Good (IMO) editorial from David Frum

[garbon]

True.

[OttoVonBismarck]

Other countries control health care costs by putting price controls on pharmaceuticals.  Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices.  Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.

Usually your posts are too long and boring for me to give too much of a shit about but I've always echoed these sentiments, some years ago I had a debate here with Malthus about it and he in his faggot Canadian lawyer way essentially argued that no such thing was true.

[OttoVonBismarck]

The problem with the US system is that drug companies are indifferent to whether their dollars are earned from (1) inventing new cures to benefit all of humanity, or (2) evergreening existing patents, advertising directly to consumers, and paying docs in various ways to prescribe their products, through "phase 4" trials and the like.

Right, that's why all the major HIV drugs, cholesterol medications and blood pressure medications come from Canadian pharmaceutical companies. The failed US system obviously cannot compete with the overly regulated Canadian market.

Just face it, Canada is a small, 30m large market that is only able to negotiate with big pharma because they would have easy supply of generic forms of the drug from U.S. generics companies if they revoked big pharma's patents. For 90% of the world and all of Africa that option isn't on the table, and if that option was on the table for America no one would have these drugs at all.

[Zoupa]

Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.

I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.

Patients don't need to be involved in their treatments in 99% of cases.

[Martinus]

Other countries control health care costs by putting price controls on pharmaceuticals.  Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices.  Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.

You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor.

[Martinus]

I could think of things worse.  For instance, self medicating.

What if you are listening to your body?

[OttoVonBismarck]

Other countries control health care costs by putting price controls on pharmaceuticals.  Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices.  Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.

You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor.

That's already happened in several States, where you are now seeing caps of $250,000 - $500,000 for medical malpractice claims.

[Warspite]

I could think of things worse.  For instance, self medicating.

What if you are listening to your body?

How? Voices in your body coming through on the radio?

[garbon]

Patients don't need to be involved in their treatments in 99% of cases.

I've heard that at least 75% of the time or more that they need to.

[Iormlund]

Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.

I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.

Case in point: It really depressed me when I was doing in-person interviews about rheumatoid arthritis in Europe. Many of the patients would talk about wanting specific delivery methods for their medication, that were often available (even for the same drug they were taking) but their physician never told them about the wealth of options.

It's a valid but minor point.

Any patient not involved in his treatment is a total moron. Even a good doctor will not have the time to tell you everything there is to know about your illness. That's where associations come really handy. Ours organizes regular meetings with specialists for that very purpose. And you can always take a look at the Web. I've read about quite a few studies and listened to very good broadcasts.

BTW, I went for pen instead of IV drip for the kind of medication you are probably talking about. I'd rather be elsewhere than wasting a few hours at the hospital every two weeks.

[Malthus]

The problem with the US system is that drug companies are indifferent to whether their dollars are earned from (1) inventing new cures to benefit all of humanity, or (2) evergreening existing patents, advertising directly to consumers, and paying docs in various ways to prescribe their products, through "phase 4" trials and the like.

Right, that's why all the major HIV drugs, cholesterol medications and blood pressure medications come from Canadian pharmaceutical companies. The failed US system obviously cannot compete with the overly regulated Canadian market.

Just face it, Canada is a small, 30m large market that is only able to negotiate with big pharma because they would have easy supply of generic forms of the drug from U.S. generics companies if they revoked big pharma's patents. For 90% of the world and all of Africa that option isn't on the table, and if that option was on the table for America no one would have these drugs at all.

Sure, Canada is a small market. That would of course be true no matter what system Canada adopted.

Though the Canadian public research system has historically punched above its weight in terms of biotech discoveries. Case in point: insulin.

You guys keep discounting the importance of public research, and inflate the importance of private research. Fact is, much of private "research" is of dubious worth, aimed as much at prolonging patent monopoly by developing "me too" products than at discovering fantastic new breakthroughs, or at essentially selling existing product through the fiction of "phase 4" trials.

The reason is quite simple: actual breakthroughs are rare and unpredictable creatures, best deveoped by pure science, which is unpredictable. Think of the discovery of DNA - what company would have the patience to fund pure speculation?

Obviously, tyhere is a role for private research, but the notion that Americans (or anyone) has to pay absurdly inflated drug prices to fund it, and that the whole world is beholden to Americans selflessly paying,  is a mirage. I can understand why this mythology would ease the pain of being had by the drug companies, but there is no reason for intelligent peopole to buy into it.

[Malthus]

Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.

I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.

Case in point: It really depressed me when I was doing in-person interviews about rheumatoid arthritis in Europe. Many of the patients would talk about wanting specific delivery methods for their medication, that were often available (even for the same drug they were taking) but their physician never told them about the wealth of options.

This is probably true to an extent; but advertising is probably not the best or even the major source for patient involvement these days - there are tons of resources on the 'net.

The reality is that companies advertise because it sells their products. In the case of prescription drugs, this can only come about as a result of patients pressuring physicians to prescribe where they would not otherwise - meaning over-medication, or switching from one brand to another. Resources devoted to over-medication or brand-switching are essentially resources thrown away in terms of public benefit; drug companies can charge less in jurisdictions with strict advertising controlls and still make a profit, in part because they do not carry the cost of this type of competition among themselves.

It is the problem of having a competitive system with a "learned intermediary" who is supposed to actually make the decision.

[Admiral Yi]

Obviously, tyhere is a role for private research, but the notion that Americans (or anyone) has to pay absurdly inflated drug prices to fund it, and that the whole world is beholden to Americans selflessly paying,  is a mirage. I can understand why this mythology would ease the pain of being had by the drug companies, but there is no reason for intelligent peopole to buy into it.

Are you arriving at this conclusion based on the evidence, such as an examination of pharmaceutical volumes sold in Canada that were researched using private vs. public funds, or from first principles?

[garbon]

It's a valid but minor point.

Any patient not involved in his treatment is a total moron. Even a good doctor will not have the time to tell you everything there is to know about your illness. That's where associations come really handy. Ours organizes regular meetings with specialists for that very purpose. And you can always take a look at the Web. I've read about quite a few studies and listened to very good broadcasts.

BTW, I went for pen instead of IV drip for the kind of medication you are probably talking about. I'd rather be elsewhere than wasting a few hours at the hospital every two weeks.

I don't think it is a minor point. We did hear a lot about education from the associations in Spain, but really on both large quals that I did, the "ignorance" of European patients about their options was rather vivid in contrast to the interview American patients. Especially in France where a great many patients stated that they trusted their doctor and that they would feel bad if they tried to second guess him - after all they hadn't gone to medical school. And that wasn't just old folk.

[garbon]

This is probably true to an extent; but advertising is probably not the best or even the major source for patient involvement these days - there are tons of resources on the 'net.

The reality is that companies advertise because it sells their products. In the case of prescription drugs, this can only come about as a result of patients pressuring physicians to prescribe where they would not otherwise - meaning over-medication, or switching from one brand to another. Resources devoted to over-medication or brand-switching are essentially resources thrown away in terms of public benefit; drug companies can charge less in jurisdictions with strict advertising controlls and still make a profit, in part because they do not carry the cost of this type of competition among themselves.

It is the problem of having a competitive system with a "learned intermediary" who is supposed to actually make the decision.

Obviously that is why anyone advertises - that doesn't mean that their can't be secondary benefits.  You might not be inclined to look certain things up if you don't know they exist. 

Besides, how exciting is DTC advertising? It typically shows some happy individual enjoying life, the product name, a long scary list of side effects and then often nary a mention of what the product is actually for.  Seems a bit overblown to suggest that those ads cause physicians to beat down their physicians until they give them what they saw in the advertisement.

The main place where I've seen somewhat compelling and detailed DTC ads are the patient brochures that pharma companies leave with physicians for their patients. My physician handed me the "ads".