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EDITORIALS:
John Young
Ageism in services for transient ischaemic attack and stroke
BMJ 2006; 333: 508-509 [Full text]
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[Read Rapid Response] Ageism or cost/benefit analysis ?
Michael A McDowall   (8 September 2006)

Ageism or cost/benefit analysis ? 8 September 2006
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Michael A McDowall,
Stroke Registries Co-ordinator
University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU

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Re: Ageism or cost/benefit analysis ?

Dear Editor,

John Young raises the question of Ageism in his editorial commenting "Ageism will always prosper when resources are inadequate for the target population."

Hmm, is this really Ageism, or is it application of a cost-benefit analysis ? Spending the limited resources where the greatest benefits will accrue ?

I suspect most "Ageism" in the system is based on the belief that the greatest benefit over cost is obtained by a subconscious estimation of something like Quality Adjusted Life Years. There may be a further subconscious estimation of the economic contribution a patient may make. Doesn't sound too bad - so let's have a proper debate about how to measure benefit reasonably dispassionately.

The main problem I see is a failure to face up to reality : we cannot provide a perfect health service; resources will always be inadequate; what we really need is transparency in admitting this and a fair system for allocating what resources are available.

My guess is that the situation will get worse. Health care costs will rise as research produces more treatments. I'd also guess that the money available will reduce as world resources become stretched - I believe the recent rises in energy costs are indicative of what we will face in the future. We may need a fairer system much sooner than we hope.

Yes, there may be discrimination within our system. Yes, it may be unfair. Before we can deal with that, we must face up to the reality of resource restrictions, recognize the (potential) need for rationing, and devise fair systems for implementing it.

Too politically unpalatable ? OK - that vision leads to a future with continued pointless efforts to expose and deal with "unfair" discrimination, when the disease is much more fundamental.

Yours faithfully,

Mike McDowall.

Competing interests: None declared