Viewpoints in This Issue of JAMA


Why the Ethics of Parsimonious Medicine Is Not the Ethics of Rationing

In this Viewpoint, Jon C. Tilburt, M.D., of the Mayo Clinic, Rochester, Minn., and Christine K. Cassel, M.D., of the American Board of Internal Medicine, Philadelphia, discuss the ethical differences between parsimonious medicine (limiting the use of wasteful tests and treatments) and rationing health care resources.

“Both parsimonious medicine and rationing aim to reduce resource use. Nevertheless, the ethical difference between the two is clear. Rationing requires principles of distributive justice, which is good and important in circumstances of resource scarcity; parsimonious medicine rests squarely on the principles of doing no harm and attending to the good of patients in need. This is an essential attribute of professionalism.”

(JAMA. 2013;309[8]:773-774. Available pre-embargo to the media at


The Value of Low-Value Lists

 An international groundswell of activity is seeking to identify and reduce the use of health care services that provide little or no benefit— whether through overuse or misuse,” writes Adam G. Elshaug, Ph.D., M.P.H., of Harvard Medical School, Boston, and colleagues.

A major challenge faced by initiatives to address this issue has been how to identify and prioritize candidate services for consideration in a reasoned and transparent manner. “Today, several lists compiled by prominent organizations have identified numerous services as potentially low value in certain clinical circumstances. The challenge facing payers and health care service providers such as physicians and hospitals is to develop and implement strategies to reduce the use of services that are identified in these lists, many of which are discretionary, if not potentially harmful.”

(JAMA. 2013;309[8]:775-776. Available pre-embargo to the media at

 Editor’s Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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