“Research ethics and health care reform”, a stunning letter written by James Kahn, a professor in Health Policy and Epidemiology University of California, and Paul Hofmann, president of the Hofmann Health Group with a Ph.D. in Public Health, was published in the June 19th issue of Science.
Bottom line of the letter- it is unethical to research and write on partial fixes to the multi-payer system of health care in the USA when we already have plenty of compelling evidence that single payer health care systems improve patient outcomes, serve more people, and do it more economically than multi-payer systems.
Kahn and Hofmann wrote the letter in response to a Policy Forum essay by Amy Finkelstein and Sarah Taubman published in Science in February, 2015. “Randomize evaluations to improve health care delivery” made the point that too few randomized control trials for U.S. health care reform research means there is not enough solid research to base policy on. Kahn and Hofmann do not disagree with this, but say it is a secondary problem to a “major ethical breach.”
The ethical breach defined by Kahn and Hofmann is based on the “principle of equipoise,” which says that deviations from the standard of care are allowable in research with humans only if there is real uncertainty about which intervention is better. Because there is enough research to conclude that single payer healthcare works better, further experiments and trials to define the better system are unethical.
“To ignore this compelling evidence risks lives in the United States as we experiment with partial fixes to the multi-payer system. This experimentation would be rejected by any responsible university institutional review board as violating the principle of equipoise and causing unacceptable patient harm.”
Strong words- and hopefully, they will be spoken by more scientists, physicians, researchers, and academics. The development of drugs and vaccines, research on surgeries and devices, basic work on cell physiology, applied genomics research to target individuals health problems, social and psychological health interventions- all are funneled in the USA through the health care system. And in this system, where money can purchase excellent care for some, while others must hold bake sales and run crowd sourcing campaigns on line to pay for medicine, not all people will benefit from your research.
Most people don’t go into medicine or research to impact only the lives of people who can afford good health insurance. Single payer health care will mean that more people can be served by your work.