Re.Priority setting for new technologies in medicine
A qualitative study

Thank very much for your letter of September 5, 2000.We are delighted you have offered to publish our paper. Please find attached a revised version that responds to your editorial comments (see below).

1. Reviewer comments

We now indicate in the sampling and sample size subsection of the methods that the analysis was saturated with respect to major domains.In the data analysis subsection of the methods we now indicate that the coding scheme was arrived at by consensus among the two investigators.

2. Membership of the 2 committees

This is now described in the sampling and sample size subsection of the methods

3. We went too far in our conclusions

We have cut back on our claims throughout the manuscript in two major ways.First, we have increased the emphasis on limiting the generalizability of our findings to new technologies for cancer and cardiac disease. Second, we have increased the emphasis on the fact that we are describing how the committees do make decisions, rather than prescribing how they should make them.Accordingly, we have deleted any reference to what decision makers should do.

4. Paper 3519

We have chosen to send you paper 3518 without combining it with 3519

5. Length etc.

The paper is now 1956 words with 19 references. I will send the signed forms and other bits by post.

Your well-taken critique that our conclusions went too far, as well as a key point i anticipate Norman Daniels will make in his editorial, prompt me to make a suggestion. The current paper (3518) describes how priority setting decisions are made. This is important but needs ultimately to be combined with an account of how such decisions should be made. Since we submitted our original paper, we have finalized a new paper that harmonizes our empirically based account of how decisions are made (3518) with Daniels' and Sabin's ethically based account of how decisions should be made. The paper is highly innovative because it uses a transdisciplinary method -- i think it is one of my very best pieces of esearch. My suggestion is that you consider publishing this paper (which i have attached) along with 3518 and that Daniels' editorial should address both papers. The combination of our 2 complementary papers plus Daniels' editorial has alot of synergy all around and would in my view make an important collective contribution to the field of priority setting. What do you think?

Thank you for your offer to publish 3518. I trust the revised paper attached responds appropriately to your helpful editorial comments.

Thank you also for your consideration of my further suggestion.

Peter Singer, MD, MPH, FRCPC
Sun Life Chair in Bioethics and Director,
University of Toronto Joint Centre for Bioethics
Professor of Medicine, University of Toronto
Canadian Institutes of Health Research Investigator
Associate Editor, Canadian Medical Association Journal

e-mail: peter.singer@utoronto.ca

website: http://www.utoronto.ca/jcb

fax: 416-978-1911
phone: 416-978-4756

mail: 88 College St., Toronto ON Canada M5G-1L4