The Truth About Tamiflu: Has the US wasted $1.5 billion on an ineffective drug?
theatlantic.com
theatlantic.com
Doctors are pressured by patients to prescribe pain killers, anit-biotics, etc. But isn't it up to the doctor to say yes or no?
Note the "if the patient is paying" clause. MDs shouldn't be doing cost-benefit tradeoffs - patients should.
Politicians shouldn't be doing cost-benefit tradeoffs either. (That's a statement against interest - my demographic group has way more say than other groups, so we'll be subsidized by politicians. And no, it won't be different this time.)
MDs and politicians should absolutely be doing cost-benefit tradeoffs. I'd go so far as to say that's basically their job. I go to a doctor because they have skills and knowledge I don't possess.
That doctors (being experts) so often don't apply their judgment, and politicians (often being charismatic amateurs) so often do is lamentable. Politicians should be required to be experts. Doctors should be (aren't they?) required to exhibit judgment on behalf of their patients.
Expecting everyone to be able to exhibit the judgment of a professional in every field is so wildly implausible that I've obviously mistaken your meaning.
My wife and I are both from Europe originally, and going to the doctor in the US is sometimes really frustrating for us. We go with the idea that we're consulting an expert for their advice, but sometimes find them quite unwilling to make any kind of judgment call. Sometimes they just offer a bunch of options and say "pick one". When pressed for an opinion, they'll sometimes just hint in one direction or another. Compared to a British doctor, who will almost always confidently tell you exactly what he or she thinks should be done, it can be quite an unnerving experience.
I'm not sure if it's simply for fear of lawsuits or if it's coded in the law itself (although I think I read that it's the latter somewhere).
I'd certainly hope the MD would provide guidance in that decision, since it's the MD who knows what the costs and benefits are. But the MD knows neither the patient's marginal valuation of the costs, nor of the benefits. That is, he doesn't know how precious each dollar is to the patient, nor the fact that, e.g., he is resigned to his terminal illness but just wants to live long enough to see his daughter graduate.
Since nobody else knows how much those things are worth to the patient, nobody is qualified to balance them.
Most especially not politicians, who ought not to have a horse in the race at all. The availability of the treatments ought to be metered by the price of providing them versus the patient's (or the patient's contracted insurance provider's) willingness to pay (given an understanding of the treatment as guided by the MD). Period.
No, they shouldn't. If I'd rather spend my money on hookers and booze, that's my decision to make. If I'd rather spend all my money on health care so I've got a chance to see my first grandchild, that's also my decision to make.
I expect MDs to be experts on health benefits ("your knee won't be stiff in the morning") and health costs (like "you'll limp if you let this slid"). I expect someone associated to have a handle on how much money is involved.
However, that's not enough information to make a health care decision. Someone has to decide the relative value of those things, to decide if the costs are worth the benefits.
I am the expert in deciding how much these things matter to me. Booze vs grandchild is my call for me. It's your call for you. It's okay that we make different decisions.
If you think that I'm not "the expert" wrt those things for me, who is?
Or, do you think that those decisions shouldn't be made wrt my values for me? I'll be happy to make them for you if you want, but I don't want you making them for me.
> Expecting everyone to be able to exhibit the judgment of a professional in every field is so wildly implausible that I've obviously mistaken your meaning.
Either I was unclear or you don't understand what experts are experts at.
> Politicians should be required to be experts.
It's easier to require them to be unicorns.
As a general rule, you don't get to assume unobtanium even if that's the only way to make your preferred approach work. Any approach that requires unobtanium is, by definition, wrong, no matter how many ponies that you think that we'd get if it worked.
Doctors obviously shouldn't have access to your wallet, but they SHOULD tell you without pussy-footing around, this will save your life, that is stupid and unnecessary, that one over there will kill you.
If you want to buy drugs without a doctor interjecting good sense, it really is a pharmacist you need.
And since libertarian governments are forged from pure unobtainium anyways, they might as well be competent. I think it's a smaller jump from here to qualified politicians than it is from here to politicians who don't meddle in people's lives.
No one said anything about libertarian govts.
Different govts meddle in different amounts. Some don't meddle much at all, providing an existence proof.
Where are govts with qualified politicians?
Govts select for the ability to stay in power. Anything else is a coincidence. (Yes, I'm blaming "the people" here for not connecting expertise to survivability more strongly.)
And, as you point out, that's a temporary state of affairs.
BTW - Tightly centralized govts are pulled to the comptence/expertise of the center, wherever that is. It may be average, it may not be. See North Korea for an example. (And yes, you can point to Singapore.)
- commercial interests. - advertising. - religious beliefs. - political party affiliations. - market transparency. - peer pressure - etc.
That there are marginal drugs has long been an issue; how many of us read the available studies? In some cases, you'll find a commercially-successful drug is little better than placebo, or little better than a generic.
The most reliable approach toward truth and knowledge in a capitalism-based society? Follow the revenues. Find and then follow what the folks involved value. Often monetary profit or status within the group.
I understand the social pressure etc. However, when I go to a doctor I expect him/her to prescribe something that is necessary not just write a script to get me out of the office.
Can much of health care problems be pinned directly on the doctors? I know its unpopular to criticize doctors, but I'm beginning to think that we can only address the health issue by directly confronting the MD's.
If all the doctors agreed to not write unnecessary prescriptions you wouldn't have this problem but that's unlikely to happen since only a few doctors will deviate to get the extra patients.
This kind of reporting annoys me. It's a logical fallacy that having a stake in the outcome makes your research invalid. And who else is going to fund a study? Nobody without a stake is going to foot the bill.
If the drug is going to be used to prevent death, it seems reasonable to ask whether or not its potentially deadly side effects are outweighed
Quite the opposite. If the patient is likely to die anyway, then side effects be damned. It's time for a "Hail Mary" play. Get the patients past the immediate danger, and sort the rest out later.
The answer may lie in the politics of disease.
Sorry to be political here, but this is exactly what you'll be getting more of when the government starts to dictate how much will be spent on what kind of healthcare. When lobbyists or constituents are pushing for something to be covered, even though they're ignorant or are just interested in profits, the politicians will tilt the rules toward the squeaky wheel rather than rational science.
For example, in the link you provided he impugns the motives of the publishers of this latest analysis, and says about the their acceptance of the paper: "I don't think it served the public purpose or the public health."
A couple places, he emphasizes "during a pandemic, no less" or "here we are in the middle of a pandemic" as factors that should weigh against raising doubts about Tamiflu's effectiveness at this time.
That kind of political calculation applied to scientific or medical results creeps me out -- and often backfires on the officials who try it.
# epidemic over a wide geographical area; "a pandemic outbreak of malaria"
# an epidemic that is geographically widespread; occurring throughout a region or even throughout the world
# existing everywhere; "pandemic fear of nuclear war"
wordnetweb.princeton.edu/perl/webwn
the first hit searching define"pandemic on Google
The troubling subtext I saw in revere's comments is the suggestion that we're in some sort of unique crisis where it's irresponsible to give prominent coverage to substantive doubts about Tamiflu. We're not in such a crisis, and even in a real crisis, we need to retain our skeptical faculties.
Tamiflu is a relatively new drug (not many decades old) with known and potentially-unknown side-effects.
It's being used being to treat a disease for which, whether new-strain or old-strain, 99.9%+ of all sufferers recover completely. (Recent CDC estimates are that 1-in-6 Americans has already had H1N1/09, with up to 10K deaths. That's a 99.98% survival rate.)
And, the strongest case for Tamiflu's effectiveness seems to be that if given promptly at the right early stage of infection, it might make symptoms a bit less severe or duration a little shorter.
People with a high risk of complications may still find the costs and side-effects worth it, but for everyone else, it's important to know and emphasize how tentative and limited the evidence is for Tamiflu's effectiveness.
Viagra is probably the best example for heavy marketing of a drug (at least in the US): TV ads, NASCAR sponsorship, etc.
Honestly, I don't remember cigarettes being marketed so heavily to the public, which disturbs me greatly about what the pharma companies are intending with viagra and other identical drugs.
http://news.ycombinator.com/item?id=894903
you submitted earlier and just linked back to above.