Background

                  In order for health care to remain accesible and sustainable reorganisation of both medical care and societal inequities are being addressed in Govermental programs in The Netherlands. Capital is being reserved for programs addressing determinants of health starting at birth irrespective of economic background with aim of preserving good health as long as possible, thereby reducing health care consumption and societal spending on the long run in health care. Even though it remains to be seen to what extent such lifestyle interventions will result in a healthier society with better outcome and less health care expediture, on the long run, critical appraisal of health care as offered in the present can directly lead to a reduction in spending when widespread administration of low value care would be halted. This would not only lead to savings in health care, allowing immediate re-allocation of scarce funding, but will also protect patients from exposure to ineffective and maybe even harmful treatments.  

                  Modern Western medicine is increasingly characterized by overdiagnosis and over treatment. In (acutely) ill patients, medical interventions can lead to significant benefit. For almost all interventions, the greatest gain is in those with highest risk of poor outcome (e.g. treatment of severe hypertension benefits many, as opposed to treating mild hypertension, which benefits few, if any, but leads to high medical consumption). Costs of many new interventions are high. Even in affluent countries rising costs of medical interventions strain increasingly scarce resources and adequate analyses of costs in relation to effectiveness (value) should form the basis for optimizing patterns of resource allocation. However, adequate choices can only follow proper determination of effectiveness of an intervention. Adequate interpretation of medical data by physicians and policymakers is therefore crucial. However, medical education is lacking in adequate preparation of physicians to be able to critically appraise medical research. Physicians should be better prepared to view the impact of medical interventions in a broader scope. Also, when interventions turn out to be no better than a previous standard of care or placebo, it takes many years to abandon such therapies. This leads to ongoing exposure to patients to sometimes intensive treatments and society to waste of financial resources. To re-allocate funding to long term programs for improving health outcomes, choices of interventions in health care should be limited to interventions of high value. Choices should lead to sensible care. Sensible care equates judicious use of interventions in health care leading to an improvement in quality of life (QOL) and/or an increased overall survival (OS). Sensible care is affordable in its specific societal context.  Sensible care is refrainment from or termination of low value interventions, and sensible care is implementation of high value interventions.  

For this to be achieved, physicians need to be able to assess the relative merit of costly interventions without concomitant benefit. For example, even though spending on cancer care is very high in The Netherlands, the outcome of cancer patients is among the worst in high income countries. Fundamental understanding the limitations of medical advances in general and a clear understanding of the many factors at play in drug and medical device development is needed and should be taught during medical education. 

Our research and education program aims to both address shortcomings in evidence underlying development and implementation of (new) medical interventions (with special focus on oncology) as well as implementation of an educational program to better prepare medical students to critically interpret medical evidence, recognize underlying pitfalls and emphasize integration into the context of public health.