Health and efficiency: clinical effectiveness dissected.

If the exclusive promotion of values inimical to our basic humanity extends to the health care policy arena, we face a defensive, restricted, impersonal and ultimately impoverished health care system. Americans known it already as 'managed-care'. This is why it is crucial for health policy analysts to make explicit the role of values in policy-making, especially that involving the input of 'value-neutral' economics. The nature of any clinical effectiveness policy will be determined by the understanding of cost-effectiveness employed in its design and implementation. Given that cost-effectiveness is nowadays usually defined according to health economists' criteria, the battle over the meaning of clinical effectiveness is a significant development in health economics' move to assume control of the NHS.