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Okay - but what happens when your doctor is getting bribed to say you're dying to get you to try expensive experimental drugs with no evidence of working? In t

Okay - but what happens when your doctor is getting bribed to say you're dying to get you to try expensive experimental drugs with no evidence of working? In the best case, you end up bankrupt. In the worst case, you end up bankrupt and dead. This is only a slightly more extreme version of the Sackler problem. Deregulation sounds great if you believe everyone is logical and has accurate information to make decisions for themselves. I'm sure there must be a much better solution than what we've got for the people who are dying. But I doubt the answer is to just let drug companies sell anything to anyone and make Medicare pay for it.

ChrisMarshallNY 2y ago
> but what happens when your doctor is getting bribed to say you're dying That was like Robert Stack, in Joe Versus the Volcano[0]. [0] https://www.youtube.com/watch?v=oAB9Y2CVqZU https://www.youtube.com/watch?v=oAB9Y2CVqZU
krisoft 2y ago
> what happens when your doctor is getting bribed to say you're dying We pay people to figure out that this is happening (the police), then we prosecute the doctor and if that is what happened we hit the doctor with the full force of law, and they never walk as a free person ever. We also do the same thing with those who bribed the doctor and they also never walk as a free person again. What you describe already crosses into criminal conduct. We do not need FDA approval process to prosecute it. In fact I’m not sure how the FDA approval of the drug prevents it in your opinion.
- dontlikeyoueith 2y ago
  > What you describe already crosses into criminal conduct. Does it? How many people from Purdue Pharma went to prison exactly? There are no consequences for the behavior you describe regardless of whether it's technically illegal.
  - krisoft 2y ago
    > How many people from Purdue Pharma went to prison exactly? Have they told the patient that they are dying?
willmadden 2y ago
No, medicare shouldn't pay for it, but it should be completely legal for patients to take whatever drug or procedure they want, and for startups to provide those drugs and services. The medical industry in the United States is a gate kept, over-credentialed, bureaucratic mess.
chmorgan_ 2y ago
This is an understated reality of the situation. Patients are already able to receive treatments with experimental drugs. It's the "forcing medicare and insurance companies to pay for it" part that's not a good idea, especially considering that most of these treatments may be worse than the current ones. Treatments should have solid evidence they improve overall survival when compared against the best treatments available today, and unfortunately too many studies either aren't aiming at revealing that info, and/or are comparing against inferior treatment options.
southernplaces7 2y ago
>Okay - but what happens when your doctor is getting bribed to say you're dying to get you to try expensive experimental drugs with no evidence of working? You might as well be saying "what happens if some improbable risk of X exists in this very unusual context". That's existence, especially in complex and fraught situations. You can't completely regulate it away and especially not if the regulations themselves can cause much greater harm in the much, much more probable situation of patients who are already dying being willing, as human beings with autonomy, to try something personally risky. Deregulation shouldn't and doesn't depend on the world being one of everyone being logical and always having accurate information. Those two conditions don't exist in the human world at all times, period. Furthermore, the exact same problem applies to regulators and legislators as well, whose poorly reasoned decisions can cause broad harm too. Making a lack of perfect information and attendant risk into the key basis for onerous regulations is bad reasoning with sometimes grotesque consequences, particularly in situations where the regulations are known to cause suffering to people in extremes (as is the case with denying risky treatments to those who are in any case at death's door.. Also, very basic but obvious: anyone in the extreme situation of having a doctor suggest a very experimental treatment can go and get a second opinion from another doctor.
- noobermin 2y ago
  This isn't an improbable situation. They literally mentioned the Sackler family, which is a real world example of corruption is medicine of the type they're talking about.
  - southernplaces7 2y ago
    The Sackler's company bribed and "financially encouraged" doctors into over-prescribing opioids to millions of people who weren't necessarily mortally ill and with lesser individual risk of those people dying from these prescriptions. It's a largely different clinical and treatment situation from specific cases in which people are genuinely, terminally ill and a genuine though dangerous treatment option exists that might save their very lives. The Sackler case is a valid and powerful criticism of medical/pharma dishonesty, but it's extremely unfair to desperate patients that it be used to prevent them from having the autonomy over their own bodies and literal chance at life that they might legally be allowed to pursue. Also worth noting that even in the market for prescription opioids, the Sackler case has more recently been used to wrongfully prevent patients who are in deep pain from obtaining a drug that provides needed relief despite its addiction dangers. So even here, obsessions about malpractice are hurting legitimate use.
m348e912 2y ago
>Okay - but what happens when your doctor is getting bribed to say you're dying to get you to try expensive experimental drugs with no evidence of working? If it's experimental it shouldn't be expensive. In fact it probably should be free until it's approved as effective. So with that out of the way, what are your other objections? (I am genuinely interested)
- noobermin 2y ago
  Nothing is free, including the clinical trials, which are funded often by the government.

ChrisMarshallNY 2y ago

> but what happens when your doctor is getting bribed to say you're dying That was like Robert Stack, in Joe Versus the Volcano[0]. [0] https://www.youtube.com/watch?v=oAB9Y2CVqZU https://www.youtube.com/watch?v=oAB9Y2CVqZU

krisoft 2y ago

> what happens when your doctor is getting bribed to say you're dying We pay people to figure out that this is happening (the police), then we prosecute the doctor and if that is what happened we hit the doctor with the full force of law, and they never walk as a free person ever. We also do the same thing with those who bribed the doctor and they also never walk as a free person again. What you describe already crosses into criminal conduct. We do not need FDA approval process to prosecute it. In fact I’m not sure how the FDA approval of the drug prevents it in your opinion.

dontlikeyoueith 2y ago
> What you describe already crosses into criminal conduct. Does it? How many people from Purdue Pharma went to prison exactly? There are no consequences for the behavior you describe regardless of whether it's technically illegal.
- krisoft 2y ago
  > How many people from Purdue Pharma went to prison exactly? Have they told the patient that they are dying?

willmadden 2y ago

No, medicare shouldn't pay for it, but it should be completely legal for patients to take whatever drug or procedure they want, and for startups to provide those drugs and services. The medical industry in the United States is a gate kept, over-credentialed, bureaucratic mess.

chmorgan_ 2y ago

This is an understated reality of the situation. Patients are already able to receive treatments with experimental drugs. It's the "forcing medicare and insurance companies to pay for it" part that's not a good idea, especially considering that most of these treatments may be worse than the current ones. Treatments should have solid evidence they improve overall survival when compared against the best treatments available today, and unfortunately too many studies either aren't aiming at revealing that info, and/or are comparing against inferior treatment options.

southernplaces7 2y ago

>Okay - but what happens when your doctor is getting bribed to say you're dying to get you to try expensive experimental drugs with no evidence of working? You might as well be saying "what happens if some improbable risk of X exists in this very unusual context". That's existence, especially in complex and fraught situations. You can't completely regulate it away and especially not if the regulations themselves can cause much greater harm in the much, much more probable situation of patients who are already dying being willing, as human beings with autonomy, to try something personally risky. Deregulation shouldn't and doesn't depend on the world being one of everyone being logical and always having accurate information. Those two conditions don't exist in the human world at all times, period. Furthermore, the exact same problem applies to regulators and legislators as well, whose poorly reasoned decisions can cause broad harm too. Making a lack of perfect information and attendant risk into the key basis for onerous regulations is bad reasoning with sometimes grotesque consequences, particularly in situations where the regulations are known to cause suffering to people in extremes (as is the case with denying risky treatments to those who are in any case at death's door.. Also, very basic but obvious: anyone in the extreme situation of having a doctor suggest a very experimental treatment can go and get a second opinion from another doctor.

noobermin 2y ago
This isn't an improbable situation. They literally mentioned the Sackler family, which is a real world example of corruption is medicine of the type they're talking about.
- southernplaces7 2y ago
  The Sackler's company bribed and "financially encouraged" doctors into over-prescribing opioids to millions of people who weren't necessarily mortally ill and with lesser individual risk of those people dying from these prescriptions. It's a largely different clinical and treatment situation from specific cases in which people are genuinely, terminally ill and a genuine though dangerous treatment option exists that might save their very lives. The Sackler case is a valid and powerful criticism of medical/pharma dishonesty, but it's extremely unfair to desperate patients that it be used to prevent them from having the autonomy over their own bodies and literal chance at life that they might legally be allowed to pursue. Also worth noting that even in the market for prescription opioids, the Sackler case has more recently been used to wrongfully prevent patients who are in deep pain from obtaining a drug that provides needed relief despite its addiction dangers. So even here, obsessions about malpractice are hurting legitimate use.

m348e912 2y ago

>Okay - but what happens when your doctor is getting bribed to say you're dying to get you to try expensive experimental drugs with no evidence of working? If it's experimental it shouldn't be expensive. In fact it probably should be free until it's approved as effective. So with that out of the way, what are your other objections? (I am genuinely interested)

noobermin 2y ago
Nothing is free, including the clinical trials, which are funded often by the government.