Intended for healthcare professionals


This House believes doctors are neglecting their duty to lead health service change: Proposer

BMJ 2009; 338 doi: (Published 21 April 2009) Cite this as: BMJ 2009;338:b1578
  1. Alan Maynard, professor of health economics, Department of Health Sciences, University of York
  1. akm3{at}

    At worst the doctor should do the patient no harm. At best they should practice EBM—in this case, economics based medicine—by focusing on the comparative cost effectiveness of competing interventions.1 EBM requires doctors to recognise the universal issue of opportunity cost, where a decision to treat one patient involves the denial of treatment to another patient. It also obliges the doctor to focus on value: the value of what they give up when they treat a patient (cost) and the value of what is gained as a result of treatment—hopefully improved length and quality of life for the patient. Clinical practice should …

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