In the broadcast, there is a real patient needing stroke rehabilitation and the choice of using either robotic-led exercise or a human therapist. Each has advantages and disadvantages, but there is has been little incentive or desire among the medical publishing establishment to publish cost-benefit analysis. One reason is the fear that published evidence might be cited by insurance companies in rejecting claims for a nearly-as-effective treatment that was more expensive. Also, cost factors are frequently cited as as an inhibitor of innovation. Yet no one denies that we have the most expensive health care system in the world, and Atul Gawande’s article “The Cost Conundrum: What a Texas town can teach us about health care” makes it painfully clear that defining health care costs for the purpose of choice is a pressing need.
“…journal editors avoid the topic because its controversial. And because editors are doctors,…they’re trained to think about what’s best for the patient, not what costs less….And, if there’s never anything that we read in the medical literature that has to do with cost, it might cause us not to think about the resources that we’re using.”
I now submit that open access journals are more inclined to publish something controversial that is based on credible evidence. PLoS Medicine published an article back in September 2007: Physician Awareness of Drug Cost: A Systematic Review.