Alex Tabarrok skewers Marcia Angell.
Email medicine works, mostly.
A ruling I like: discussing off-label drug uses is protected as free speech.
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+1 on the off-label drug uses link. It’s terrifying to think that big pharm wasn’t discussing off label uses with doctors, especially considering the potential for abuse. OR that we’d be pigeon-holing medications. For example, a very effective treatment for nightmares started out as blood pressure medication.
I don’t think doctoring via email will become the new trend in medicine. While SLIGHTLY better than something like webmd, nothing can replace the value of face to face interaction when diagnosing. Considering that many symptoms can have different causes, it can be risky diagnosing through a checklist and an email correspondence.
Furthermore, becaue emailing is simple, the frequency of patients seeking medical help will increase. And along with that, so will face to face interactions as more patients follow up with their doctor to make sure that their diagnosis was correct.
The email connection with your personal doctor is a great way for doctors to catch worsening conditions, abuse of substances, and miss use of medication.
I like the e-mail thing. I commute fairly far and work a traditional schedule. Although my employer is incredibly flexible and fair when I need medical care, I hate missing additional work time and getting behind when I know I only need some antibiotics.
By the time I’ve waited for an office visit, seen the nurse, waited again in the exam room, and filled out all the paperwork, it’s hours that I could be productively working.
A great example of how this s hould work is the medical practice of Dr. Dappen at Doctokr Family Medicine. He will do consultations by email, phone, in-person and even makes house calls to those patients living within a couples miles of his office. Each visit comes with a different consultation fee. A phone call to renew a prescription is cheap – something like $20. A call about a condition is (as I recall) about double that amount. An in-office visit is more expensive than an email consultation, and a house call is much more expensive. He tries to steer patients to the least expensive method that suits their needs. However, if he decides your condition warrants an office visit, he will tell you to make an appointment rather than discuss your condition on the phone. People are free to contact him as often as they wish but pay a fee for each consultation.
Marcia Angell does not really understand the economics of drug development. She criticizes drug makers because their R&D budgets are about the size of their marketing budgets ($70 billion as I recall).
Of course, half of drug marketing is distributing free samples to patients. Also, there are very few companies — including Apple — where the R&D budget is as large as marketing. These budgets vary based on economic conditions and marginal diminishing returns. Furthermore, marketing is a function of sales and the size is not closely related to R&D. Basically, firms should continue to invest in marketing until the last dollar invested equals one dollar of profit. The same is true of R&D.
This seems a very viable alternative and all, but I can think of a number of things that could go wrong here.
This is solely relying on the fact that the patient is in a good enough condition to fill out these “series of questions about his or her condition.” If the patient is in no condition to do so, then they can submit information that’s not even accurate or they can do a poor job at describing especifically what their symptoms are, which the physician could determine if they were in a face-to-face consultation.
This really seems like a very good way for certain patients to save time and avoid long waits if they don’t have an emergency, but I wouldn’t think it’s a safe option for patients with more complicated and serious conditions.
also, does a doctor still have to meet with that patient to prescribe medications or could they receive it via email? seems like there is potential for misuse.
Emailing with doctors will almost assuredly increase the volume of visits per year.
Alex Tabarrok skewers Marcia Angell
Let’s see now. Alex Tabarrok is a run of the mill economics professor. Marcia Angell is a physician and former chief editor of the NEJM and currently teaches at Harvard Medical School. Who do you think has a better understanding of drug development?
I heard that interview. She makes a number of points.
First, virtually all real drug innovation come from NIH funded university research. Once the riskiest work has been completed, the drug company “R&D” very little R with almost all being D. It pretty much all clinical trials, which although expensive and time consuming is not leading edge innovation. The main “R” is me too drugs for the purpose of patent law manipulation. She cites the Nexium/Prilosec and all the various pretty much identical to Atorvastatin cholesterol medicines as examples.
Second, she want’s organizations that don’t have a financial interest in a clinical trial’s outcome to design and run clinical trials. The current rules allow the drug companies to not only design the trials, but they get to redesign them until they get two trials that show the new drug is safe and effective. The trials that don’t are kept secret. In addition, she wants clinical trials to not only test against placebos but also test against the existing standard treatment. What’s the good a new drug that’s less effective and has more side effects than existing drugs? With the current clinical trials there’s no way to know. It’s a good bet that Merck wouldn’t have killed 60,000 people if an independent organization ran the Vioxx clinical trials.
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