In Reply: Dr Baral is correct in her assessment that many improved technologies and medicines, although costly, are effective. However, the key is to use them at the right time, in the right way, and for the right patient. To use the example she cites, for patients with acute ST-segment elevation myocardial infarction, angioplasties are lifesaving, preserve heart muscle, and thus reduce the risk of future congestive heart failure, and are almost always considered appropriate.1 However, only 50% of non–acute percutaneous coronary interventions are clearly appropriate,1 representing a costly misuse of medical resources.
Webster JR. Cost of Health Care and the Role of Physicians—Reply. JAMA. 2012;307(12):1253. doi:10.1001/jama.2012.355
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