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QALYs: Their Ethical Implications

David A. Danford, MD
JAMA. 1990;264(19):2503. doi:10.1001/jama.1990.03450190032017.
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To the Editor.—  The Special Communication by La Puma and Lawlor1 attempts to discredit the use of the quality-adjusted life-year (QALY) as a quantitative method of outcome assessment in medicine. At the crux of their arguments is the issue of control of medical practice through allocation of scarce resources, and how the QALY might be applied by forces outside the physician/ patient dyad to restrict access to care. The article conjures a vision of an army of cost-effectiveness analysts, perhaps based in government and the insurance industry, whose primary interest is cost-containment and the development of policies to achieve it. This perceived army is poised to apply its new weapon, the QALY (the weaknesses of which they don't understand or choose to ignore), to wrest the control of medical practice from those most directly involved, the patient and the physician. For this, the authors indict the QALY as problematic, speculative,


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