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The future of medicine and a small soultion to rising costs

SkinsNDeacs

SkinsNDeacs

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Wal-Mart shoppers: The doctor will see you now

Full disclosure...the equipment that is outlined in this article (and pictured) is produced by my wife's company so I am a touch brainwashed on this.

That being said with fewer and fewer doctors, access to routine screening is likely to become even less prevalent. If equipment and programs like the one described become common place we might be able to catch small problems before they become large problems and save lots of money. Also the possibility of opening access to more remote, less affluent areas are endless. telemedicine medicine could revolutionize modern medicine as we know it (hopefully).
 
Telemedicine, personalized (genetic) medicine, and preventative medicine are the future of medicine.

The culture has to catch up to the technology. Researchers are 10 years faster than clinicians.

Part of the blame for slow uptake of electronic health/medical records has to rest on clinicians who are uneager to adapt to new technologies. Obviously there are HIPAA concerns to work out with privacy, data integrity, security, etc. But if clinicians were quicker to adapt and accept new technology, give feedback more quickly, etc., we might be on 2.0 right now instead of still beta testing EHRs around the country.

Similarly, as algorithmic medicine, decision support, etc. moves to the cloud and to mobile devices, expect clinicians to be looking at their tablets and computers and phones instead of you for a while. The ergonomics of doctors offices may need to change to accommodate the shift away from a desktop computer in an exam room, as will bedside manner in kind.

I disagree with Skins that access to routine screening will become less prevalent, but it may be a semantic disagreement. I think the nature of screening will change permanently going forward, and telemedicine is one piece of that puzzle.
 
Yeah...I think that is more semantics. When I say "screening" I mean catching small problems before they become big...not necessarily a Dr putting eyes on you. Without adopting some of the new technologies we are talking about those will become less prevalent. But with the adaptation of new lines of thinking and technologies they become better and more prevalent.
 
here is a better solution to rising costs: have a "public option" and give it super-duper power to exert downward pressure on pricing.

Germany's healthcare system is very much like ours (employer-based, privately owned doctor practices and hospitals) but they spend a little more than half our per capita health costs and get better results. The big difference, as far as I can tell, is that all the insurance comes from a "public option" - not quite single payer as apparently there are many of these "sickness funds" - and all the providers get their pricing from there. http://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/

Hard to imagine this happening in the US anytime soon because the political power of doctors, hospitals, and Big Pharma will be dead set against it. They would make much less money in the German model, and the rest of us (as payers and taxpayers) would get to keep a lot more of ours.
 
I'm not sure I understand how this is less routine screening. A person can go into the Walmart clinic, get observed by a doctor some miles away in a 1 on 1 but has a nurse with them at the same time.....which does not happen in the real clinic. If the doctor thinks the problem is bad, tells the patient to visit the real clinic where he's located. It saves some time..the person doesn't have to drive a long way. The doctor might be able to see more patients in a day but the nurse still has to be at the WalMart clinic. It still seems like a lot of healthcare provider time.

The future is a better underlying understanding of diseases and biomarkers that are predictive, especially tests that accurately suggest someone is predestined to develop diseases down the road like neurodegenerative diseases, drug addiction, heart conditions. For example, researchers developed a simple test they think will show if you're destined for Alzheimers. With that in place, then measures can be taken very early to halt the loss of synapses before the balance tips far in that direction...people can take certain anti-inflammatories, natural product supplements, avoid certain things that aggravate disease....simple lifestyle changes that lead to better health for the individual.
 
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http://theincidentaleconomist.com/wordpress/if-a-10-cent-coupon-incentive-works-is-anyone-surprised-that-120-does/

Here’s how the system works: When a doctor administers a drug in his or her office, Medicare pays 106 percent of its average selling price. The doctor keeps the extra as compensation for administering the injection.

What has this got to do with eye doctors? The drug Lucentis, used to treat macular degeneration, cost Medicare almost $2,000 a shot in 2012. Another drug, Avastin, which works just as well, costs about $50. If you were the doctor, faced with a system that pays you 6 percent of the drug’s cost, which would you choose? That Medicare spent a total of about $1 billion on Lucentis in 2012 suggests most ophthalmologists went with the more expensive one.
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I feel like just fixing blatantly obvious low-hanging fruit like this could save our economy billions every year.
 
Agreed. But that low hanging fruit would cost doctors, Big Pharma, etc billions every year. And that's why we're not seeing change.
 
PhDeac said:
Agreed. But that low hanging fruit would cost doctors, Big Pharma, etc billions every year. And that's why we're not seeing change.
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Pharma draws a lot of ire, and for good reason. The FDA is complicit in driving up drug costs for consumers, too.

You couple pharma's greed (or business savvy, depending on where you stand) and advertising costs with the FDA's (requisite?) stringency and high administrative costs (requisite?) and drugs are very expensive from start to finish.

Genetic research has grown by leaps and bounds this decade. But it's another staggering example of where pharma/biotech and the FDA are standing between consumers and cancer cures. Oncogenes are big targets in cancer research. p53, RAS, etc. are linked with dozens, in some case hundreds of types of cancer, and draw a lot of funding from NIH, NCI, pharma, biotech, etc. Some oncogenes that are linked with very rare cancers have "low hanging fruit" type paths to biomarker identification, preventative care, and potential pharmaceutical treatment or even cures. however, due to the cost of taking drugs to market, with the small number of cases involved each year, it is simply not cost effective enough to put the research dollars, drug development dollars, or marketing dollars there to bring forward these kinds of cures.

There are lots of little battles like this that take place in biomed research that are very frustrating to see, but that I hope can be addressed in future generations.
 
TownieDeac said:
Telemedicine, personalized (genetic) medicine, and preventative medicine are the future of medicine.

The culture has to catch up to the technology. Researchers are 10 years faster than clinicians.

Part of the blame for slow uptake of electronic health/medical records has to rest on clinicians who are uneager to adapt to new technologies. Obviously there are HIPAA concerns to work out with privacy, data integrity, security, etc. But if clinicians were quicker to adapt and accept new technology, give feedback more quickly, etc., we might be on 2.0 right now instead of still beta testing EHRs around the country.

Similarly, as algorithmic medicine, decision support, etc. moves to the cloud and to mobile devices, expect clinicians to be looking at their tablets and computers and phones instead of you for a while. The ergonomics of doctors offices may need to change to accommodate the shift away from a desktop computer in an exam room, as will bedside manner in kind.

I disagree with Skins that access to routine screening will become less prevalent, but it may be a semantic disagreement. I think the nature of screening will change permanently going forward, and telemedicine is one piece of that puzzle.
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wow you're clearly very well educated on this topic. good post.

@all: i also agree that thinking at the margins, doing the little things can make a huge difference.

Unrelated, but we'd save millions on crude if every local intersection were redesigned to roundabouts in the US. Also less accidents, don't need to power lights or pay for smart lights, and just generally more efficient.
 
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Townie knows drugs better than dmcheatw.
 
Well they're comparing the top executives to regular physicians, but the numbers don't surprise me that much.
 
Saw somewhere recently that the top exec of the Ontario health system makes $350,000 for overseeing a system bigger than most US insurers portfolios (and in a place with better health outcomes and higher customer satisfaction). Wish I had saved the link.
 
Deacon923 said:
Saw somewhere recently that the top exec of the Ontario health system makes $350,000 for overseeing a system bigger than most US insurers portfolios (and in a place with better health outcomes and higher customer satisfaction). Wish I had saved the link.
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Obviously the Koch brothers had it destroyed immediately.
 
It's been about a year since Section 902 of the FDASIA (Food and Drug Administration Safety and Innovation Act) was amended, adding the "Breakthrough Therapies Designation," which is essentially a way to fast-track a treatment through clinical trials into drug development. In that time, 28 drugs have been given the designation and have been taken to market, drastically reducing the amount of time typically seen. It's rare a program works so well so quickly and with such bipartisan support, but it's basically a no-brainer. The legislation also mandated more transparency for industry guidance on supporting/interoperability between academia, pharma, and biotech.

12 of the 28 drugs treat cancers of various kinds; 10 of those 12 were either for untreatable or inoperable states.

Here are a couple links if anyone is interested - http://www.fda.gov/regulatoryinform...antamendmentstothefdcact/fdasia/ucm329491.htm

http://www.focr.org/breakthrough-therapies

I report this with a cancer research bent since it's my field, but this is the kind of stuff we need more of in Washington.
 
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