Is there a meaningful definition of the value of a statistical life?

A definition of the value of a statistical life is derived. This definition has a meaningful interpretation in terms of the monetary value of expected present value utility if consumption is age-independent. In all other cases, empirical estimates of the value of a statistical life are biased estimators of the monetary counterpart to expected present value utility.     

Are estimates of the value of a statistical life exaggerated?

The magnitude of the value of a statistical life (VSL) is critical to the evaluation of many health and safety initiatives. To date, the large and rigorous VSL research literature has not explicitly accommodated publication selectivity bias (i.e., the reduced probability that insignificant or negative VSL values are reported). This study demonstrates that doing so is essential. For studies that employ hedonic wage equations to estimate VSL, correction for selection bias reduces the average value of a statistical life by 70-80%. Our meta-regression analysis also identifies several sources for the wide heterogeneity found among reported VSL estimates.     

Is there additional value attached to health gains at the end of life? A revisit

Researchers have in recent years sought to establish whether the general public value treatment at the end of life (EOL) more highly than other treatments. Results are mixed, with social preferences most often exhibiting lack of preferences for EOL treatments. This null result may be driven by the often applied study design, where respondents are to choose between treatments targeting patients with varying fixed life expectancies. When remaining life is certain and salient, a rule‐of‐rescue sentiment may drive preferences across all scenarios. This study presents a different design, where the comparator is a preventive intervention. We study preferences from both an individual and social perspective and find no preference for an EOL premium.     

Does air pollution trigger suicide? A case-crossover analysis of suicide deaths over the life span

In addition to underlying health disorders and socio-economic or community factors, air pollution may trigger suicide mortality. This study evaluates the association between short-term variation in air pollution and 10 years of suicide mortality in Belgium. In a bidirectional time-stratified case-crossover design, 20,533 suicide deaths registered between January 1st 2002 and December 31st 2011 were matched by temperature with control days from the same month and year. We used municipality-level air pollution [particulate matter (PM₁₀) and O₃ concentrations] data and meteorology data. We applied conditional logistic regression models adjusted for duration of sunshine and day of the week to obtain odds ratios (OR) and their 95% CI for an increase of 10 µg/m³ in pollutant concentrations over different lag periods (lag 0, 0–1, 0–2, 0–3, 0–4, 0–5, and 0–6 days). Effect modification by season and age was investigated by including interaction terms. We observed significant associations of PM₁₀ and O₃ with suicide during summer (OR ranging from 1.02 to 1.07, p-values <0.05). For O₃, significant associations were also observed during spring and autumn. Age significantly modified the associations with PM₁₀, with statistically significant associations observed only among 5–14 year old children (lag 0–6: OR = 1.45; 95% CI: 1.03–2.04) and ≥85 years old (e.g. lag 0–4: OR = 1.17; 95% CI: 1.06–1.29). Recent increases in outdoor air pollutants such as PM₁₀ or O₃ can trigger suicide, particularly during warm periods, even at concentrations below the European thresholds. Furthermore, PM₁₀ may have strong trigger effects among children and elderly population.     

Is suicide contagious? A study of the relation between exposure to the suicidal behavior of others and nearly lethal suicide attempts.

This study sought to determine the association between nearly lethal suicide attempts and exposure to the suicidal behavior of parents, relatives, friends, or acquaintances and to accounts of suicide in the media. The authors conducted a population-based case-control study in Houston, Texas, from November 1992 through July 1995. They interviewed 153 victims of attempted suicide aged 13--34 years who had been treated at emergency departments in Houston and a random sample of 513 control subjects. After controlling for potentially confounding variables, the authors found that exposure to the suicidal behavior of a parent (adjusted OR = 1.5; 95% CI: 0.6, 3.6; p = 0.42) or a nonparent relative (adjusted OR = 1.2; 95% CI: 0.7, 2.0; p = 0.55) was not significantly associated with nearly lethal suicide attempts. Both exposure to the suicidal behavior of a friend or acquaintance (adjusted OR = 0.6; 95% CI: 0.4, 1.0; p = 0.05) and exposure to accounts of suicidal behavior in the media (adjusted OR = 0.2; 95% CI: 0.1, 0.3; p = 0.00) were associated with a lower risk of nearly lethal suicide attempts. Exposure to accounts of suicidal behavior in the media and, to a lesser extent, exposure to the suicidal behavior of friends or acquaintances may be protective for nearly lethal suicide attempts, but further research is needed to better understand the mechanisms underlying these findings.     

A question of value. What does ethics contribute to the life and work of an organization?

In faith-based healthcare, the scope of ethics reaches beyond clinical ethics-which, up to now, has been its primary focus-to encompass the entire culture of the organization and all its relationships. Consequently, sustained attention to ethics contributes to the life of, and adds value to, the organization. Ethics' role is to articulate the beliefs and values that are to be embodied in the organization's culture, given its fundamental commitments. Ethics devises methods for shaping and nurturing the culture, and has a role in periodically assessing the state of the organization's relationships, both external-with other healthcare entities, the community, and society-and internal-with employees and patients. Further, ethics shapes the relationships the organization's associates have with each other and with the organization. Attention to ethics encourages improvement in the moral quality of the interactions within the organization; provides an opportunity for moral growth; creates a climate in which ethical issues are dealt with, not ignored; and, over time, creates a community of moral discourse.     

Does prevention save costs? Considering deferral of the expensive last year of life

Published cost-effectiveness analyses may overstate the cost-effectiveness ratio of preventive care if they do not explicitly model the costs of the last year of life, which is postponed by prevention. To determine the degree of overestimation, the authors built a statistical model using Medicare expenditure data on survivors and decedents. The model shows that the cost-effectiveness ratio of prevention may decrease by up to US$ 11,000 per quality-adjusted life year saved when expenditure data on the last year life are used. The model is able to explain more than half of the median cost increase of published cost-effectiveness analyses on clinical preventive services.     

Is clinical pathology accreditation worth it? A survey of CPA-accredited laboratories

Following two pilot studies, Clinical Pathology Accreditation (CPA) accreditation was introduced to UK pathology laboratories in 1992. Since then, significant numbers of laboratories have undergone accreditation but many have never applied. We carried out a postal survey of 145 accredited laboratories in the UK to independently determine the opinions of laboratory managers/clinicians about CPA and whether accreditation had produced any significant benefits to pathology services. Ninety-three replies were received (64 per cent) a good response to an unsolicited questionnaire. Most laboratories felt accreditation by CPA had resulted in better laboratory performance with more documentation and better health and safety and training procedures. CPA accreditation was believed to provide useful information by approximately 50 per cent of laboratories but was also felt by a significant proportion of laboratories to be over-bureaucratic, inefficient and expensive (46 of 93 respondents). Many complaints were voiced about the excessive paperwork that CPA generated and there was also a significant body of opinion that felt that CPA assessed areas were the domain of other regulatory bodies such as the CPSM, IBMS and HSE.     

Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives

In a survey of 568 physician members of the American College of Physician Executives (ACPE), most of whom had advanced management degrees (MBA, MMM, MPH), approximately 90% of respondents reported that their investment in the education was "worth it." The return on investment was independent of the quality of the academic institution, although primary care physicians stood to gain more relative to specialists. Salary comparisons showed that female physicians had approximately 20% lower incomes than male physicians, confirming the presence of a "glass ceiling" for female physician executives as seen in other medical specialties. These findings have implications for early and mid-career physicians and physician recruiters.     

Is a telephone helpline of value to the workplace smoker?

This paper reports the findings of the evaluation of a nationalsmokers' helpline which was set up by British Telecom (BT) forits employees. The helpline formed part of a new comprehensivesmoking policy for all BT staff. Over 1000 employees, more than3.0% of all smokers, phoned the helpline during the first threemonths of its operation. Two-thirds of callers tried to quitsmoking after calling the helpline, and a quarter were stillsuccessful three months later. One in six callers reduced thenumber of cigarettes that they smoked on working days. Whilethe helpline and other cessation support services were evaluatedpositively by callers, it appears that helplines only appealto a small minority of smokers. However, they do seem to bean effective mechanism for a nationwide company to identifythose smokers who want support, and a useful means of centralizingthe administration of support services. They are potentiallya cost-effective option for larger employers.     

Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges

Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions.Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006–2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers.619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CCA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified.     

Vitamin D for the prevention of preeclampsia? A hypothesis

Preeclampsia has been suggested to result from a partial breakdown of tolerance to the developing fetus after maternal immune maladaptation. Several of the proposed immunomodulatory properties of the hormonal vitamin D system could potentially have beneficial effects for successful maintenance of pregnancy. Preeclampsia is characterized by marked changes in vitamin D metabolism. This paper reviews the evidence suggesting that the immunomodulatory properties of 1,25(OH)2D may play a key role in maintaining immunological tolerance in pregnancy, and proposes that ensuring adequate vitamin D status/intake may help in the prevention and management of preeclampsia.