One of my hobbies at work is developing "quick wins" and process improvements. Lately, I've been thinking this is critical not only to business sucess, but to the stability of our healthcare system. Health science has been rapidly developing new miracle treatments such that people live longer, babies can survive when born younger, and as a result, quality of life improves. But this is not without added cost. Health care costs are increasing, and they should, as we are paying for more amazing results. But, this cannot continue for ever because there is only so much cost our economy can support. The way to fix this is through efficiency, by making older drugs cheaper or creating new, less expensive versions of current drugs. The savings in the older drugs can offset the new cost of the newer treatments.
However, efficiency in pharmaceuticals does not necessarily mean cheaper treatments or less expensive health insurance. When a company has a monopoly on the treatment, they have no incentive to reduce cost. Any saving through efficiency will only lead to greater profits. This is not entirely without benefit to patients, as greater profits may lead to greater investment in R&D, but lower costs are needed as well.
Monday, May 24, 2010
Sunday, May 16, 2010
Wednesday, March 31, 2010
I heard this story on NPR recently and it has me brainstorming a pharmacoepidemiology paper about exclusion criteria (types, reasons, and effect).
Report Questions Excluding Gays From Some Studies
by The Associated Press
March 17, 2010
A small but significant portion of medical studies exclude gays from participating, sometimes without an apparent scientific reason, several cancer researchers say.
In a letter in Thursday's New England Journal of Medicine, three scientists from the Fox Chase Cancer Center in Philadelphia cite several dozen studies requiring a participant to be "in a reciprocal relationship with a person of the opposite sex."
There are legitimate scientific reasons for excluding gays from certain studies. Scientists would want only heterosexuals if they were studying how HIV spreads during male-female sex, for example.
But the Fox Chase folks found cases where the reason for excluding gays is not clear: tests of a drug for attention-deficit disorder, a treatment for erection problems after prostate cancer surgery, and studies on sexual function related to diabetes, depression and benign enlargement of the prostate as men age.
Brian Egleston, a biostatistician at Fox Chase, made the observation while overseeing enrollment of patients into clinical trials at the cancer center.
"When I first saw this, I thought it was a fluke. The second time, I thought I'd dig deeper," he said.
Egleston and Roland Dunbrack Jr., a biologist, and Dr. Michael J. Hall, a medical oncologist, did a spot check of a government database of thousands of studies and turned up more examples, most of them private-industry trials.
Researchers seeking federal money for their work must explain why a study excludes a group based on gender, race or ethnicity, but no explanation is needed for exclusion based on sexual orientation, Egleston said.
Exclusion can become self-perpetuating: Researchers designing a study often "cut and paste" participation criteria from earlier trials on a similar subject.
"It becomes the way it's done," and any bias gets repeated, Egleston said.
Estimates of how much of the U.S. population is gay or bisexual vary widely; some polls have put it around 4 percent.
———
On the Net:
Medical journal: http://www.nejm.org
Report Questions Excluding Gays From Some Studies
by The Associated Press
March 17, 2010
A small but significant portion of medical studies exclude gays from participating, sometimes without an apparent scientific reason, several cancer researchers say.
In a letter in Thursday's New England Journal of Medicine, three scientists from the Fox Chase Cancer Center in Philadelphia cite several dozen studies requiring a participant to be "in a reciprocal relationship with a person of the opposite sex."
There are legitimate scientific reasons for excluding gays from certain studies. Scientists would want only heterosexuals if they were studying how HIV spreads during male-female sex, for example.
But the Fox Chase folks found cases where the reason for excluding gays is not clear: tests of a drug for attention-deficit disorder, a treatment for erection problems after prostate cancer surgery, and studies on sexual function related to diabetes, depression and benign enlargement of the prostate as men age.
Brian Egleston, a biostatistician at Fox Chase, made the observation while overseeing enrollment of patients into clinical trials at the cancer center.
"When I first saw this, I thought it was a fluke. The second time, I thought I'd dig deeper," he said.
Egleston and Roland Dunbrack Jr., a biologist, and Dr. Michael J. Hall, a medical oncologist, did a spot check of a government database of thousands of studies and turned up more examples, most of them private-industry trials.
Researchers seeking federal money for their work must explain why a study excludes a group based on gender, race or ethnicity, but no explanation is needed for exclusion based on sexual orientation, Egleston said.
Exclusion can become self-perpetuating: Researchers designing a study often "cut and paste" participation criteria from earlier trials on a similar subject.
"It becomes the way it's done," and any bias gets repeated, Egleston said.
Estimates of how much of the U.S. population is gay or bisexual vary widely; some polls have put it around 4 percent.
———
On the Net:
Medical journal: http://www.nejm.org
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