Comparative Effectiveness: Humanities Initiative Grant Awarded to the Center for Bioethics

The Indiana University Center for Bioethics (IUCB) has recently been awarded a $1,300 Humanities Initiative Grant for a new Comparative Effectiveness (CE) project. The official title of the project is, “Ethical and Social issues in Comparative Effectiveness Research: How the Humanities can Contribute to the Developing National Conversation about Research Reform.” It is Co-sponsored with IU School of Liberal Arts, Department of Philosophy and the IU-School of Law Indianapolis, Hall Center for Law and Health and works closely with the School of Public and Environmental Affairs, Center for Health Policy.

Current discussion of healthcare reform emphasizes the importance of determining what drugs, treatments, and procedures work best, in order to improve healthcare and control spending. However, carrying out CE research and healthcare raises crucial ethical, legal, and social issues. Measuring “effectiveness” requires quantifying and comparing diseases, disabilities, and suffering, which raises profound moral questions about how society should make these assessments and then utilize them. The technical aspect of CE assessment can be done by mathematicians, statisticians, and economists. However, the corresponding ethical, legal, and social issues can only be addressed through conversations amongst the humanities and social sciences.

The need to conduct comparative effectiveness research and use it as a cornerstone in healthcare reform stems from recognition that healthcare in the United States excessively adopts forms of testing and treatment that are expensive and ineffective. CE can involve complex questions and tradeoffs. In many cases the most effective treatment is also the most expensive, leading to questions about when an increase in effectiveness is worth an increase in cost. For instance, an extremely expensive drug for treating cancer may cost hundreds of thousands of dollars per patient but extend life by only a few months. When insurance companies cover such treatments the costs rise and more people go without health insurance. The uninsured and under-insured then forgo treatments that are most effective and inexpensive. Instead, they end up in the emergency room much sicker than they would have been and requiring much more expensive care. As health care costs keep rising there is a need to know what we have to show for it.

The IUCB collaborative project comprises of two substantial efforts. It will host at least two public lectures by prominent humanities experts focusing on the ethical, legal, and social issues raised by comparative effectiveness research. It will also convene a year-long Comparative Effectiveness Study Group (CESG) from September 2009 – May 2010. CESG will read the most important literature on the ethical, legal, and social issues raised by CE research. The goals of both projects are to produce academic publications. Contribute to informed policy development within the state, and provide the public with additional knowledge to aid in their own deliberations on these issues. Experts from different areas of the humanities will provide leadership including: Eric Meslin PhD (Philosophy, IUCB), Peter Schwartz MD, PhD (Philosophy, IUCB), Eleanor Kinney, JD (Law School), Ralph Hall JD (Law School), Jason Eberl PhD (Philosophy), and Eric Wright PhD, (Health Policy, SPEA).

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