Good (IMO) editorial from David Frum

[Barrister]

And I'm just telling you how it is. Doctors often make mistakes, have their own biases, don't choose what is actually the optimal course of treatment for their patients.  Doing research with doctors has only served to convince me that a patient needs to question what they are told and should seek out second opinions.

Oddly enough, Iorm has stated in this thread that a patient is foolish if they aren't involved in their treatments.

Doctors don't often make mistakes, no. They're human like everybody else, and just as BB pointed out, shit happens. In about 1% of cases. I'm not saying you shouldn't ask questions about your condition or treatment options, just that the person you're asking knows better than you.

And don't tell me how the game goes because you "did research" with doctors for you summer internship, boy. I've been at it for 11 years, plus 5 years of schooling and training.

It's not just about mistakes however.  As humans we want to put things into predictable patterns or categories, because doing so is more often than not correct.  Usually you can tell almost the entire story about a person as soon as you look at them - but not always.

We had a ratehr unhappy trip to the ER last night.  Nurse on shift started to tell my wife it was heartburn because they've seen a lot of cases of that recently.  After we said "no, let us tell you some more" the now likely diagnosis is some form of gall bladder problem.

[Berkut]

And I'm just telling you how it is. Doctors often make mistakes, have their own biases, don't choose what is actually the optimal course of treatment for their patients.  Doing research with doctors has only served to convince me that a patient needs to question what they are told and should seek out second opinions.

Oddly enough, Iorm has stated in this thread that a patient is foolish if they aren't involved in their treatments.

Doctors don't often make mistakes, no. They're human like everybody else, and just as BB pointed out, shit happens. In about 1% of cases. I'm not saying you shouldn't ask questions about your condition or treatment options, just that the person you're asking knows better than you.

And don't tell me how the game goes because you "did research" with doctors for you summer internship, boy. I've been at it for 11 years, plus 5 years of schooling and training.

I don't think of it so much as a matter of doctors making mistakes, but that there are a lot of different options about what treatment decisions are made, and doctors choose one way over another based on the training, experience, biases, etc., etc. A given option may not be wrong, but that doesn't necessarily mean it is the right choice for the patient. At the end of the day, it is the patient who has to choose what treatment they want, hopefully with the advice of their doctor about what the options are, the risks and benefits of each option, etc. etc.

Sometimes there is one "right" choice, but often there are several options, and the right option is based on factors the doctor may not even be aware of, or may very well weight very differently from the patient.

[The Minsky Moment]

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.

Not so, i support that concept.
And the fact that I don't do any med mal work is just coincidental,

[Malthus]

I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.

But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.

Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.

[garbon]

I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.

But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.

Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.

Not everyone uses the internet to look up meds and DTC med ads exist online as well.

[Berkut]

I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.

But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.

Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.

I may not be following this argument very well, but are you arguing that something should be done about medical prescription drug advertising, because convincing people they want to use a product might cause them to, uhh, want to use the product, and that could be bad for them?

[The Minsky Moment]

The point being that drug research by private companies is perhaps not the most efficient method: for various reasons having to do with the absolutes of life and death, medicine and medical care are not well suited to pure capitalism. Americans are not being well-served by their system, and the fault is not that of other countries.

Drug research by private companies has resulted in many useful treatments.  I agree that "pure capitalism" shouldn;t apply here, and it doesn't.  There is a lot of research done in the US through the non-profit and public sectors.  that's a good thing.  There is value in being able to have research not subject to market pressures; OTOH there is also value in having research that is responsive to market needs and subject to makret discipline.  There is place for both.  Problem is that financing the private effort has to be done out of profits, and due to how health care systems operate in elsewhere, most of those profits have to be taken out of the US consumer.  That isn't an attack on Canada or the Euro countries - they are doing what they think best for their own national interest.

[Zoupa]

I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.

But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.

Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.

I may not be following this argument very well, but are you arguing that something should be done about medical prescription drug advertising, because convincing people they want to use a product might cause them to, uhh, want to use the product, and that could be bad for them?

Medication is not just any other product. Allowing advertisement for prescription medication is incredibly counterproductive.

[Malthus]

I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.

But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.

Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.

I may not be following this argument very well, but are you arguing that something should be done about medical prescription drug advertising, because convincing people they want to use a product might cause them to, uhh, want to use the product, and that could be bad for them?

To want to use the product when they don't, in fact, need to.

Put it this way: a consumer can't just go to the store and buy prescription meds when they want them. A prescription is necessary. Why is that? One reason is that such drugs are in fact somewhat dangerous and the risks of taking them are only justified if they are outweighed by the benefits - and only a trained professional can make that determination.

If a phyiscian (or other HCP) is the only person who can prescribe a drug, why advertise to the patient? There are two basic reasons:

1. So that the patient puts pressure on the doc to prescribe a drug (as opposed to doing nothing, or advocating a non-drug treatment). Docs are humans too, and if a patient really really wants something, they can sometimes be persuaded - even against professional judgment - to give it to them, particularly if the doing nothing/non drug option isn't *that* much better.

2. To get docs to prescribe brand X rather than brand Y.

[Malthus]

The point being that drug research by private companies is perhaps not the most efficient method: for various reasons having to do with the absolutes of life and death, medicine and medical care are not well suited to pure capitalism. Americans are not being well-served by their system, and the fault is not that of other countries.

Drug research by private companies has resulted in many useful treatments.  I agree that "pure capitalism" shouldn;t apply here, and it doesn't.  There is a lot of research done in the US through the non-profit and public sectors.  that's a good thing.  There is value in being able to have research not subject to market pressures; OTOH there is also value in having research that is responsive to market needs and subject to makret discipline.  There is place for both.  Problem is that financing the private effort has to be done out of profits, and due to how health care systems operate in elsewhere, most of those profits have to be taken out of the US consumer.  That isn't an attack on Canada or the Euro countries - they are doing what they think best for their own national interest.

Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.

I do not doubt that private research is a good thing. I am simply pointing out that the notion that we would not have progress without allowing the drug companies to fleece US consumers is simplistic. The US companies do indeed spend more on "research", but much of that is aimed at goals that are not really condusive to progress. Take that spending away, and it is not at all certain that companies spend more in the US on beneficial research.

[derspiess]

Just not the obscenely inflated profits made in the US.

[Iormlund]

Oddly enough, Iorm has stated in this thread that a patient is foolish if they aren't involved in their treatments.

And I stand by it.

Doctors are human beings and they occasionally make mistakes. Furthermore, medicine is a huge field and few will be specialized in your area of interest. For example, chances are your random dentist won't know what antibiotics will go well with my illness or treatment. And of course few like to admit there are limits to what they know. Human nature. My advice there is to look for another doc in those cases.

Finally, as you own the body it is much easier for you to notice certain things which will later help with diagnosis and quality of life. In my case knowing what, how much and when to eat is a very necessary skill. I can also tell easily without any test whether a blockage is bad enough to require suction through NG tube, when the situation is finally resolved, etc.

[DGuller]

Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.

The problem with drugs is that they're the kind of good that take very high fixed expenses to come up with, and very low variable expenses to produce.  These kinds of goods are problematic for a number of reasons.  One of the problems with them is that it allows price discrimination.

Since the variable costs are low, you can sell the drug at a profit per unit even if you sell it for a pittance.  Therefore, you can sell with profit per unit at a wide range of prices.  Those who can tolerate the highest prices are financing the biggest chunk of your fixed expenses or profits on top of that.

[Admiral Yi]

Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.

This is saying nothing at all.  Of course drug companies are selling at a profit.  But that's only true because the US consumer is covering their fixed costs (including R&D) and they can sell to Canadian consumers at a markup over marginal cost, which in the cost of a pill is pennies, if even that.

[Iormlund]

Prices in Europe are not THAT low. It depends a lot on the drug in question. For example a single injection pen for my latest treatment goes for around € 1100. That's median wage over here.