Our Endangered Integrity — It Can Only Get Worse

In this issue of the Journal, Asch and Ubel call our attention to a common problem for physicians — namely, whether to choose the “best” test or treatment for their patients or a second-best, cheaper one.1 They illustrate the problem with several realistic clinical scenarios and describe the second-best choice as a compromise that could be considered a form of rationing. The rationales for the compromise choices vary: in one case the physician chooses a cheaper item because he is concerned about the high cost of care to society, in another the inferior alternative is chosen because it is considered . . .