong>:<\/p>\n<p>Mathias Barra, PhD, The Health Services Research Unit \u2013 H\u00d8KH, Akershus University Hospital, Norway. ORCID: 0000-0002-0022-4042<\/p>\n<p>Mari Broqvist, PhD, Department of Medical and Health Sciences, The national Centre for Priority Setting in Health Care, Link\u00f6ping University, Sweden. ORCID: 0000-0002-1664-9846<\/p>\n<p>Erik Gustavsson, PhD, Centre for Applied Ethics, Department of Culture and Communication; Division of Health Care Analysis, Department of Medical and Health Sciences, Link\u00f6ping University, Sweden. ORCID: 0000-0001-5448-9209<\/p>\n<p>Martin Henriksson PhD, Center for Medical Technology Assessment, Department of Medical and Health Sciences Link\u00f6ping University, Sweden. ORCID: 0000-0003-1699-3185<\/p>\n<p>Niklas Juth, PhD, Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Sweden. ORCID: 0000-0002-1339-4956<\/p>\n<p>Lars Sandman, PhD, The National Centre for Priorities in Health, Department of Medical and Health Sciences, Link\u00f6ping University, Sweden. ORCID: 0000-0003-0987-7653<\/p>\n<p>Carl Tollef Solberg, MA, MD, PhD, Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway. ORCID: 0000-0003-3321-3793<\/p>\n<p><strong>Competing interests<\/strong>: None declared.<\/p>\n<p><strong>Social media accounts of post author:\u00a0<\/strong><\/p>\n<p><a href=\"https:\/\/www.researchgate.net\/profile\/Mathias_Barra2\"><em>Mathias Barra<\/em><\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/marbr97\">Mari Broqvist<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/erigu18\">Erik Gustavsson<\/a>, <a href=\"https:\/\/liu.se\/en\/employee\/marhe38\">Martin Henriksson<\/a>, <a href=\"https:\/\/staff.ki.se\/people\/nikjut?_ga=2.203644304.1831865.1581943800-1793220187.1549368849\">Niklas Juth<\/a>, <a href=\"https:\/\/www.researchgate.net\/profile\/Lars_Sandman\">Lars Sandman<\/a>, and <a href=\"https:\/\/www.researchgate.net\/profile\/Carl_Tollef_Solberg\">Carl Tollef Solberg<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Mathias Barra, Mari Broqvist, Erik Gustavsson, Martin Henriksson, Niklas Juth, Lars Sandman, and Carl Tollef Solberg In an ideal world, everyone one of us would receive medical treatments in a timely manner, in the best possible way. There would be an unlimited number of organs available for transplantation. There would be enough health workers [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/02\/26\/why-care-about-severity\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2143,8057,7988],"tags":[],"class_list":["post-3697","post","type-post","status-publish","format-standard","hentry","category-distributive-justice","category-medical-ethics","category-regulation-and-regulators"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Why care about severity? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/02\/26\/why-care-about-severity\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why care about severity? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Mathias Barra, Mari Broqvist, Erik Gustavsson, Martin Henriksson, Niklas Juth, Lars Sandman, and Carl Tollef Solberg In an ideal world, everyone one of us would receive medical treatments in a timely manner, in the best possible way. 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