Or…..we have to eat too!
“Pareto Economics: Research Ethics And Law Violations In Interventional Continuous Quality Improvement (CQI) Reports”
Recent reports offer examples of efficiency driven non therapeutic CQI projects in Anesthesia and Critical Care (1,2,3). These reports describe innovations in process designed to conserve resources but with no intent to improve the outcomes of the patients involved in the reports. I expect those health care providers involved in implementing these processes did not conceptualize that they were involved in the involuntary taking of quality from the involved patients…. kind of like eminent domain when they take your house for the new highway (or shopping center). This is actually a medical form of Pareto economics.
This conservation and reallocation of resources assumes that the Pareto Improvements (4,5,6) in an economic system depicted in the figure are both ethical and legal in health care process innovation notwithstanding the constitutional protections when it comes to eminent domain.
Pareto Economics. In an economic system a Pareto improvement occurs if a person made better off can compensate a person potentially worse off such that resources remain after such compensation. This is used to lawfully justify public policy of building roads. If a property must be taken by eminent domain to promote the public good, the American Constitution provides that just compensation must be provided. As everyone knows this taking of property certainly involves awareness of the “takee” with a due process recourse. Too bad the patients suffering involuntary taking of quality are seldom aware and have little recourse for appeal or for compensation. This leads to the notion that not CQI but CQD is the process of our time… a time wherein health care costs are predicted to double. That will never happen. After all as a society, we have to eat, provide for the common defense, and make sure our CEOs are well fed.
Conclusion. The creation of undisclosed Pareto trade offs in health care clash with individual rights to previously agreed upon contractual services in medical care and may constitute unethical and illegal human experimentation. For maintenance of professional integrity and public confidence in the medical profession, medical organizations should begin public disclosure of the CQD decisions that are undertaken in our clinical practices. In addition, editorial boards of peer-reviewed journals should review their policies concerning ethical review of CQI/CQD type interventional reports
1. Anesthesiology 91:83947,1999
2. Anesth Analg 96:1104-8,2003
3. J Trauma 46:6259, 1999
4. J Health Econ16:131,1997
5. JAMA 276:11727,1996
6. Am J Respir Crit Care Med 165:54050,2002
8. Crit Care Med 31(suppl):S143-52,2003
9. Curr Opin Crit Care 3:329-33,1997