The article discusses two main topics: the ethical and financial considerations surrounding the treatment of primary pulmonary hypertension, and a critique of a comparison between asthma mortality rates in New Zealand and England. 1. **Primary Pulmonary Hypertension**: - An anonymous letter raises concerns about the high cost of treating a patient with primary pulmonary hypertension, which is £150,000 per year, and questions whether such expensive treatments should be prioritized in a cost-limited health service. - The letter also highlights the moral dilemmas faced by healthcare providers when deciding whether to prescribe such treatments. 2. **Asthma Mortality: Comparison Between New Zealand and England**: - The critique points out two major flaws in a study comparing asthma mortality rates between New Zealand and England. - The first flaw is the potential for diagnostic errors in older age groups, as the studies were conducted in 15-64-year-olds, who are more prone to misdiagnosis. - The second flaw is the use of historical control groups and differences in therapeutic policies, such as the availability of bronchodilator nebulizers, which could influence patient care and mortality rates. - The critique suggests that a more rigorous study is needed to determine if the use of bronchodilator nebulizers contributed to the increase in asthma-related deaths in New Zealand. - It also notes the significant differences in asthma mortality rates among different ethnic groups in New Zealand and the potential impact of changes in patient care and drug treatments on these rates.The article discusses two main topics: the ethical and financial considerations surrounding the treatment of primary pulmonary hypertension, and a critique of a comparison between asthma mortality rates in New Zealand and England. 1. **Primary Pulmonary Hypertension**: - An anonymous letter raises concerns about the high cost of treating a patient with primary pulmonary hypertension, which is £150,000 per year, and questions whether such expensive treatments should be prioritized in a cost-limited health service. - The letter also highlights the moral dilemmas faced by healthcare providers when deciding whether to prescribe such treatments. 2. **Asthma Mortality: Comparison Between New Zealand and England**: - The critique points out two major flaws in a study comparing asthma mortality rates between New Zealand and England. - The first flaw is the potential for diagnostic errors in older age groups, as the studies were conducted in 15-64-year-olds, who are more prone to misdiagnosis. - The second flaw is the use of historical control groups and differences in therapeutic policies, such as the availability of bronchodilator nebulizers, which could influence patient care and mortality rates. - The critique suggests that a more rigorous study is needed to determine if the use of bronchodilator nebulizers contributed to the increase in asthma-related deaths in New Zealand. - It also notes the significant differences in asthma mortality rates among different ethnic groups in New Zealand and the potential impact of changes in patient care and drug treatments on these rates.