Valuing the well connected

doi:10.1136/bmj.a1675

Published 23 September 2008, doi:10.1136/bmj.a1675
Cite this as: BMJ 2008;337:a1675

Observations

Only Connect

Valuing the well connected

Nicholas A Christakis, professor of medical sociology, Harvard Medical School, and attending physician, Mt Auburn Hospital, Cambridge, Massachusetts

christak@hcp.med.harvard.edu

Should the healthcare system favour people whose treatment ismore likely to also benefit those around them?

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

When illness in one person is treated or prevented, others towhom that person is connected also benefit. Replacing an elderlyman’s hip or providing better terminal care for a womanimproves the health of their spouses. Getting people to loseweight or quit smoking encourages their friends to do likewise.Treating depression in one man makes those around him happier.Vaccinating part of a population benefits everyone.

All these effects are reflections of our embeddedness in vastsocial networks involving our fellow human beings. The benefits(and costs) of healthcare interventions can ripple through thenetwork, creating additional benefits (and costs) for othersboth near and far.

But the better connected that people are—the more familyand friends they have, and the more central they are in thenetwork—the larger these effects. If we were to replacethe hip of a hermit or get him to quit smoking no . . . [Full text of this article]

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Rapid Responses:

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The well connected and prevention: Pawan Randev
bmj.com, 27 Sep 2008 [Full text]
Prioritising the well-connected has grave implications: Dylan J Summers
bmj.com, 28 Sep 2008 [Full text]
Dr Christakis uses a hermit to explain his question, interestingly a hermit from literature tried to answer his question in 1885: Craig Stangroom
bmj.com, 29 Sep 2008 [Full text]
Health and Life: Hugh Mann
bmj.com, 29 Sep 2008 [Full text]
Using people as means rather than ends: David N H Greig
bmj.com, 29 Sep 2008 [Full text]
Encourage connectedness rather than selecting for it.: Stephen J Cotton
bmj.com, 30 Sep 2008 [Full text]
Public health measures: Peter M English
bmj.com, 3 Oct 2008 [Full text]
Ethical conflict: Andre Crismer
bmj.com, 23 Oct 2008 [Full text]
Modern times: Vijay Kumar
bmj.com, 29 Oct 2008 [Full text]