birdog1960

in essence, most doctors are already employed by the gov't. those that have large medicare/medicaid populations have no say in reimbursement rates. payment is entirely dictated by the gov't. employed physicians make up a significant percentage of the total pool. so that ship has sailed or at least is moving at a rapid rate. therefore, to turn this around, why shouldn't drug makers be dictated to in the same way? i certainly agree that everyone is expendable and would fully expect to be put out to pasture when fairly judged an underperformer.

no problem. 'i'll redo tommorow.

coincidentally, i was at a doctor targeted financial seminar last night sponsored by a large regional bank. they obviously assumed we were clueless as the rate qouted me to get in a group of funds i find desirable was 1.25% before the actual fund fees. it would be successful, because we now have a patchwork of private and public funding for healthcare with the gov't picking up the very large portion of the tab, especially for drugs. if a govt entity can produce them (or at least develop them) and directly or indirectly supply it's own system, there are massive savings to be had. i don't deny there are enormous obstacles and i didn't say that it would have to hold a monopoly on r&d but even in a competitive market against private companies it would very likely bring down costs for drugs for patients and ultimately the entire country. i don't see why creativity would necessarily be trampled in such a model. it hasn't in universities. many medical devices and procedures commonly in use were developed in just such settings from faculty members who gave up patent rights as a condition of employment.

we spent less than $1000 on marketing our practice last year, most of that on yellow pages listings. we have no personnel significantly tasked with marketing. since the practice's inception, it's been housed in a rather dated, unattractive building but we do splurge on magazines and have a flat screen tv. nevertheless, i'm quite certain patients don't come for the ambience. i rarely see the worried well. most patients carry at least 2 or 3 diagnoses for chronic illnesses (often more), most commonly diabetes,hypertension and hyperlipidemia but with many other serious conditons, including the sequelae of these 3 common ailments,diagnosed and managed. if your impression of an internist' role is as stated and that's based on personal experience, i would suggest you look for a new one. i can't recall ever running a thermometer across a patients forehead unless you are referring to the tape temperature sensors used in the icu.

i wouldn't visualize stalinism as the model for a state run r&d facility nor do i think the us govt's foray into pharma research will lead there. but if it were successful, and it well might eventually be, i doubt top scientists would have to be coerced in order to be recruited. many of the top minds in the country already work at state sponsored universities. they often do this for the academic freedom enjoyed at such institutions and the creativity fostered. many of the basic, nonapplied research scientists that i have known consider permanent industrial positions undesirable (although they are often asked to consult or lecture to industries such as pharma). i have certainly witnessed academic envy, laziness and occasional dishonesty but as of yet the university system of scientific research has not unraveled. a state run r&d endeavor does not require a marxist gov't behind it. witness the NIH. it's been pretty successful and i'm pretty sure the usa is still a capitalist country.

the wise ones are did fox get bought out by youtube? hooray!

yup. she's hysterical....and she'd be funny too if she wasn't so chillingly scary.

and that's exactly the point. the brilliant scientists can work unincumbered by concerns of sales and having the rug pulled out on him/her if his project isn't looking like it will generste enough profit, in a gov't run scenario. yes, the sales force becomes useless and unnecessary (they already are). maybe something useful can be found for them to do. maybe they can go back to school and learn some bench skills to assist the real contributors. i did a cursory search on the russian state supported research center that gg cited. i didn't find epic fail. maybe you can point out a reference for me. i found an announcement for a symposioum in conjunction with commercial european enterprises on new devlopments and on the government sponsored model. sort of a "how to". some of the projects and initiatives mentioned looked quite exciting.

you mean the bills front office?

the placebo effect is most evident in psych drugs. double blinded studies have repeatedly shown that in patients presenting with an initial dx of major depression, the prescriber can close his eyes, pull a prescription for one of the ssri's out of a hat and 70% of patients will have a good response. the other 30 % are more problematic but include a significant proportion of those refractory to all available treatments. the major differences between antidepressants are side effects not efficacy. vioxx was a crappy drug released by an irresponsible company. there are many more examples of drugs voluntarily and forcibly removed from the market for safety issues in recent history if you're not convinced about vioxx. timmo, i'm guessing it would take a little more than you surmised to inspire a team of phd research scientists. i was thinking that without marketing costs they might be paid about 2X what the now superfluous drug reps and managers currently make.

working on the tenth statin (cholesterol drug) to market because the 1% of market share expected to reult is a billion dollars or so is serpentine. no one needs another statin, especially one inferior to those currently available. but hey maybe they'll get some whore inventor who claims to be a cardiologist (like jarvik) to hawk it and sell it to the unsuspecting sheep. when has government supported r and d into drug development ever been tried on a large scale? it's not like we can't afford to pay the real innovators (chemists. biochemists, molecular biologists and such) competitive wages in gov't. they make less than the sales people with marginal bs's but pretty faces that they send to my office to gladhand.

or move it to the public realm from the private...make it less serpentine. work on novel drugs only and those likely to have the greatest impact on public health.

i agree that changes should be made to the approval process (the fda requires a complete overhaul with LESS industry input) but i don't think it needs to be more porous. ever heard of avandia, vioxx or redux? how about thalidomide? this is a pilot program. the drug companies aren't doing it so gov't is starting to step in and test the waters. if nothing else it exposes the fallacious argument for high prices that big pharma has sold for most of it's existence. that is good.

for years, the primary argument put forth by big pharma for high drug costs has been the high cost of developing drugs. this supposedly justifies their extensive patent protections and anti competetive market. this, despite the fact that most drugs developed are "me too" products usually offering little in significant benefit to drugs already in the class. now, there are even less of these being developed and novel class molecules are quite rare. enter the federal gov't npr. big pharma's raison d'etre seems threatened. it's a first small salvo but i find it encouraging. comments?

well caveman says their interior line is one of the best in the league and you're saying one of the worst. somebody's wrong. pittsburg's near the top of the league in rushing and in the superbowl. buffalo finished 4 and 12 and scored more points than 3 teams in the nfl last year. i'm thinking most objective non bill fans would take the position that these facts alone support the conclusion that pittsburg's line is superior to buffalo's.

i wonder if moving this to off the wall would garner more participation...doesn't appear to many here want to test their skills.

just as adams wouldn't have made a 4-12 team into a 12-4, swapping pitt's entire defense for ours would not have produced a sb winning bills team. the offense wasn't playoff caliber much less sb caliber and the o line was a big part of the problem. it's not always either/or..it's sometimes both or neither. but why not try putting the best team that can be assembled on the field one year (on both offense and defense)? it seems you all feel undeserving of that as bills fans.

pitts was 3rd in rushing, 9th in total offense and rothlisberger didn't play the beginning of the season. yeah, i'm sure it's overly pessimistic to make such comparisons. their line sucked.

from the dallas morning star: adams sat 3 months until pittsburgh's willie colon went down with a season ending injury" i'm betting if we made a decent offer in those 3 months, he would have taken it. you think that's unlikely?

he wasn't brought in for an interview. he had very few interviews when he first become available. i believe the steelers even waited quite a while to bring him in. and yes, if offered enough, i do think he would have come. 25th in total offense. 29th in scoring. doesn't take much to please some folks i guess.

and again i was seriously asking why things played out so much better for the steelers line than ours..so maybe it's not primarily the coaching. maybe players don't care as much in buffalo and don't put out the effort. i've put forth severaL theories. no one's added anything except to defend a below average o line. but many here now seem so quick to defend an oline that was the constant target of criticism this year. if you're satisfied with garbage, then that's what you deserve. it's certainly what you've been getting. giving cheap, practice squad players and late round draft picks experience has worked out so well after all. sure the defense sucked but does that make the need for a decent oline (which was there for the taking) any less??

but that's just defeatist for the sake of it...we had what most here consider 2 good guards to start the season and a servicable center. so the parts were available for a line as good as the steelers. we were given the same parts bin, told to build a car and we ended up with a go cart and they got a bmw. how come?

and i would argue that this "build to win in 2-3 years" philosophy is one of the reasons for 11 playoff-less years. maybe it was the coaching? maybe the incohesiveness of a group? the surrounding cast? i don't know, that's why i'm asking why a team with 2 different starters this year at offensive tackle (including a bills failure) just ran all over the jets in the afc playoff game while the jets whipped the bills line twice this year.