Morning Ed: Healthcare {2017.02.16.Th}

John Timmer writes about a new study suggesting better heart outcomes when cardiologists aren’t around. They’re not sure if it’s a staffing thing, holding off procedures until they get back, or extra caution on the part of the remaining doctors.

The visa crackdown could have adverse effects on ruralian healthcare as many of their doctors have visas. A lot of people underestimate the reliance on immigrants in rural hospitals, because we often assume that immigrants wouldn’t be caught dead there, but that’s not the case and it would be better if such programs were expanded rather than contracted.

I was about to say that the pharmaceutical industry needs to stop doing this, but actually it’s the government that needs to stop it.

Thomas Nasca writes about the new residency working hours, and the expected effects. The 2011 requirements were actually better than what my wife had in 2011.

Aaron Carroll reports that for some medication – such as asthma inhalers, we can raise the price without decreasing utilization.

I hadn’t thought about it, but now that I have the ethical issues of crowdfunding medical expenses do seem kind of problematic. {More}

China has revised its organ donation programs, trying to convince the medical world that it has reformed.

As we’re doing with Down Syndrome, are we setting the stage to abort autism out of existence?


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Will Truman is a former professional gearhead who is presently a stay-at-home father in the Mountain East. He has moved around frequently, having lived in six places since 2003, ranging from rural outposts to major metropolitan areas. He also writes fiction, when he finds the time. ...more →

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19 thoughts on “Morning Ed: Healthcare {2017.02.16.Th}

  1. A lot of people underestimate the reliance on immigrants in rural hospitals, because we often assume that immigrants wouldn’t be caught dead there…

    I thought this was common knowledge. For instance, if I meet a person of South Asian decent who grew up outside of a big city, the first thing I ask is whether one of their parents was a physician or a college professor.

    I was about to say that the pharmaceutical industry needs to stop doing this, but actually it’s the government that needs to stop it.

    I look forward to another article from Sarah Kliff at Vox on how our prescription drug market doesn’t work because it operates just like the market for “chairs, mugs, shoes, or any other manufactured goods would.”

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  2. Unlikely but perhaps possible fourth reason for better outcomes when cardiologists are away: less white-coat syndrome? Or less “oh crap, I must really be sick, here comes the doctor again”? Where the patient figures that if they’re being left largely alone, they’re probably not fatally ill?

    I think the “fewer aggressive procedures and fewer outpatient things that could be put off” is more likely, though. But there are people whose blood pressure reads high when a doctor or nurse is in the room, and normal when there is no medical professional present….

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  3. I was about to say that the pharmaceutical industry needs to stop doing this, but actually it’s the government that needs to stop it.

    The article you linked doesn’t really explain what’s going on. As a rule, tech sites are terrible when reporting on anything economics-related. What happened is that the drug was imported and off-patent in the UK, and a handful of customers were paying out of pocket to import it from there. If the US had reciprocal approval with the UK (i.e., drugs approved for use in the UK would automatically be approved for use in the US, or at least have a greatly expedited and less rigorous reapproval process), that would have been the end of the story. It would already have been available as a generic in the US.

    However, the FDA doesn’t do that, because the FDA believes that it’s better than all other countries’ drug approval agencies. So Marathon had to go through a bunch of ridiculously expensive trials to get approval to market it in the US. This one is mostly on the FDA, not for allowing high prices, but for creating the costs that necessitate a high price.

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    • Is it even legal for the FDA to approve a drug based solely on a foreign country’s approval process?

      Agency bashing is good sport for a lot of people here, but I’m going to keep raising the point that in many cases the agency simply lacks the statutory authority to do what people want.

      (ETA:) And therefore the remedy lies with Congress and the President.

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      • Here’s when we discussed the epipen thing last time!

        Is it even legal for the FDA to approve a drug based solely on a foreign country’s approval process?

        How heavily are you leaning on “solely”?

        Now, I agree that the legal requirements might be absolute bs and, as such, would need to change… but there seems to be some sunlight between “required to do a thing” and “not doing a thing that they’re not required to do” and one of the big things that got pointed out in the above thread is that if a drug gets denied, we (the people) don’t know why.

        Even as we see it approved in Europe.

        The question that strikes me as troubling (then and still today) is that my response to hearing about some hypothetical person having a friend in the EU send him/her epipens for cost plus a bottle of something is not to say “but those epipens weren’t approved by the FDA!” but, instead, something like “I’m glad you have a connection”.

        The fact that drug re-importation from Canada (even for drugs manufactured in the US) is illegal and prosecuted tells me that what is going on is a racket rather than something done for the benefit of the citizenry.

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        • See, this is where you all reveal your inner Trump.

          When it comes Pharmaceuticals, we basically have NATO. We have all sorts of agreements, mutual sharing pacts, joint training, readiness and preparedness drills, and a shared regime to exchanging data… but ultimately, the costs are born by the US.

          And we hate those costs, except where we love them… the ability to set the agenda, determine the rules, “encourage” our partners to adopt our standards, etc. But most of all we love the benefits that come from spending all those collective Security/Health dollars on ourselves and all the commensurate side benefits in terms of standards of living and innovation and technology that fuels secondary, tertiary and whatever the word is for fourthiary benefits. Heck, I have a pool built and paid for out of the marginal gain of improving the speed to fail of Phase 1 trials. Yay FDA!!

          We could change all this… we could definitely devolve our Drug Regime just as we could devolve our Security Regime… and the outcome would be lower drug costs in the US… but higher (much higher) drug costs elsewhere. Plus, we’d voluntarily give up or ability to [nearly] unilaterally determine safety standards and we’d have to be willing to accept a lot more risk that comes from Regional definitions of what a good cost/benefit ratio might look like. We’d expose our market domination to new coalitions that take different views on human experimentation and other routes to innovation. Some of the outcomes might be spectacular or disastrous… they could change very real power and economic relationships globally…

          In short, a Trumpian argument for breaking up NATO and having the Freeloaders pay their way.

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      • Is it even legal for the FDA to approve a drug based solely on a foreign country’s approval process?

        It would be shocking if it was, but it also seems like it might not be a terrible idea.

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        • The alpha and the omega of why this has not happened yet is Thalidomide. If the idea gets traction, the story of Thalidomide will be told over and over again. It’s the same reason why security ratchets up but not down. No one wants to be the person who loosened things up and allowed the next Thalidomide to get through for both political and look themselves in the mirror reasons.

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          • As usual, it goes back to people being very bad at estimating probability and doing cost/benefit calculations. We’ll gladly do something that kills 1 in every 10 of us slowly and silently but we’ll raise bloody hell if there’s something that kills 1 in every 10,000 of us spectacularly.

            Hardly anybody misses the medical treatments that they’ve never heard of because they were never invented.

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  4. Raising the ethical issues posed by medical crowdfunding doesn’t mean it is a bad endeavor or should be avoided. Instead, it highlights the need to set norms that protect patient privacy, make crowdfunding more accessible regardless of social position, and harness its power as a vehicle for positive social change.

    No it very doesn’t. It highlights the need for single-payer healthcare.

    That’s exactly what taxes are – “crowdfunding” that disburses to recipients without regard for social position or willingness to air in public what many would rather keep somewhat private.

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  5. My understanding is that roughly 60% of post-graduate year one family practice doctors are graduates of foreign medical schools. This doesn’t correlate one to one with visa status, but any shakeup of the immigration system could have devastating effects on primary care in the United States.

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    • On this subject has anyone heard how folks trained in Cuba do on US board exams? Because once we get over the rest of our national mad with cuba, It will be an obvious place for folks from the US to go to med school. And in the process learn how to do more with less than US trained folks.

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