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There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. It often doesn't fully turn over until an
by darkerside 8y ago
There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. It often doesn't fully turn over until an older generation of doctors retires.
It seems to me that, of many imperfect systems, one where doctors have control is more preferable. They are legally and duty bound to serve their patients. The same can't be said of pharma company marketers, not by a long shot.
Let's solve the right problem (updating doctors with new training), not the wrong one (let people but prescription drugs they may not understand). Not all drugs are as cut and dry as birth control pills may seem to be.
- nanagull 8y agoPlease see this report by the American College of Obstetricians and Gynecologists : https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives https://www.acog.org/Clinical-Guidance-and-Publications/Comm... It discusses a series of studies on the "ability of patients to self-screen for birth control pill eligibility", and determines that patients are good enough at self-screening that the medication may as well be over-the-counter. It sounds like, from the initial article, that the FDA is taking a similar approach: "Drug companies would have to submit data to the FDA that shows consumers are capable of accurately assessing their need for a medication and their ability to use it correctly." Obviously we'd need to wait to see what the FDA actually approves/disapproves for these purposes, but it actually seems quite likely the approved drugs will, in fact, be restricted to cut and dry ones, such as birth control pills.
- darkerside 8y agoThanks for the link. I'd like to see intelligent changes to the system in these cut and dry cases where we are unlikely to do harm through action. The problem is, I don't think statins, the first drug in the article, fall under that category. BTW, the 33% number you cite in parent comment doesn't include responses to the pap smear question, only the pelvic exam, and is specific to family doctors.
- yourapostasy 8y ago> They are legally...bound to serve their patients. In the US, with the cost of attorney-mediated access to the judicial system, this is not really a protective constraint for the bottom 90-95% of the population against exploitation by unethical medical providers. I'm interested in discussions about data transparency: anonymized, aggregated data about the patient population seen, the outcomes, and the amount spent, per doctor or set of doctors (if multiple specialists are seen). The former data set so doctors don't start cherry-picking for best outcome patients. The latter data set so doctors can start observing the average and median standard of care, and there is more uniformity of care across the field. At the moment, only the health insurance companies have access to this kind of data.
- darkerside 8y agoI don't agree. It is a protective constraint because of the legions of trial lawyers who are happy to bring a malpractice suit, albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. It doesn't come close to making anybody whole when things go wrong, but the threat of litigation certainly modifies the way medicine is practiced.
- yourapostasy 8y ago> ...albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. > It doesn't come close to making anybody whole when things go wrong... You are advocating that the system works for a value of "works" that rises above the hurdles of incentives where the minuscule fraction that trickles down to the patient and where "the way medicine is practiced" is a lucrative enough target for the expensive litigation. If you build software systems like you advocate for course corrections in medical practice, then you'd bin every trouble ticket until it came from a "big enough" customer with a "severe enough" problem. To each their own, but I'm personally in favor of granular, incremental changes that are more manageable and responsive to the market. Waiting for litigation to change medical practices is no different than ignoring a defect in the design, implementation, and testing phases of software, and letting users find it beat down your door before fixing it. US doctors largely won't even adopt checklists yet, despite proven efficacy. It is unacceptable to have to wait for future litigation to see it adopted in mainstream medical practice.
- madhadron 8y ago> There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. In the US, where we have no standards of care, this is true. In centralized systems like France, doctors receive updates to expected standards of care annually based on analysis of the latest evidence. This has interesting effects. My father did the statistical work for a set of expert consensus guidelines in psychiatry. He found an interesting pattern: the European practitioners produced basically the same decision tree, from Sweden to Spain (that is, physicians practicing in completely independent healthcare systems). American practitioners were so scattered that sometimes you couldn't extract guidelines. This is also why you can have an operation done safely in a rural hospital in Italy, whereas in a rural hospital in the US, the only thing you should let them do is put a bandage on you and transfer you to a real medical center in a major urban area.