Asume we live in a world of fixed amounts of investments. The option to invest in a new project or product will automatically reduce the amount of investment in another product. The investment decision, therefore, is subject to opportunity costs. A recent study by Naci et al. (2025) applies this rationale to the investment in new drugs compared to financing other traditional treatments. The results for the U.K between 2000 and 2020 revealed that the „quality-adjusted life-years (QALYs)“ is not in favor of the investment in new drugs. The relatively small numbers of beneficiaries of the new drugs is compared to the many other persons who could have benefited from the less costly previous treatment. Investment in one new drug causes disinvestment in other ones. The overall balance for the UK turned out to be negative. Particularly the disinvestment in prevention of diseases appears to have very detrimental effects in view of the results based on this study. Preventative measures are relatively cheap compared to the estimated 20.000 pounds for one additional quality adjusted year of life for a new drug. The message is: choose your health investments wisely to avoid ever rising health costs and health insurance. (Image: rest room Belgium) 
Health Tech
Health technology assessment (HTA) is an interesting scientific field. The new digital opportunities allow people to participate in medical and medication trials in their homes or even in bed. Their health data and the administration of medication is also encouraged and sometimes supported through digital devices. The pharma and health industries have many devices ready to go. The differences to the traditional forms of medical trials, however, is an issue as we want to compare the results from both kinds of trials. Participants of trials, might prefer or struggle with these novel kinds of study designs. In any case the results will be impacted in several forms (Study Link). In the best of all worlds for the researcher the effects will cancel out each other, but is rather unlikely. Some participants will reach more positive effects with the use of digital tools, whereas others are challenged and might even abandon during the trial. Monitoring during the study (for example through digital inhalors) is another advantage of such distributed trials. Rather than taking adherence to a trial medication for granted, digital tools allow a more precise monitoring of subgroups as well. Data and effort invested in the trial is preserved through the easier access to person’s information, assuming continuous readiness to stay on in the trial.
Our own smartphones are still underexploited in terms of health monitoring and use in research designs. The possibilities to link data to other external data sources shall further advance the research potentials in many interesting ways. Data protection and data security become even more important with the ever smarter phones and connected devices.
Book Value
What is the value of a book? For the author of a book each book s/he has written or sweated the value of the accomplishment is pretty high. From the publisher’s perspective a book is an investment and sometimes a very risky one. The book store makes choices and takes the risk to devote time and effort to select the bestselling books or the best one suited to the local or passing audiences. Next in line are librarians who either stock everything published in a specific language or country (legal deposit) or select from the offer according to perceived interests of their subscribers. On the way to their audience many mistakes may occur. Books miss their targets or librarians go wild in their efforts to guard or discard books. In any case, many books do not find their audience. Some sit on shelves for years and will never be touched by anybody. Other ones pass from one hand to the other rapidly with long waiting lists.
Even if many conservationists don’t like it, it is the use of books that honors books and authors. Pocket books play a specific role in this link of readers and writer. Use rather than conservation, is the prime role of these lighter versions of books. They also have to endure heavy weather, scratches and folding of persons focused on content rather than precious form.
Last but not least in line comes the market for recycled books. Re-use of read or unread books has increased over years and some readers are happy to discover a discarded book from a previous owner (public or private). The value of a book lies in most cases in the eye of the reader. This then makes it an object of competitive marketing and continuous auctioneering.
(Image: pocket books at display of Popular heritage Lost and Found at the Royal library of Belgium 2024.
Patient Empowerment
The empowerment of patients is a well-established practice in the treatment of diabetes. Measuring your own blood sugar and adjusting your medication to the self-monitored data is common practice. For patients with high blood pressure this patient empowerment is less prevalent. A medical study carried out in Valencia (Spain) by Martínez-Ibáñez et al. (2024) has tested the effects of such a self-monitoring and self-medication experiment.
The results publishes in (JAMA) gave rise to considerable attention in the profession as the empowerment of patients is one way out of the likely increasing shortage of medical professionals in aging societies. Whereas other studies found that total costs to the medical system might increase, the study in Spain provides evidence of the cost-reduction effect of such an empowerment. 24 months after the beginning of the trial. After the establishment of a “medication based on an individualized prearranged plan used in primary care” the self-administering participants achieved a significant decrease in their blood pressure that lasted until the end of the study after 2 years. The drop-outs of the study seem to follow a random pattern.
The conclusion gives support to the potential of patient empowerment in the widespread treatment of higher blood pressure beyond the regular visits of medical doctors. The monitoring of changes in lifestyle add to this to keep the costs of health care under control in aging societies. 
Hospital Bias
Asking people about differences between private and public hospitals, you are most likely getting answers that the private hospitals deliver superior patient outcomes. Whereas private hospitals seem to have a positive stigma attached to them, public hospitals commonly have a negative stigma. Scientific evaluations are helpful to set the record straight again. The study published in “The Lancet Regional Health” in 2024 shows that in the simple descriptive statistics on several patient outcome indicators, this is what the data showed between 2026 and 2019. However, a more precise statistical analysis reveals that there is also a selective admission to the private and public hospitals in England. Using so-called instrumental variables approaches that account for the selection process between admission to the 2 types of hospitals (private versus public) most of the differences between the hospital types disappear. The underlying mechanism is a sorting of different patients into the private or public hospitals. Put in easy words, for a routine intervention people tend to chose the private hospital, but the more rare and difficult operations were more likely admitted to public hospitals. The number of co-morbidities (heart disease) is also of importance as they might negatively affect patient outcomes. Jumping to conclusions and reinforcing stigma about public or private provision of services hinders progress and an equitable provision of services.
The analysis of a potential selection bias can reveal the “creaming” effect of private provision of (health) services. Just caring for the “easy” or routine cases and avoiding the more difficult and costly cases has economic advantages, but for society as a whole the costs overall remain the same. A good public service in health is a definite asset.
(Image: Exposition Isa Genzken 2023 in Neue Nationalgalerie Berlin)
