Suppose there are two medical treatments for a disease. The scientific evidence says they both work the same. But one costs four times as much as the other.

Should insurers pay for both treatments, and leave doctors and patients to decide between them which they want? Or should insurers pay only for the cheaper treatment?

That medical treatment issue is an example of a health policy question that raises serious ethical issues that was discussed by two disparate groups in a new study conducted by the University of Texas Medical Branch at Galveston.

UTMB researchers are hopeful that discussions among non-health care communities may provide insight to the ethical questions that can arise with rising costs and emerging technologies and procedures.

Researchers also want to learn more about how people in different social circles form opinions or make decisions about their health care. That could help shape health policy.

The study is part of a project overseen by Dr. James Goodwin, UTMB vice president and chief research officer and funded by the Patient Centered Outcomes Research Institute. To complete the study, UTMB faculty worked with two different communities in Galveston.

One organization that signed on was St. Vincent’s House. The other community group was a collaboration between the Galveston Association of Island Neighborhoods and the Galveston Citizens Police Academy Alumni Association.

“We approached both groups for guidance and help identifying likely participants,” said Dr. Howard Brody, study coordinator and director of the Institute for the Medical Humanities at UTMB. “The participants spoke for themselves; we did not ask them to represent their organizations or anyone else.”

Both groups were provided information about the topic — patient-centered outcomes research and comparative effectiveness research. They were presented with various case studies illustrating the ethical questions.

Each group was asked to produce a report summarizing their ethical values, in a form that could be used to guide future health policy.

“It happened that each group was able to produce a report that members unanimously endorsed,” Brody said. “But we stressed that we were not after consensus; if there were serious differences, and people wanted to write dissenting or minority reports, they were free to do so.”

Participants appeared pleased with how the dialogues went. “They seem to agree that they want to do this again, tackling new ethical issues in the future,” Brody reported. “Most said that they had not had a chance to engage in this kind of special dialogue in the past, where you stick with a topic and really dig down to understand it from all angles.”

The two reports agree on a lot of ethical ideas, Brody stated. The UTMB study team now has the task of analyzing the reports in detail to study similarities and differences.

“Both groups agreed on the importance of solid relationships between patients and care providers, and the ethical need to control costs so that health care remains affordable,” Brody summarized. “I was most interested in one apparent difference. The group at St. Vincent’s spent a lot more time discussing how much you believe scientific evidence about what works in medicine, and how much you believe the personal testimony of one of your neighbors who has had a treatment and swears by it. From a scientific viewpoint, personal testimony like that is considered next to worthless. But our dialogue participants didn’t believe in completely discounting it, even though they understood the science.”

That could be an example, Brody added, of how an idea that might never arise in an academic debate among “experts” could emerge from community dialogue.

“Nowhere in the U.S., right now, is there regular engagement of ordinary citizens in bioethics dialogue in a sustained manner,” Brody observed. “We are trying to show at UTMB, taking advantage of the cultural diversity of our region, that this is a feasible way to enrich bioethics debate in the future.”