Years ago I read an article that listed how many calories we don’t burn from various modern conveniences. It had everything from push mowers, to manual typewriters. When you counted the calories over the course of a year it’s no wonder our collective weight has been creeping up.
Tangentially related: I wonder how the new standing desk fad will affect our weight and other health.
(Random thought because I just saw an ad for one.)
Its pretty interesting to consider the issue.
I keep seeing various “new” studies in the past several years that seem to all have in common the idea that we really don’t need to spend money on this or that test, or drug, or procedure. I’m sure there are plenty of situations where there’s some truth to that.
But I’m also suspicious that as the government shoulders more and more of the cost of healthcare, with no ability to control expenses, there is an unholy alliance developing between them and private insurers that will fund studies to reach conclusions that expensive treatments or tests are unnecessary.
“There are many medications where the choice of A vs B is six of one, half a dozen of the other. There’s no incentive for a doctor to choose a worse-performing medication, but if two meds are interchangeable, I don’t see the big deal if the doctor chooses A because he likes the drug reps better and gets samples and better service. It’s like choosing between Office Max and Office Depot for your staples and file folders. No harm if you make one choice over the other even for “superficial” reasons.”
It is a problem because as someone else has said, A can be a lot more costly then B, especially if B is a generic drug or an older class of prescription drug that is still name brand that costs a lot less. One of the problems with medicine today is that the medical provider often doesn’t have incentive to think like that, if the 80 year old comes in demanding a n arthritis drug that costs 1500 a month it is no skin of their teeth, either medicare/insurance or the patient pays for it, even if they know the drug likely won’t have the person running after their dog again…or if drug A requires monitoring tests while B doesn’t, A can be a lot more expensive. One of the problems with our current healthcare system, especially in managed care networks, is that either the provider has no skin in the game with what they prescribe, or they have incentive to order tests and such (for example, doctors who own MRI clinics or testing labs or do it at their office).
"is a problem because as someone else has said, A can be a lot more costly then B, especially if B is a generic drug or an older class of prescription drug that is still name brand that costs a lot less. One of the problems with medicine today is that the medical provider often doesn’t have incentive to think like that, "
H has all the incentive in the world to care that medicine A is covered by a patient’s insurance and B isn’t, and alter his recommendation accordingly if there is no / minimal difference. The insurance companies themselves are all over docs to choose the cheapest medicines. It’s part of how he is “measured” by the insurance companies and the hospital. And patients aren’t shy in asking for genetics if warranted and he has every incentive to give them cheaper generics if warranted - patients who feel gouged don’t stay loyal.
The bigger fear, IMO, isn’t “doc prescribes expensive meds willy-nilly with no care.” It’s that he can’t prescribe an expensive med when he believes it’s warranted without both insurance company and patient pushing back.
We’ve had studies for years and years that demonstrate that procedures and meds are far overused. They’re just finally starting to get a significant amount of attention.
Most of my docs and pharmacist do listen when patients have financial issues with medications prescribed. Everyone wants the patient to regularly use the prescribed medication. When it’s not used as directed due to financial constraints, it will NOT help the patient. When there is an equally good and effective alternative, it should be considered but the doctors and pharmacists can’t be experts in all the permutations and differences among the medications available AND the different insurance/Medicare/Medicaid and other coverages that may or may NOT apply. It’s very challenging all around for everyone.
Sales reps can see them in their offices whenever they can to impart information, no problem there. It’s practically impossible for a doctor to have time to see them, it’s a tough gig.
One could argue that if the sales rep’s info was deemed important a doctor would make time to visit WITHOUT food being offered.
One could argue that if the sales rep’s info was deemed important a doctor would make time to visit WITHOUT food being offered.>>>>>>>>
Yep. Doctors and pharmacists need information, period.
Doctors need UNBIASED info, but many do not have time or inclination to attend professional education events where they have to take time off from their practices, especially if they are solo and they still have to pay overhead when they’re not running their offices. I have had several of my docs give me info that made it clear they were NOT keeping up with current or even recent guidelines. I tried giving one of my doctors national guidelines in his specialty (allergy), but he rejected it and said he has more than enough to read to keep up with all the things the insurer is faxing him and he doesn’t have time to read national guidelines in his field. (I stopped seeing him after that–it was clear to me he wasn’t following national guidelines.)
I never trust a single study. And I’m old enough to have seen things that were once considered dangerous to be later deemed safe, and vice-versa. But I do tend to go with whatever the preponderance of the evidence suggests.
“One could argue that if the sales rep’s info was deemed important a doctor would make time to visit WITHOUT food being offered.”
How will he know whether the sales rep’s info is the same-old-blah-blah about a drug or new info about a new drug til he sees it?
It’s 5:15 am where I am, and my spouse is already at his office (having gotten there at 4:30 am) to squeeze in a few hours of paperwork before the first patient at 7:30. He works 7 days a week and has not read anything non-medical related aside from the WSJ in 20 years (I’m totally serious. Not a single book. No time.). Keeping up with literature is a full time job. He simply doesn’t have time for visits with drug reps during the day when he has a waiting room full of patients. So yeah, the drug reps bring food to sweeten the pot, as well as samples (if relevant). I would too if I were a drug rep.
Himom - good call to leave a doc who isn’t following or keeping up with national guidelines, but where were you getting them from? H doesn’t have time to, and won’t read, all the crud patients print out from the Internet and hand to him.
UpToDate is the best database to keep up to date (ha) on guidelines and new info.
I requested and got the guidelines from NIH, NHLBI. They are official publications and were recently adopted and released. I do not swamp my providers with printouts–it’s not productive.
I have had other providers recommend Rx/treatments that upon consulting with an expert I’ve been seeing for 16 years we agreed would not be best for me and opted to stay the current course of treatment.
It does take effort to keep up. I personally attend national medical conferences 1-3x/year and read a lot to keep up as best I can in the field I’m most interested in.
"The court documents detailed all sorts of questionable sales strategies: Sales reps paid for take-out lunch at restaurants the doctors liked, giving their pitch in the few minutes it took to pick up the food—a move called the “Dine and Dash.” They gave surgeons bookstore coupons, and pitched the drug while waiting to pay. Top-performing reps—like the doughnut arrangers—were rewarded with prizes, from travel coupons to lottery tickets.
As the internal Abbott bulletin would put it: “All hail the Knights of the Round Table in the Royal Court of OxyContin!”"
I still cannot in any way support the anti-vaxxers - the researcher falsified results so he could make a name for himself. Those data were made up. If you can believe the tobacco and sugar data were corrupt, then you should also accept that vaccines are indeed safe, the one corrupted study set aside.
This goes more towards the studies side.
The fda just approved another way to deliver drugs. This could benefit some drug companies that own drugs that are about to go off patent. A friend has invested in the new drug delivery product. If the cost to manufacture the drug delivery product can be brought down, the patent on drugs using the new delivery product are going to be extended. Drug prices are going to increase. We are talking about a transfer of wealth of billions of dollars from consumers to drug companies.
Is this new drug delivery product the cost?
It is to the drug companies. 
(I don’t know how much the patients benefit. I think things were working fine but I don’t know for sure).
Hmmmm…that was a bad edit.
Should be …
Is this new drug delivery product worth the cost?
It is to the drug companies.
Why wouldn’t it be? I can guarantee you years of research and/or additional clinical trials go into the drug with the new delivery system, too, just as they did with the original drug and its delivery system. Humira is a great example of this. When it first came out as a drug for RA, it could only be given via IV infusion. My mom was one of the first to try Humira; unfortunately, her RA was far too advanced for it to help, but she was desperate after living with this crippling disease for decades and talked her doctor into giving it a try. But because Humira could only be given via IV from a visiting nurse, my mom had to be placed on home-health care, which meant she was not allowed to drive anywhere. Now things may have changed since then (2002), but having a drug being only administered via IV, thus forcing a person on home-health and making them ineligible to drive was not convenient at all. My mom didn’t drive very much; she was already living in an assisted living facility, but she did like to go to mass on Sundays at her old church, and didn’t have a problem driving early on Sunday mornings when there was no traffic (and yes, I know she probably cheated a few times and did drive, but the guilt around it ate at her). She had to stop that once she started Humira. It was a deficiency of the drug at the time of development, but it was the quickest way to get it to market so that it could benefit people who were incredibly desperate for a new class of drugs for RA; years later and after much more research and clinical trials (which all costs lots of money), Humira became available via self-injection and is now used for several auto-immune disorders. But for every other auto-immune disorder it was found to help, the drug company had to invest in more clinical trials, and eventually they were able to develop a way to administer it via self-injectable. It’s not like they can just take the original compound, throw it in a vial and say, “Here, inject this yourself for all those new conditions we think it helps.” Although I don’t know this to be true, my bet is they are also looking for a way to eventually administer this drug via oral form, which might also allow people to be more compliant with their medication, and what part of that is not a good thing? If my mom were still alive today and Humira worked for her, I doubt with her level of disability in her crippled hands and tremors, she would be able to even administer a self-injectable. So yea, drug companies are always looking for ways to make administering drugs easier so that patients can be more compliant, and get relief from their illnesses. But it takes resources to make that happen.