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When good ideas make bad business

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Re: When good ideas make bad business

#281

Post by logfromblammo »

beat wrote: post #184
logfromblammo wrote: post #176

Earlier quoted context omitted.

That anecdotal interaction is extremely damning for the entire US healthcare system. Physician admits she prioritizes practice revenues over patient outcomes. Other physicians express similar preference. Inventor of useful tool tosses it into the mothballs. That tool isn't just a physician aid. If that's what doctors are really doing, it's more like a physician replacement. If they won't do evidence-based medicine, a…

I don't know how old you are, but at a certain point, the input of a general practice doctor becomes very valuable. Remember, the doctor doesn't even do the little tests you mentioned, like taking measurements and blood tests - they just order them, and nurses or technicians do the work. The doctor's job is to make decisions and give advice . About a dozen years ago, my doctor caught my blood pressure shooting up in…

So your doc abrogated her responsibility to warn you about the side-effects of the prescribed drug.

You went to the ER, because you were not aware that cramps, constipation, spiking BP, and muscle weakness are symptoms of hypokalemia, which could be resolved quickly by dissolving KCl from the grocery store in water and drinking it.

That's patient education that needs to happen before you go to the ER.

Just like with the GlacialMD thing, it's no skin off your doc's nose if you have to drop $500-$2000 on an ER copay because you had an electrolyte crisis from the medication she prescribed, and didn't know ahead of time that could be a possibility.

And the rest of you out there, learn to measure your own BP. You can't leave it to an annual exam to find out it's getting high, and the BP taken in the doc's office may include the "white coat effect" (or as I call it, the "what will this cost me effect").

Re: When good ideas make bad business

#282

Post by omegaworks »

planetzero wrote: post #209
omegaworks wrote: post #187

Earlier quoted context omitted.

This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to p…

>Government-run healthcare isn't a panacea

I didn't claim it was. Only that our present standards incentivize fee-for-service and not outcomes-driven, as exemplified by the author's inability to sell his outcome optimizing software. ACA tried to remedy that with preventative care standards, but the current administration is actively dismantling it.

Your model works for cosmetic surgeries because they are cosmetic - optional and not life threatening.

When calculating price, the cost to produce a drug is the last thing on pharmaceutical companies' minds. The question they ask is how much are you willing to pay for something that allows you to continue living. The factors they actually consider: the patient's perceived cost-benefit of continued suffering, the credit/insurance-worthiness of the treatment cohort, and whether the company faces competitive pressures from others selling the drug on the market.

Nothing better depicts the situation than what goes on when pharmaceutical companies merge or acquire the rights to rarely used drugs[1].

The only way to structurally combat this is with the monopsony power of a single payer system.

>I can't think of anything that the government runs better than the private sector. Healthcare is no different.

Government run care has the highest satisfaction rate of any healthcare coverage[2].

1. https://www.nytimes.com/2015/09/21/business/a-huge-overnight...

2. https://news.gallup.com/poll/186527/americans-government-hea...

Re: When good ideas make bad business

#283

Post by NeedMoreTea »

planetzero wrote: post #209
omegaworks wrote: post #187

Earlier quoted context omitted.

This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to p…

Don't have to put money into R&D.

Between the MRC and NIHR, the UK's NHS puts at least a couple of billions (Sterling) into clinical research each year, making them the largest clinical research funder in Europe. They're not researching generics. Oh and they were one of the original funders of PubMed Europe.

I can think of lots of things the government does better than the private sector, although admittedly outside the US.

Re: When good ideas make bad business

#284

Post by Buge »

wayoutthere wrote: post #215
planetzero wrote: post #209

Earlier quoted context omitted.

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to p…

> The US is the back-bone of the medical system for the rest of the world and also has the best medical schools and best quality hospitals (the majority of people with money come to the US for life-saving surgeries..this has to tell you something). This just means American consumers end up subsidizing health care R&D costs for the rest of the globe — purely because our government prevents us from collectively bargain…

If American consumers stop subsidizing health care R&D costs, what will happen to the R&D? Will it decrease? Will health care costs in other countries increase as they start to bear some of it?

Re: When good ideas make bad business

#285

Post by justincredible »

beat wrote: post #86
rjkennedy98 wrote: post #66

Earlier quoted context omitted.

That line stood out to me also. Anyone who feels that the primary goal of healthcare in the US is to improve health outcomes is incredibly naive about how this industry (which is over 20% of the us economy) works. There is only one group in the entire industry which has an incentive to keep people healthy (insurance) and that is the most hated of the bunch!

Perverse incentive structures are the fundamental reason US healthcare is so expensive and stupid. It's not "greed" in a simple sense, and it's not "regulation" in a simple sense. It's a system of interacting problems that needs treated in a systemic way. Blaming the insurance companies strikes me as the political equivalent of yelling at the cashier.

s/systematic/systemic/

Re: When good ideas make bad business

#286

Post by DanBC »

planetzero wrote: post #209
omegaworks wrote: post #187

Earlier quoted context omitted.

This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to p…

> Most new drugs come out of the US

How true is this though?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

> Objectives. We explored whether the United States, which does not regulate pharmaceutical prices, is responsible for the development of a disproportionate share of the new molecular entities (NMEs; a drug that does not contain an active moiety previously approved by the Food and Drug Administration) produced worldwide.

[...]

> Conclusions. Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation, and many countries with drug price regulation were significant contributors to pharmaceutical innovation.

And

> In the United Kingdom, the pharmaceutical industry invests more of its revenues from domestic sales in research and development than do companies in the United States.

The US pays a lot for medication, but a lot of that money is used for things that are not innovation (eg advertising). Countries that have better free markets for medications don't see less spending on innovation, they see more spending on innovation.

Re: When good ideas make bad business

#287

Post by sweeneyrod »

pgsbathhouse wrote: post #268
sweeneyrod wrote: post #257

Earlier quoted context omitted.

> Marketing budgets are several orders of magnitude higher than R&D budgets. This is a lie. Marketing budgets are approximately equal to R&D ( https://www.bbc.co.uk/news/business-28212223 ) so you're off by several orders of magnitude. > Most of the real "hard science" R&D is paid for with NIH grants. Also not true. NIH grants are ~$40 billion/year whereas industry R&D are around $80 billion ( https://www.statista.co…

>This is a lie. Marketing budgets are approximately equal to R&D Your own source doesn't even say that. In the exact BBC article you linked: >But as the table below shows, drug companies spend far more on marketing drugs - in some cases twice as much - than on developing them Here's some very very basic reading on the subject that you can find in 10 seconds of googling: https://en.wikipedia.org/wiki/Pharmaceutical_ma…

In the context of a claimed difference of "several orders of magnitude" (i.e. >1000x), a difference of 1-2x rounds down to 1.

If you follow the citations for that Wikipedia claim (a very very basic step) you will see that they don't provide any evidence for an order of magnitudes difference.

I'm not usually in the habit of shilling for Big Pharma, but since you've taken such a condescending tone I'll make an exception and point out that according to that exact Wikipedia article you linked, literally the same paragraph on the topic mentions that the majority of marketing spending is on free samples. Unless you think that drug companies should raise their prices in order to fund more R&D (which would have the same effect as reducing free samples) this doesn't seem very objectionable.

Re: When good ideas make bad business

#288

Post by rossdavidh »

achillean wrote: post #231
rossdavidh wrote: post #201

Earlier quoted context omitted.

Another possibility: how many people would be willing to donate a few bucks a month to support it? Call it the public radio model. You won't get rich, but you might pay for upkeep and servers.

Donations are extremely difficult to make work. I tried it after getting decent traction in 2009 and didn't receive a single donation to cover server expenses. I'm guessing with Patreon things have gotten a bit easier but for a business I would highly advise against going down the donations route. In general, small payments also tend to take up a disproportionate amount of your support time compared to larger transac…

One big difference post-Patreon is that I no longer think "my small regular contribution is just going to get chewed up in transaction fees", since Patreon does just one transaction a month and then divides it up among several people/organizations that I support.

But, it would not be my first business model to try, just an alternative to "we built it but now let's just shut it off".

Re: When good ideas make bad business

#289

Post by cal5k »

mbesto wrote: post #279
cal5k wrote: post #247

Earlier quoted context omitted.

> because if you could prove there were cost and health outcome benefits on a national scale you would be able to convert the idea into a viable business with a single corporate sales pitch, instead of trying to sell to every doctor individually. As someone who ran a healthcare business in Canada, I can tell you that this is absolutely not the case. Single payers are outrageously conservative buyers... sure, you may…

> As someone who ran a healthcare business in Canada, I can tell you that this is absolutely not the case. Correct me if I'm wrong, but doesn't Canada have publicly funded providers? I'm all for single payer, but with a completely privatized provider network. Make the free market compete for the government's dollars. Technology should theoretically reduce costs because it more automation generally means higher profit…

You are wrong. The single payer in Canada is each province's respective health insurance plan. Anything listed on their "schedule of benefits" can only be paid for by the province.

Providers are actually in many cases like contractors... most family doctors, for example, bill for services rendered and are otherwise free agents (unlike in the UK).

Re: When good ideas make bad business

#290

Post by Frqy3 »

legitster wrote: post #89

I wish he could have invested more in the idea - I think it's an amazing concept but the creator pulled the plug too early. Sales cycles in B2B can take months, and in healthcare they can take years. Especially the doctor's feedback, she described the possibility of changing her habits slowly as she got used to using the tool. Unrelated: "I always have the best interests of my patients in mind, but, you know, it’s no…

Or like a lot of GPs, she just prescribes whatever medication is top of mind after the last visit from the friendly pharma sales rep.
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