Intended for healthcare professionals


Tight control of blood glucose in long standing type 2 diabetes

BMJ 2009; 338 doi: (Published 06 March 2009) Cite this as: BMJ 2009;338:b800

Re: Re: Re: Re: Ethics of QOF

Dr. Lewis,

You do not seem to understand the specific ethical concern I
expressed. You state that the scheme is voluntary yet you make repeated
reference to the importance of the cash provided by your meeting QOF
targets. It is fortunate that you personally agree with the
interpretations of the data that led to current targets but the point I
was trying to raise was that in situations where reading of evidence is
controversial (and you concede there is often more than one
interpretation), financial incentives will unacceptably bias decision

You do not need me to raise the issues of publication bias and
pressures from pharmaceutical companies as a reminder that the apotheosis
of EBM is hazardous. I fear a time when doctors will be rewarded for
adhering to targets concerning number of referrals or discharges per year.
("Would it not be unethical to reward doctors equally, whether or not they
rationed NHS resources efficiently?"- might go its defence).

Competing interests:
None declared

Competing interests: No competing interests

21 April 2009
Edward TJ Chandy
Medical Student
Edinburgh University Medical School EH16 4SB