U.S. to make More Drugs Easily Available, Cutting Role Doctors Play • Hacker News Board

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#181

Post by jessaustin » Wed, Jul 18, 2018, 1:34 AM UTC

u801e wrote: post #177

adrr wrote: post #166

Earlier quoted context omitted.

They should start their own practice and set their own rules. Good practices/doctors in my area are so in demand most aren't accepting new patients.

Is it even possible to set up an individual practice these days? Most individual practices were established decades ago. Most new physicians will work with an established group practice on contract.

It would be for those physicians without crippling debt loads. So, no, for those whose medical degrees were issued in the last couple of decades, it isn't possible.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#182

Post by csdreamer7 » Wed, Jul 18, 2018, 1:36 AM UTC

refurb wrote: post #168

csdreamer7 wrote: post #161

Earlier quoted context omitted.

> There is very little financial incentive to push consumers to buy drugs they don’t need. I have to disagree: Homeopathics and Viagra. In general I am in favor of this change, but homeopathy and vitamins are 'generic' and companies see a huge incentive to sell them, even if we do not need them. Supplemental vitamins are mostly wasted when you urinate. Viagra is another drug I can (and do) see a lot of money spent to…

The margins on homeopathic are way higher than generic drugs and there is a ton of competition among manufacturers. Most generic companies make their profit off the first 6 months of exclusivity. The rest of the time they are barely breaking even (hence the drug shortages).

> Most generic companies make their profit off the first 6 months of exclusivity. The rest of the time they are barely breaking even (hence the drug shortages).

I read that it was due to factory outages and the government keeping tight control over production of controlled substances. The FDA actually forced Pfizer to give up their quota this year to other manufacturers because they didn't produce enough of it due to their factory outages. It seems more like a large business playing hardball with the government and insurers than a lack of profit.

Also, you need to provide proof of your assertion of generics barely breaking even. I just glanced at Mylan who sells generics. They bring in 2B a year in operating cash flow on 12B in revenue.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#183

Post by wu-ikkyu » Wed, Jul 18, 2018, 1:36 AM UTC

cimmanom wrote: post #70

How do they propose to deal with the potential dangers of drug interactions?

Could be as simple as having the user input any other drugs, foods, substances, etc. they are currently consuming and then checking for interactions on the back end. There are already many sites that do this.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#184

Post by PatentlyDC123 » Wed, Jul 18, 2018, 1:40 AM UTC

cassowary37 wrote: post #163

I'm always struck by the intensity with which some HN folks hate their doc - reminded of this by the number of comments invoking conspiracy theories about docs scheduling extra appointments to bill more or push more generic drugs. Perhaps obvious but perhaps not: in the US and most EU countries I'm aware of, you can choose a new doc. You can shop around. Despite the flaws in online reviews, just as with Amazon, you c…

For me the issue is not exactly “burning down” the FDA, but rather changing its purpose from regulatory to only advisory (and hopefully changing associated statutes). The FDA provides a very valuable service by identifying the risks associated with various food and drug. It is one thing to educate the public and say “XYZ presents risk of ABC for this specific group of consumers.” It is a very different thing to also add “therefore, consumers cannot make the decision to take on the risks associated with XYZ because the FDA (and associated governing bodies) have decided the general population should not take these risks (regardless of the overall risk level and their individual risk factors).”

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#185

Post by flukus » Wed, Jul 18, 2018, 1:43 AM UTC

exabrial wrote: post #81

My pharmacist friends have long bemoaned the 'go to the doctor for everything' scheme. Some conditions are easily diagnosable and the side effects of the drugs are minimal. They'd much rather see the doctor as an escalation if treatment isn't responding or the patient has additional symptoms that could indicate something more serious. The behind-the-counter system is a great idea.

Yes, it's incredibly inefficient to have highly trained, expensive doctors acting as tier-1 tech support. But they have a powerful union, so they can keep being paid top dollar for their grunt work.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#186

Post by Gatsky » Wed, Jul 18, 2018, 1:50 AM UTC

Given the degree to which people waste time and money taking supplements that do absolutely nothing, this doesn’t seem like a great idea. Sure, if you are on HN and stay up late reading meta-analyses it would be fine, but then governing the “Democratic Republic of HN” would be very easy in many ways.

If there was actually a proper system to enable evidence based and cost-effective usage of pharmaceuticals without doctors it might improve things for patients, but I don’t see that there is.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#187

Post by danso » Wed, Jul 18, 2018, 2:11 AM UTC

wu-ikkyu wrote: post #180

danso wrote: post #75

Earlier quoted context omitted.

A permission process seems inextricable from a system in which there are regulations. But algorithmic agent would theoretically make approved drugs more accessible. The expense and time of a doctor visit is enough friction to stop people from getting drugs they may find beneficial.

There are many systems in which production requires the following of regulations but the purchasing and consumption does not, i.e. food.

There is definitely more leeway with food. But the FDA, for instance, bans raw milk from interstate sales: https://www.npr.org/sections/thesalt/2015/02/20/387558373/wh...

Local governments can also regulate what food is purchaseable, more specifically, who is legally allowed to sell food; restaurants have to agree to pass health inspections, for instance. As another example: Peking Duck was effectively illegal because of health regulations until legislators (of Asian descent) were able to pass laws saying otherwise: https://www.nytimes.com/1982/03/31/us/around-the-nation-cali...

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#188

Post by yourapostasy » Wed, Jul 18, 2018, 2:17 AM UTC

darkerside wrote: post #128

nanagull wrote: post #106

Earlier quoted context omitted.

For just one example: 33% of doctors always require a pap smear and pelvic exam to renew a birth control pill prescription. This is despite the fact that the WHO and ACOG both advise that the pills can be safely prescribed without the exams. 33% certainly counts as more than a "few" in my book. Citation: https://www.reuters.com/article/us-birth-control/women-seeki...

There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. It often doesn't fully turn over until an older generation of doctors retires. It seems to me that, of many imperfect systems, one where doctors have control is more preferable. They are legally and duty bound to serve their patients. The same can't be said of pharma company marketers, not by a long…

> They are legally...bound to serve their patients.

In the US, with the cost of attorney-mediated access to the judicial system, this is not really a protective constraint for the bottom 90-95% of the population against exploitation by unethical medical providers.

I'm interested in discussions about data transparency: anonymized, aggregated data about the patient population seen, the outcomes, and the amount spent, per doctor or set of doctors (if multiple specialists are seen). The former data set so doctors don't start cherry-picking for best outcome patients. The latter data set so doctors can start observing the average and median standard of care, and there is more uniformity of care across the field.

At the moment, only the health insurance companies have access to this kind of data.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#189

Post by hansthehorse » Wed, Jul 18, 2018, 2:21 AM UTC

gaius wrote: post #80

Communitivity wrote: post #69

There are better ways to go about this. As others have noted, there must be a mechanism for a continual prescription to be easily filled, e.g. insulin, metformin, etc. I could see a long term prescription that has to be renewed each year and is good at any pharmacy. For the short term prescriptions though, cutting the doctor out of it makes people much more susceptible to marketing (instead of 'ask your doctor if you…

Also, the doctor is aware of your health history Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you’re even back in the waiting room after spending 5 minutes talking to you while she’s really thinking about the new Audi. That’s as far as the awareness goes.

I sit with my primary care doctor at least a half hour each visit, but then I'm lucky. I live very close to a first class VA medical center. I don't believe the west palm beach center can be beat.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#190

Post by geomark » Wed, Jul 18, 2018, 2:22 AM UTC

15155 wrote: post #78

ryandrake wrote: post #56

Earlier quoted context omitted.

I’m one of those 90%. I simply don’t trust that doctors’ incentives align with mine. Too often it seems they do nothing but shrug and bill you for the visit, send you for expensive blood tests, or send you to their specialist med school buddies so they can bill you for 5 minutes too. Then there’s the billing: you don’t know what you’re going to pay until months later, after you sign a form saying you’ll pay anything…

My favorite doctors in 2018 all take cash and are all substantially more up-to-date than most insurance-system GPs. The A-players have left the insurance system or are in academia, make no mistake. For some cost-prohibitive things such as surgery, you really don't have much choice, though.

For some cost-prohibitive things such as surgery, you really don't have much choice, though.

Go overseas. To one of the medical tourism destinations. The care is far superior and the cost a fraction. Cheaper than the insurance premiums alone.