Quality is remembered long after the price is forgotten

In Uncategorized on March 15, 2009 by Hanna Tagged: , ,

BMJ’s blogs have been providing food for thought this week. Firstly a discussion of NICE’s research into the social value of the QALY (quality adjusted life year, a measure of health benefit where 1 QALY = 1 year of perfect health). It took too long  although this time not because of the many layers of procedure but because of confusion over what method to use. How do you find out what people want to pay for? And is this different if it’s their money that they are spending? The QALY threshold, bane of many an appraisal committee, is being pushed and pulled; big pharma saying it should be raised as health costs rise (although drug prices or at least those that the NHS will pay for are falling) and others argue that it should be lower as the number of drugs being paid for increase exponentially (the Richards review sped up cancer drugs reviewing). And yet when challenged on an international stage many want to follow where NICE lead: NICE international is working with the World Bank and the WHO to spread the word. When challenged in usually firey exchanges about NHS care we still lead the world at the patient reported outcomes stage as well.

I have seen a sneek peek at the future of health information: the new NHS evidence portal is very very different from NLH but does indeed incorporate all their hard work. Quality is the focus and the accreditation of the sources of guidance does sound a challenging process. There is now an email address for enquiries, NHS Evidence is now due to launch 30th April and will exist alongside NLH for a good few months before functionality is up and running.

Back to the BMJ blogs and two entries on what it is to be a man and conversely women sabotaging other women and their bid to lose weight through aggressive hospitality. The account of a woman bringing in the chocolate she cannot eat for her colleagues is like reading Michael Rosen’s poem about chocolate cake:

About a week into her abstinence I began to notice something surprising. Unable to eat chocolate herself she began to bring it into the office as a gift for others. It started off as a trickle: small bars of upmarket milk chocolate; a handful of truffles in a dandy box; a plate of diced chocolate brownies delicately dusted with icing sugar. But slowly the tide increased. She threw herself into nocturnal baking and rare was the day without some rich offering from her kitchen: Mississippi mud pies; Black Forest Gateaux; complex torta with dense variously-coloured strata of chocolate. Her industry was extraordinary. My first response was admiration. How noble of her, I thought, to give to others the good things she was denying herself, particularly as the sight of their pleasure must have quickened her own longing. But as the tide of chocolate rose to a flood, it was impossible to ignore the susurrus of complaint that began to rise from the other women – women on the whole younger and slimmer than their benefactress. It did not help that on presenting her gift she would remain in the office until the eating had begun, and that demurral evoked signs of slight but noticeable displeasure. Whatever was going on, there was clearly more to it than simple generosity

I’m not exactly sold on gender specific emotional complexity nor love of chocolate (my other half being a regular of the best London chocolate emporia). We have taxed alcohol and tobacco so why not tax cake as well?


4 Responses to “Quality is remembered long after the price is forgotten”

  1. Interesting post. I love behavioural phenomena and feel that ‘aggressive hospitality’ will work its way into everyday usage. I think we learned in Psych that food sharing is a hallmark of people with eating disorders–being food obsessed but restrictive with their own eating so offering plenty of food to others.

    Just saw a news story on Channel 4 news on teachers policing children’s lunch boxes for biscuits and crisps and removing these. Yikes.

  2. Oh oh oh… please do try and find a wee bit of time for another post and tell us a bit about NHS Evidence. I, for one, am immensely curious. And it is rather curious, isn’t it, to see how jolly foreigner view the NHS and NICE. The opinion seems to be either that it’s an example of socialist health care and therefore to be lumped in with other leftist mass murderers, such as Stalin or Mao Tse-Tung, or it’s all just so wonderful and equitable and sustainable that yes, we all ought to be doing it. Being British, of course, we just moan about it, regardless of how good or bad it is. It’s what makes us happy.

  3. Hi Hannah
    I’d really love it if you would think about submitting this to the MedLib’s Round blog carnival this month, which is themed around evidence.

    More details here:

    Please pass the word to the other Health Informaticist guys, too.

    Best wishes


  4. […] for good or for ill, in their assessment. Hanna Lewin, of the health informaticist, highlights the social value of the Quality Adjusted Life Year (and reveals a little bit about NHS Evidence); Dr Shock considers the (lack of) use of scales to […]

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