Organization: Penn State University
Date: Thu, 30 Jul 1992 19:56:17 EDT
From: <DGS4@psuvm.psu.edu>
Newsgroups: sci.med
Subject: Re: FDA still at large
 <92211.202315DGS4@psuvm.psu.edu> <1992Jul30.204421.8260@gateway.novell.com>

In article <1992Jul30.204421.8260@gateway.novell.com>, terry@npd.Novell.COM
(Terry Lambert) says:
>
>In article <92211.202315DGS4@psuvm.psu.edu> <DGS4@psuvm.psu.edu> writes:
>>In article <1992Jul29.172942.16494@gateway.novell.com>, I write:
>>>
>>>        I can not agree with the idea that "expensive" treatments should not
>>>be used.  Their use encourages both improvement in the procedures (lowering
>>>cost) and developement of alternative procedures to accomplish the same
>>>goals (also lowering cost).  When the cost reaches common use levels, the
>>>treatments become commonly used.  The United States is a leader in
>>>biotechnology precisely because of the market-driven bent of our medical
>>>system.  Eye glasses and Insulin are
>>
>>I'd like to see you offer a single piece of evidence that supports this
>rather
>>explicit claim.
>
>Precisely which point are you contesting, and on what grounds?
>
>1)      Use of expensive treatments being disallowed on the basis of an
>        "economy of numbers" is a bad idea.

Not this one....


>2)      Capitalism is an applicable principle in the developement of
>        medical procedures and treatment protocols.

Not this one.....



>3)      Purchasable materials (such as drugs and physician time), where
>        the perceived benefit outweigh the perceived costs, will be
>        purchased (a reiteration of a capitalist theme).

Not this one...

>
>4)      The United States is a leader in boitechnology.

Not this one...

>
>5)      The capitalistic system in use in the day-to-day operation of
>        the United States as a country has something to do with the
>        United States being a leader in biotechnology.

AHA.  Here's the one I was hoping to find.  Please offer a single economic
study that traces a measure of "leader in biotechnology" (eg. number of
patents, maybe?) to some measure of "market-driven"-ness (your original
term).  As a health economist, I'd like to include such an article in my
syllabus, since I think it is probably the most important consideration in
in the health policy debate taking place.  However, in an extendid MEDLINE
search, and a review over the last 5 years of major health journals, as
well as attendance at several major meetings per year, I have not find a
single study which was able to demonstrate this connection and show the
causal link.

>7)      Insulin and eyeglasses would cost more if less people wanted to
>        buy them.

Funny, but all the free-market economics that I learned says that insulin and
eyeglasses cost moreif MORE people want them.  You are missing a few ceteris
parabus assumtions in your analysis.

>>Funny, but quite a few medical products, drugs,and techniques are
>>developed in Canada, Germany, Switzerland, the Netherlands, etc., etc.,
>>Face the facts, there is a continuum of combining market and government
>>in health care.  Our current combination provides high cost, low access to
>>most cost-effective procedures for a large percentage of the population,
>>and extraordinary levels of interference by third parties (both government
>>and private) in the doctor-patient relationship.  Maybe, it provides faster
>>technological growth, but that claim has never been proven.
>
>First, I would have to argue that most medical advances come from people
>who believe that they can get a return on their investment.  Whether this
>is a private physician/clinic in one of these countries, or whether this
>is the result of the large provate medical and pharamaceutical firms in
>these countries is inmaterial (although Sandoz Pharmaceiticals, whose home
>office is, I believe, in Basil, Switzerland, is one of the largest
>privately held companies of it's type in the world, and certainly expects
>to make a profit).

Yet, you will notice, that this privately held company is quite able to
co-exist, nay, thrive, in the midst of a national health insurance system.
There is no law against making a profit in most NHI schemes.  All the
government has to due is finance health care, not run it.  In fact, if
you'll ask most doctors who work in NHI systems, their government is far
less involved in medical care than is the US government in our more
private system.

>Government has never been able to provide anything by a few large scale
>service cost-effectively.  This is why there are firms contracted by
>government to provide utilities, garbage collection, and other services

You have a little bit to learn about public economics.  It's also a great
way for government officials to buy votes.  But, that's just an aside...

>traditionally though of as belonging in the province of government.  It
>is cheaper than providing the services itself.  This is why there is a
>provision for government granted monopolies, usually utilities, but
>including police protection in some cities.
>
>Second, I would have to argue that the high cost associated with health
>care is a direct result of the malpractice insurance requirements due
>to a lack of civil liability legislation limiting the damages which can

If you'll pardon the expression, HORSE DOOTS.  The high cost in our system has
very little to do with malpractice, as the great volume of literature on
the topic clearly demonstrates.


>be claimed.  I will be bombarded, I am sure, by many people for this
>viewpoint, but I suggest that those same people agree with you that our
>ficticious Mr. Joneses life is not worth $20,000.  It doesn't matter if
>they agree with you on quality of life, expected duration of that life,
>or social responsibility ("greatest good").  They have placed a rather
>arbitrary limit on Mr. Joneses expected value to society, and complain
>when I suggest the same in the post facto (after the damage is done)
>case.

I agree that Mr. Jones can put any value on his life that he wishes.  If
he has the money he can pay that amount for medical care.  However, if
medical care is subsidized (through public funding, tax breaks for health
insurance purchases, medical education subsidies or any other means) than
I am, in effect, picking up part of the tab for Mr. Jones' care.  And you
damn well better believe that I'm going to insist upon having a say in
how my portion of the money is being spent.

>Third, I agree that there is way too much interference in the private
>developement of medical protocols and procedures, both by the
>government and by special interest groups.  Look at the recent attempts
                   ************************

I wasn't talking about "special interest groups", I was talking about
private corporations who contract with an employer to interfere in the
doctor-patient relationship to control costs.  PPOs. utilization review
firms, HMO administrators, etc....  These private firms, like the biotech
companies you admire, has been quite innovative in developing new
technologies which interfere in the choices that primarily affect the lives
of patients and doctors.

>to legislate ethics in the RU-486 case.  Most people think that a simple
>pill is involved, and do not realize that a physician-administered shot
>is required as a followup (per the developer of the drug).  It reminds
>me of the "Come the revoloution" joke that derives it humor from the
>"freedom fighters" advocating opression when their views are challenged.
>Litigation by the government and scpecial interest groups doubtlessly
>exerts a retarding influence on anyone advocating anything but the status
>quo in medicine (or any other branch of society, for that matter).  It
>doesn't even have to be real: a threat of litigation or a perceived
>threat of litigation is enough.  The company which manufactures RU-486
>hasn't even implied they will distribute in the US, which is sad, given
>it potential to treat several types of cancer in women.  I suppose that
>coat hangers, which can be used for the same purpose, have greater social
>benefit in their ability to keep clothes off the floor than a drug which
>can be useful in treating cancer.  Go figure.

Why should you be upset that a private firm calculated the costs and benefits
of a market decision, and decided not to offer RU-486 in the US.  Sounds to
me like the private market in action.


Dennis G. Shea, Penn State
<<DISCLAIMER>>
Ain't nobody's bizness but my own. I'll be happy to accept all
the credit for anything I've written.  It's funny, however, how
employers only acknowledge the profitable ideas.