Healthcare

that's not the point—the point is that it takes a non-zero amount of money to do that (creating samples, doing molecule-level write ups, etc, just so the government or the doctors even have a clue of what this product is doing and how it works before they start testing/distributing it), regardless of whether it's required or not.

edited 29th Jun '12 9:30:20 AM by ch00beh

And you count that as advertising?

I don't think I'm seeing your point. Having your products checked and evaluated is part of any project that deals with the production of anything. In a system where the state pays for the research, all of that would still need doing.

So are you saying that the argument that state-funded systems don't waste money on marketing is defeated by the counter-argument that even a state-funded medical company would have to send their products out for testing, as well as informing the medical community of the existence of that product (once it passes the tests)? But that's not all that marketing is in the medical industry, especially if we're including the health insurance industry. With a state-funded system, you never have to advertise the insurance policy to the clients, because they're getting the system by default anyway. So that saves a lot of money. Another thing is that you don't really have to advertise your products on TV or anything like that - you only need to send info about it to people in the medical professions, and they'll let the customers know about the product.

That said, over-the-counter products still do need some advertising, because people don't always seek treatment if they don't know that there's a product for their symptoms. But that's more or less it, in terms of what advertising there ever needs to be.

Now, I don't support a system that doesn't have any private medical corporations or insurance corporations. Competition is a good way to get great products out in the market. I'm just saying that the state should be mostly in control of all that, and that the state should be able to provide you with everything you need, even if there are some private corporations involved in the process.

BTW, I've seen claims that most of the world's medical R&D is done by the US because the US is the only Western country where it's a free market business. I can't find much hard data, but this article lists 20 countries based on how many citations of clinical medical papers produced in each country were made in publications in the field between the years 1998 and 2008.

It seems that every other country in the top-10 is getting more papers and citations than the US if you compare the figures to the population or the size of the economy of each country. Still, credit where credit is due: the US is #1 in absolute terms.

I don't think that the number of papers and citations in the US is entirely based on the contributions of the private industry. On the contrary, I'm pretty sure that most of those papers were made in government-funded institutions, such as universities. On the other hand, it's probably true that all of those countries get a significant number of their papers from private corporations, so it's not black-and-white.

edited 29th Jun '12 10:00:26 AM by BestOf

I don't think simply cutting out TV marketing will help much

Granted, there's a lot of room for optimization.

edited 29th Jun '12 10:52:48 AM by ch00beh

Wow: from that, you get the distinct impression that Scotland is a paper-producing powerhouse! I know medicine has always been big in Scotland, but when you compare those figures with the population density... that is beyond what I'd've thought by quite some margin.

edited 29th Jun '12 11:36:39 AM by Euodiachloris

Yeah, and look at Finland! Our papers get more citations that CHINA.

Well, considering the EU has a roughly similar (okay, 200 mn more) population to the US, then we (as a collective block) come out on top, then, right?

In absolute numbers, we definitely win against the US. In terms of papers or citations per capita, I think most European countries win against the US anyway.

edited 29th Jun '12 12:35:42 PM by BestOf

I'm rather unclear on the argument that choobeh is making in this case because it seems like he is indicating that the private industry doesn't have to acquire approval from the government and may just simply push products to market. That's not the case and I certainly hope he was not advocating that to be the case. You require government approval to sell anything and depending on how dangerous the product this determines whether you can sell over-the-counter or require a prescription. That's how it works in North America.

Then you went onto a point about privacy concerns or government requiring magical data or something. I'm also unclear on this point.

Government provides healthcare in single-payer systems, although they may contract out services to private entities. Collecting data on effectiveness of drugs is not difficult. A person is diagnosed with something, treatment is attempted and then effectiveness is recorded. Some of this data is private, some is not, and some is made available through "anonymizing" the source of the data. The development of e-health allows us to act more effectively and more anonymously. I'm guessing you're picturing this army of bureaucrats storming into hospital rooms measuring out statistics. America, to be honest, is the land of insane bureaucracy and privacy invasion. Actually trying to collect data requires none of that.

Private entities have no incentives to act in that manner. They seek to have the most expensive possible treatment done for any condition and treat the most number of conditions as possible. Private insurers attempt to do the opposite. At no point is treatment effectiveness built into the incentive system.

As well, R&D in general is typically done by universities. Europe has far superior universities per capita compared to America and thus why they produce way more papers. It's also why China is lagging behind Europe because they're still upgrading their education system. US spends nearly twice as much in healthcare, and many times more in R&D and look at the results. It's actually worse per capita. Many universities receive private funding for the research but the important point to note here, America has a far greater mix of private funding yet has worse results overall.

the point I am trying to make and have stated three times is that it takes a non-zero amount of money for anyone to know that a given researcher has made a thing. Even if it was just a terrible blog, that means the researcher had to spend however many minutes/hours doing the write-up, or they had to hire someone to do it for them, or whatever.

In case you don't have a job yet, the way they work is when you are doing something related to work, you are paid for your time. If you are not employed by someone, that payment is measured in opportunity cost in that you could be doing something else with your time that may or may not be a net positive in some aspect (such as more research). If you are letting the internet or some central database run by the government do the proliferating of information for you, then the opportunity cost is paid for by the doctor, who must now do their research by trawling archives instead of helping patients.

So to reiterate for the fourth time, the "advertisement" cost doesn't just magically disappear, at the very least because time=money. I'm not disputing that it can be reduced by some significant margin, though.

PS. in case you still don't get it, letting people know something exists takes a measurable quantity of money. This is called "advertisement," which does not just refer to commercials on TV.

PPS. also it costs money to disperse information regardless of how you do it.

PPPS. money=power, power=information, ergo, money=information.

PPPPS. there are costs to doing anything.

edited 29th Jun '12 6:36:06 PM by ch00beh

What does that have to do with the Affordable Healthcare Act, though?

This is the healthcare thread, not the ACA thread :P

@ Choobeh

Well, I was (as I won't presume what the others were trying to say) saying that the information you are talking about is inherently built into the safety-standards clinical trial runs required by government agencies.

For instance, in Canada in order to approve a drug you must run clinical trials approved by Health Canada, the type and scale of which is determined by health experts employed by the government. The data collected includes possible side effects, effectiveness in treatment of different conditions and effectiveness. This data is collected, analysed and then distributed to the different provinces who can then recommend the treatment option in place of existing ones for doctors to use.

As e-health evolves, the bureaucracy of that is reduced.

Marketing/sales refers specifically to corporate-funded pamphlets, tv advertisements and conferences meant to introduce this product to the general population and to medical professionals. So what is the difference we're trying to impress upon you?

The incentives.

In the first part I talked about how the government would collect metrics on the drug:

• Corporation asks to approve a drug and they say what condition it is meant to treat
• Government requires corporation to run tests and prove this with data
• Government uses the drugs according to the data

In the private advertisement

• Corporation will still probably have to pass the safety tests (the cost of this is likely to equal everything I said above, so the lower points are all additional cost)
• Corporation then attempts to market this product to doctors and patients and entice them to use the product
• Corporations hope patients/doctors are swayed by the ads to choose the highest profit margin treatment for any condition

The key point here is that doctors/patients choosing to use the new drug is based on being swayed by ads, not by actual clinical data. Thus the big final conclusion:

Corporate ad spending does not improve the quality of healthcare.

edited 29th Jun '12 7:02:00 PM by breadloaf

There's three threads that appear to be about essentially the same thing and the conversation is merging in my brain.

This here is the thread to lament America's lack of single-payer.

It could also be expanded to lamenting the lack of preventative and pharmacare in Canada.

I think my side was arguing that that margin is not only significant, but absolutely frickin' HUGE. I'm not sure if anyone said that no time or money would have to be spent on marketing, but a government-run system saves a huge amount of money that a private insurance system would spend on marketing. If everyone has a default health insurance that they get from the government, that insurance scheme will never need to advertise. Not even once; you already have it by default, so the government doesn't even want you to "choose" it.

The private insurance corporations will still advertise to get you to pick them in addition to or instead of the government-provided free health insurance, but the government-provided insurance will never pay for ads to compete with the private industry.

It's kind of the same with drugs, except it's a bit more complicated.

Well it's worse than that because advertising also increases spending because it shifts consumer purchases toward more expensive options. That is, afterall, the whole point of ads is that you make consumers spend way more than the ads cost.

So when pharmaceutical marketing is a 30-60 billion USD industry in America, how much extra unnecessary spending did it cause by pushing people to purchase unnecessary or more expensive than required treatment? Cost, afterall, in healthcare, only has a loose correlation to effectiveness.

If I spend 60 billion USD in ads, I should expect revenue increase far in excess of that, like say 300-600 billion USD more revenue. Otherwise, why spend for the ads?

We already know USA spends almost twice as much per capita in healthcare yet has worse results than any single-payer system. Where's the money going?

edited 29th Jun '12 7:19:50 PM by breadloaf

Warning, Thread Hop imminent!

I'm an American and I support the idea of socialized health care. Here's why.

Currently I've got an impacted tooth. If I don't get it taken care of, the infection could spread into the bones of my jaw and doctors would have to basically cut my face off to get rid of it. The procedure to take care of the problem is known as a root canal...if I get it taken care of promptly.

Now, I'm lucky enough to have health insurance which includes a dental option...I get this coverage through my job and I pay for it. But, the coverage only will absorb 50 percent of the cost of a root canal...and the procedure costs one thousand dollars. I don't have $500 just lying around, and co-pays have to be taken care of "at the time of service".

So basically I'm paying for something I can't afford to use even though I need it. If this sounds fucking ridiculous, that's because it is.

Yeah, I want socialized medicine. I'd pay higher taxes to get it, because the dollars are already leaving my pocket and I'd rather they go to something that will actually...I don't know, benefit me.

That's awful.

I do caution that first-step socialised healthcare won't include dental (Canada doesn't include dental). But, because your main healthcare will be paid for via taxes, there's no reason why you can't go ahead and buy kickass dental insurance with the money you now saved.

<winces> Ouch.

Damn, but I love my NHS Dentist down the road. He might not keep my teeth sparkly-white (that, you have to pay for), but the major stuff? That's either on the tax-paying tab (root canal would certainly be that), or with a majorly discounted fee if it's not as imminently important. Fees are entirely dependant on health-risk associated with the condition treated. Which is why bleached-white teeth? Are a stump-up-the-cash thing.

I've never understood the point of prescription drug ads. I mean, who are they trying to influence? Patients can't decide which prescription drugs they take; they either take what their doctor prescribes or nothing at all. And doctors presumably have to read the medical literature on a drug before prescribing it, so they should be able to see through the advertising BS. Is there something I'm missing here?

It has two uses: alerts doctors that there has been an upgrade or just update in the prescriptions available for a condition (so, please quit with the boring, old generic one, thanks, vote for us instead!) and also points them in the direction of reading they need to attend to.

Sounds pointless, but... not really. Particularly if you have several new drugs for conditions as wide-ranging in symptomatology as depression, some patients of which will have adverse reactions to some of the drugs on offer. The doctor might go for a competitor (or their usual list of stand-ins) when trying to prescribe around the rashes or the dizziness.

edited 30th Jun '12 8:35:56 AM by Euodiachloris

Isn't there some database that lists all the different drugs out there and lets you choose criteria to narrow down your options?

It's not as flashy and noticeable as a... rainforest of pamphlets? (Tries to see it...)

Well, whatever: the companies seem to think it's cost effective. <shrugs>

@Euo: It's cost effective because there are a LOT of people in the US that will see an ad for a medication, then go to the doctor and demand to be checked for that disorder. Doctors in the US also enjoy a pretty cozy relationship with pharmaceutical companies, and getting a bad doctor will mean that they'll try to put you on every medication that'll buy them lunch or send them free swag.

There are also people (like my mother) who will hop from doctor to doctor until they get the medication they think they need.

I was meaning more that the doctors are the ones being bombarded with the glossies. But, yeah... that, too.

Thankfully, in the UK, only the doctors (and hospital administrators) usually get annoyed by e.g. Roche or GlaxoSmithKlein pulling all the stops out.

edited 30th Jun '12 11:56:42 AM by Euodiachloris

Strangely enough, GSK's main operation is in the US. Forty percent of its output is to America.