Optimism in Medicine

Although this blog generally centers around health economics and policy, an article I read in the New York Times made me want to switch it up today. Let's talk about ethics and optimism. Specifically the ethics of early stage clinical trials and patient optimism.

The article I linked to above, starts with a touching story about a mother in her 30's with cancer. If you have a few minutes, the article is a must read. Aside from being a story about selflessness and courage, it also raises a tough ethical debate about optimism and patient consent.

The woman in the story had been through numerous, experimental clinical trials. The purpose of these early stage clinical trials is often to test the safety of a new drug and not to actually treat the patient. In the story, doctors told the woman exactly that: she shouldn't expect this to benefit her, it was just for the purpose of advancing science. Although the woman confirmed that she knew this...I can't help but wonder if she had at least some hope and optimism about the experimental drug.

I truly believe that optimism is a gift. However, some are debating if unrealistic optimism is an ethical issue in this case. Studies in the article show that patients can be filled with optimism in clinical trials even when only 5 percent of patients see "some" benefit from these trials. Some argue patients are going into these trials without knowing the true purpose them and unrealistically expecting to be cured. When this is not explained clearly enough to patients, it presents an ethical dilemma.

Is there such thing as unrealistic optimism? Do you think having unrealistic expectations is harmful to patients?

Personally, I believe that any kind of optimism can only help in this situation. However, I do believe that every single patient is owed a clear explanation before they enter an early stage clinical trial. Patients need to know that the purpose of the studies they are participating in. They have the right to know early stage clinical trials are strictly about efficacy. If after knowing all of this, a patient still wants to be optimistic, that is an admirable decision that should solely be reached by them.
Your opinion may differ though. Some believe that by realistically explaining this to a patient you are ruining hope and harming the patient. Looking forward to seeing all sides and opinions.

Drug Shortages Becoming a Crisis

According to The Wall Street Journal, U.S. hospitals are facing a drug shortage crisis. This shortage could be causing breaches in medicinal safety and an increase in hospital costs of over 200 million dollars annually. The alarming part of this problem is that it applies to important chemotherapy and emergency treatment drugs. The shortage is requiring doctors and pharmacists to seek treatments that ultimately do not match the effects of the original treatment or cost more.

For example a brand name drug called Fusilev is being used to fill the shortages of a generic version called leucovorin. While the generic that is in short supply costs $7.41 a dose while the branded drug costs $177 per dose.




The problem has become so dire, that in some cases the FDA is allowing non-FDA approved drugs from overseas to act as replacements.


Who ultimately has responsibility for this? Do you believe generic drug makers have the responsibility of investing capital to build resources that can handle the volume of drug demand? What incentives could be provided to increase production of these drugs? Should the FDA be allowing use of unapproved drugs from overseas? What will be the solution to this issue ultimately?

Waivers and Weakness

An earlier post detailed the recent step backwards President Obama took by allowing states to apply for waivers to the Affordable Care Act. These waivers would allow states to drop the mandate for individual  health insurance as long as an effective, affordable alternative was reached.

Since the last post, there have been a number of reactions to President Obama's decision. A recent NY Times Article shows that along with Maine, five other states have applied for these waivers including Florida, Georgia, Kentucky, Nevada and New Hampshire.

Instead of praising President Obama for his decision, many Republicans are labeling it as a sign of weakness in the law. They argue that if the law was a good law, it would need no waivers. Many see the law as pointless if there will be so many waivers allowed.

Is providing waivers an admission that health care reform is weak? Is this proof that the Affordable Care Act is not perfect?

The Future of Patient Care....Not Just Yet

Ideas about health care are continuously evolving. One vision shared by many, is a medical future characterized by team-based patient care. As explained by this piece in the NY Times, this vision would involve converting traditional medical centers to "patient centered medical homes," where patients are seen by a team of doctors rather than just one individual. This team of doctors would also focus on cost cutting measures like preventative care. The overall goal of this vision is to create efficient, high quality care at an affordable price.

Sounds nice right? Unfortunately this dream is not yet a reality. 36 small practices tried to make this conversion and have run into a number of issues. The primary issue being the time and difficulty of converting traditional medical centers into patient centered medical homes. Eventually, I believe this will become a reality for the U.S. health care system. It just needs more time.

After reading the article and my post, what issues do you see arising with team  based care? It sounds nice on paper... but will it work in a real setting?

Is the Age of the Blockbuster Over?

For pharmaceutical companies, the 90's and early 2000's were the age of the blockbuster drug. Pharmaceutical companies developed drugs that could be used by huge patient populations and could rake in revenue from their respective drug patents. According to the New York Times, it is no secret that these patents are beginning to expire; but what is alarming for the industry is that there isn't much in the pipeline to replace them.

As patents begin to expire, major pharmaceutical companies will see significant erosion to their revenues from competition of generic brands. Add to this problem the lack of new drug discoveries, pressure from the government to lower drug prices and a series of heavy fines against pharmaceutical companies. This perfect storm of factors spells trouble for the pharmaceutical industry.

Why do you think drug innovation has slowed? Should the government still be  putting pressure on industry giants to lower their prices? Does pressure on price discourage innovation?

What strategy would work best moving forward? : focusing on branded generics, acquiring companies with near market ready drugs or concentrating only on health areas of need?

Obviously this article has a number of business, health and policy implications. It would be great to explore all of the different angles so feel free to comment.

A Solution to Ignorance about the Affordable Care Act

One of my earlier posts titled Ignorance & Healthcare presented research from the Kaiser Family Foundation about America's knowledge about the health care reform. A new website was launched this week that intends to better educate Americans on the Affordable Care Act (health care reform). The site is www.healthcareandyou.org and it was developed by a coalition of health care advocacy groups including the American Medical Association and the American Nurses Association.

The great thing about the site is its simplicity. Gone is the political debate that often clouds the facts of the Affordable Care Act. The site delivers the facts about the law tailored to each individual person. Users are greeted by a simple map of the United States and a clean home page. Once a user selects their state, they are directed to a page that contains everything citizens in that state need to know about health care reform. Further, this page gives users the option to classify themselves as "Under 65," "Over 65," or as an "Owner of a Small Business." The site then provides tailored information based on which role you choose. No advertisements, No Political Messages....Just the facts.

A site like this should have been established the moment the Affordable Care Act became relevant; but better late than never. What do you think about the ease of this educational website? Do you think it will be effective in helping American's understand this important legislation? Please feel free to share any comments you have.