Ageism in services for transient ischaemic attack and stroke: Ageism or cost-benefit analysis?

doi:10.1136/bmj.333.7569.656-b

BMJ 2006;333:656 (23 September), doi:10.1136/bmj.333.7569.656-b

Letter

Ageism in services for transient ischaemic attack and stroke

Ageism or cost-benefit analysis?

The first 150 words of the full text of this article appear below.

EDITOR—Young comments that ageism will always prosperwhen resources are inadequate for the target population.¹ Isthis really ageism, or is it application of a cost-benefit analysis—spendingthe limited resources where the greatest benefits will accrue?

I suspect that most "ageism" in the system is based on the beliefthat the greatest benefit over cost is obtained by a subconsciousestimation of something like quality adjusted life years. Theremay be a further subconscious estimation of the economic contributiona patient may make. Doesn't sound too bad—so let's havea proper debate about how to measure benefit reasonably dispassionately.

The main problem I see is a failure to face up to reality: wecannot provide a perfect health service. Resources will alwaysbe inadequate: what we really need is transparency in admittingthis and a fair system for allocating the resources available.

My guess is that the situation . . . [Full text of this article]

Michael A McDowall, stroke registries coordinator

University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU m.a.mcdowall@ed.ac.uk