government funded drug development

[3rdnlng]

 

And the government labor unions that you no doubt give a free pass to will certainly be on board with that. Holy fantasy land Batman!

 

I initially thought Timmo1805's post was sarcasm. Wow, it would appear that he was actually serious. Just wow.

[KD in CA]

I initially thought Timmo1805's post was sarcasm. Wow, it would appear that he was actually serious. Just wow.

Honestly, how do these guys get this delusional? The janitor in the lab would have a six figure pension after 20 years of 'service'.

[DC Tom]

Honestly, how do these guys get this delusional? The janitor in the lab would have a six figure pension after 20 years of 'service'.

 

Shows what you know. The government contracts for janitorial services; cleaning staff would be non-government and non-union.

 

Now who's delusional?

[leh-nerd skin-erd]

I initially thought Timmo1805's post was sarcasm. Wow, it would appear that he was actually serious. Just wow.

Nah--you had me the first time, it was sarcasm. Or rather, it was what I envisioned the "let's let the government do it" plan ultimately had to look like if it was going to work and actually function. I use the term function loosely, but generally to mean work in a way that virtually every other big-government administered program has yet to. Control everything--get rid of competition, price-fix, control the supply chain, and ultimately deliver the goods in a utopian fashion where nobody actually pays for anything, except of course, the angel, in this case, the taxpayer.

 

What struck me from birddog's original post was the comment about the....ahh, what word did he use (i'm technologically challenged or I would find the phrase..but ti was the part about the glad-hander coming in to his office v. What he perceived to be the true innovator. It occurs to me that many times, the "let the government do it" people want to devalue those they see as irrelevant to the process while often inflating the value of others. To be clear, a molecular biologist who stumbles upon the next great thing has tremendous value to humanity, but may never had the opportunity to discover the next great thing absent the other pieces of the puzzle. So...the mad genius in the lab counts on the money people to generate the cash flow and so on. Intellectual innovation is a wonderful thing, other-wordly at times, but absent the cash to keep the lights on i'd bet it's a whole lot harder.

 

I'm in the "reasonable legislation makes sense but otherwise keep the politicians out of it camp". Politicians think in 2-4 year cycles, often with a thought process colored by greed and/or self-interest. One of the things that irritates the crap out of me if the talking point of "no insurance company can ever turn you down due to a pre-existing condition!". So...a business is being vilified for setting prices that consumers already B word about AND you thought it unfair they didn't want to inherit a catastrophic care patient who walks in the door with a $200,000 bill? At the same time, the expectation is that rate structure is not a profit/loss issue, but a legislative one? Look, be honest, if you want to cover every pre-existing illness, manage cost artificially and open the door to the uninsured...at some point, it's got to be paid for. All these thoughts are noble, indeed, but beyond the capacity of government to develop (efficiently), administer (efficiently), and, well, self-regulate (efficiently).

 

 

 

Tim

[birdog1960]

 

 

What struck me from birddog's original post was the comment about the....ahh, what word did he use (i'm technologically challenged or I would find the phrase..but ti was the part about the glad-hander coming in to his office v. What he perceived to be the true innovator. It occurs to me that many times, the "let the government do it" people want to devalue those they see as irrelevant to the process while often inflating the value of others. To be clear, a molecular biologist who stumbles upon the next great thing has tremendous value to humanity, but may never had the opportunity to discover the next great thing absent the other pieces of the puzzle. So...the mad genius in the lab counts on the money people to generate the cash flow and so on. Intellectual innovation is a wonderful thing, other-wordly at times, but absent the cash to keep the lights on i'd bet it's a whole lot harder.

 

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.

[leh-nerd skin-erd]

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.

 

 

I didn't geta chance to do the search on the russian state. I did however do a quick search on the financial condition of many partners in the European experiment. Some of the prospects for future financial stability seem quite frightening. I also did a search on the condition of the United States government and found similar results.

 

Your argument regarding brilliant scientists working unencombered by those pesky concerns of financing is all well and good, but regardless of how you look at it, those issues have to be addressed. Your suggestion that the rug can't be pulled out from them due to the lack of desire for profit is unreasonable. We only have to go back to, um, yesterday to see the budgetary football being played in Washington. The prez says one thing, the house another, and on it goes. Expanding the argument somewhat is the recent talk gaining traction that would allow states to declare bancrupcy to get out from the under the burden of the crushing debt accumulated after years of financial dawdling.

 

Unfortunately, government is bascially just a re-engineered corporation. While a pharmaceutical company ultimately answers to stockholders in the pursuit of profit (and the next great miracle drug), the government answers to whatever party master holds the stick at any given point in time. The very fact that there is not a profit motive is why it seems to get off track. No one watches the bottom line, no one is ultiamtely accountable for the bottom line, and thus corruption ensues. I was looking for some evidence of a successful governmental or quasi-governmental program if the ultimate objective was sound fiscal management and I'm hard-pressed to find one. From the post office to education to social security to medicare, it seems that progams are in place, they just have a tendency to get real close to imploding.

 

By the way, I'm all for reasonable government and taxation is a necessary part of life. I'm not anti-union or necessarily pro-big business. I think it's naive to think that government will magically find a way to govern itself in this area. Emotionally, it's a wonderful to consider all those middlemen out of the way to allow the brilliant chemist to work unimpeded to deliver the miracle drug that would cure late stage melanoma. Rationally, there's no evidence to suggest the dream is remotely attainable.

 

Allow businesses to continue r&d and get out of their way by removing unreasonable legislative barriers. As for your thoughts on salespeople, you're not alone in your inability to see beyond the scope of your own experience. For every irrelevant sales person you've decided needs to find something else to do to satisy your vision of the world, there is a physician who bills astronomical rates for running a thermometer across your forehead. For an internist, the 80% of the patients who are healthy and have little need for routine health maintenace provide the funding for the 20% that should be referred to a specialist. The physician can't survive on a 5 patient practice, so they sell their practice by locating it properly, advertising, providing an attractive office, magazines in the reception roo, right near the fancy flat screen with drug commercials running while we wait. It's all sales at some point, dog.

 

Nice chatting with you...

[Mr. Dink]

No, there are differences in efficacy, and many are contraindicated for specific conditions (like I already mentioned: there are significant differences between Prozac and Zoloft), and they're not just used for depression - also panic disorders, OCD, social disorders, neurological and cognitive disorders...

 

Also, your statement was idiotic on its face - "the major differences are efficacy", but 30% won't respond to a randomly chosen SSRI? That right there is completely contradictory bull ****.

 

Also...don't underestimate how important the side effects are. By your asinine logic, depakote is completely unnecessary since we have lithium...never mind that many people (including myself) are completely intolerant of lithium's side effects.

 

Also...if such drugs were interchangable, then why does it take on average YEARS to establish an effective treatment regimine for a major depressive or bipolar depressive, going through an average of three and five drugs, respectively?

 

 

As a pharmacist, I have to say that in many patients the SSRIs and SNRIs are considered to be equally effective. The individual agent is often chosen based on the individual patient and the drug's side effect profile (some are more activating, some cause more sexual dysfunction, etc.)

 

The same can be said with anti-psychotics. All have been shown to be equally effective, with the exception of clozapine, and are, again, often chosen based on side-effect profile (changes in lipids, glucose, weight gain, extrapyramidal effects, etc.)

[DC Tom]

As a pharmacist, I have to say that in many patients the SSRIs and SNRIs are considered to be equally effective. The individual agent is often chosen based on the individual patient and the drug's side effect profile (some are more activating, some cause more sexual dysfunction, etc.)

 

The same can be said with anti-psychotics. All have been shown to be equally effective, with the exception of clozapine, and are, again, often chosen based on side-effect profile (changes in lipids, glucose, weight gain, extrapyramidal effects, etc.)

 

A lot depends on the diagnosis. If you're prescribing an SSRI to a manic-depressive, "activating" isn't a side-effect, it's absolutely contra-indicating (speaking from direct experience, and much consultation with my pshrink). For cognitive dissociation, an SSRI's likely to be completely ineffective (speaking from my wife's direct experience, and consultation with her neurologist), and an SNRI is vastly preferred.

 

I know of no prescribing doctor who would agree with you (at least, no one responsible and knowledgable about psychopharmacology - I know plenty of PCPs in HMOs who'd agree with you. And are idiots.) I also know from the research (which I have read, yes) that the pharmokinetics of SSRIs and SNRIs vary not just from drug to drug but from person to person, so any prescribing physican who makes any sort of statement that SSRIs are all equally effective is probably being grossly irresponsible (or, again, is a PCP in an HMO.)

[GG]

 

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.

 

Stalin created the secret cities for the precise reason that you cite - put the brightest minds in one place, keep them happy & fat and they will produce good research for the benefit of the state. It was similar to all his central planning fiascos that ran under the theory of segregating industries to certain locations where you would get the best utilization of the people and infrastructure. The thinking was that freed from the worry of making a profit the individual would be most productive because his needs would be met and he would me making a positive contribution to society.

 

Too bad mankind doesn't work along Marxist's principles, which ignore the individual human characteristics of ambition, greed, envy and laziness. Capitalism is much better than Marxism in washing away the effect of those imperfections, because by making profit you are keeping score and are measuring one enterprise against another in how it completes a task.

 

While your Marxist eperiment in centralizing R&D in a city for scientists may be utopian mecca for a brief time, it will start to unravel as soon as one PHD stumbles onto a discovery that his suitmate was working on for years, and the second guy thinks his idea was stolen. Even beyond that trite example, centralized economies never worked because the people who judge the output are rarely the ones who are capable of that analysis, nor are they held accountable for its failure (case in point Fannie Mae)

[erynthered]

Stalin created the secret cities for the precise reason that you cite - put the brightest minds in one place, keep them happy & fat and they will produce good research for the benefit of the state. It was similar to all his central planning fiascos that ran under the theory of segregating industries to certain locations where you would get the best utilization of the people and infrastructure. The thinking was that freed from the worry of making a profit the individual would be most productive because his needs would be met and he would me making a positive contribution to society.

 

Too bad mankind doesn't work along Marxist's principles, which ignore the individual human characteristics of ambition, greed, envy and laziness. Capitalism is much better than Marxism in washing away the effect of those imperfections, because by making profit you are keeping score and are measuring one enterprise against another in how it completes a task.

 

While your Marxist eperiment in centralizing R&D in a city for scientists may be utopian mecca for a brief time, it will start to unravel as soon as one PHD stumbles onto a discovery that his suitmate was working on for years, and the second guy thinks his idea was stolen. Even beyond that trite example, centralized economies never worked because the people who judge the output are rarely the ones who are capable of that analysis, nor are they held accountable for its failure (case in point Fannie Mae)

 

 

 

Damn. Good stuff, G. Thanks.

[birdog1960]

Stalin created the secret cities for the precise reason that you cite - put the brightest minds in one place, keep them happy & fat and they will produce good research for the benefit of the state. It was similar to all his central planning fiascos that ran under the theory of segregating industries to certain locations where you would get the best utilization of the people and infrastructure. The thinking was that freed from the worry of making a profit the individual would be most productive because his needs would be met and he would me making a positive contribution to society.

 

Too bad mankind doesn't work along Marxist's principles, which ignore the individual human characteristics of ambition, greed, envy and laziness. Capitalism is much better than Marxism in washing away the effect of those imperfections, because by making profit you are keeping score and are measuring one enterprise against another in how it completes a task.

 

While your Marxist eperiment in centralizing R&D in a city for scientists may be utopian mecca for a brief time, it will start to unravel as soon as one PHD stumbles onto a discovery that his suitmate was working on for years, and the second guy thinks his idea was stolen. Even beyond that trite example, centralized economies never worked because the people who judge the output are rarely the ones who are capable of that analysis, nor are they held accountable for its failure (case in point Fannie Mae)

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.

[birdog1960]

For every irrelevant sales person you've decided needs to find something else to do to satisy your vision of the world, there is a physician who bills astronomical rates for running a thermometer across your forehead. For an internist, the 80% of the patients who are healthy and have little need for routine health maintenace provide the funding for the 20% that should be referred to a specialist. The physician can't survive on a 5 patient practice, so they sell their practice by locating it properly, advertising, providing an attractive office, magazines in the reception roo, right near the fancy flat screen with drug commercials running while we wait. It's all sales at some point, dog.

 

Nice chatting with you...

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.

Edited January 27, 2011 by birdog1960

[GG]

P

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.

 

One of my first jobs was in financial planning serving the doctor community. At first I was shocked at how clueless many of our clients were when it came to basic finance. My boss explained it to me that doctors had bigger things to worry about than balancing a checkbook and that's why his business thrived.

 

Your rationale for centralizing research is very naive and you still haven't explained why it would be successful, when you have a century's worth of real life examples of it not working. NIH is a bad example because it's an institution that resides along side private facilities and scientists get the choice of where they want to work. You totally sloth off the concept that once the government creates a monopoly on research, that choice is gone. You also haven't addressed the real life issue of how the direction of research will be handled and who's going to be responsible? It has never been successful in a centralized industrial society and it never will. At best these organizations will develop knock off drugs, but never lead cutting edge research.

 

Funny how you bring creativity into the picture. One can argue that Kirov was the finest balet in the world. Yet why did its biggest stars defect because they didn't get creative freedom?

[birdog1960]

P

 

One of my first jobs was in financial planning serving the doctor community. At first I was shocked at how clueless many of our clients were when it came to basic finance. My boss explained it to me that doctors had bigger things to worry about than balancing a checkbook and that's why his business thrived.

 

Your rationale for centralizing research is very naive and you still haven't explained why it would be successful, when you have a century's worth of real life examples of it not working. NIH is a bad example because it's an institution that resides along side private facilities and scientists get the choice of where they want to work. You totally sloth off the concept that once the government creates a monopoly on research, that choice is gone. You also haven't addressed the real life issue of how the direction of research will be handled and who's going to be responsible? It has never been successful in a centralized industrial society and it never will. At best these organizations will develop knock off drugs, but never lead cutting edge research.

 

Funny how you bring creativity into the picture. One can argue that Kirov was the finest balet in the world. Yet why did its biggest stars defect because they didn't get creative freedom?

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.

[Passepartout]

Well drugs are from the FDA. If you stop and think about it. As it is how you use your drugs. You can use them for good or use them for misuse/abuse. It is how to use and fund the drugs in a good kind of way.

[leh-nerd skin-erd]

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.

 

Actually, I think my doctor is great, and enjoy going to him. If I didn't like him and respect him, I would do as you have suggested. In fact, I did just that a few years ago with a doctor who's approach to patient care didn't meet my standards for what I expected from my physician. I think a good physician is a wonderful thing, but don't necessarily think every physician provides the exceptional level of care that you may indeed provide. No doubt some are in it for the good of the patient, some for the money they can earn, some are caring and some cold, some good, some bad. The point I was making was in regard to the process where government takes over drug development, eliminates the useless cogs you perceive to be in the wheel, and everyone wins. Since we likely agree that there are some physicians who should not be practicing medicine due to incompetence, why not take the discussion to it's logical conclusion? Why stop at drug development? Once government takes that over, we can solve the problem of allowing bad doctor's to practice by the government taking over all medical practices? This would save you the costs associated with running your practice, insurance, billing, salaries, utilities, drugs (they would be free in our new model), price maintenance, payroll and accounting costs~~~freeing you up to do what you love to do---provide exceptional care to your patients. in the meantime, since the government addressed all the underlying bs you deal with, it can save me the ever-increasing cost of care and pay you a modest stipend of $37,500 annually.

 

I'm a business owner, see the results of overregulation and excessive taxation everyday-----and believe it's a recipe for disaster. If you want to go that way, I humbly suggest that you don't overvalue your role in the food chain. Everyone is replaceable, even the exceptional. That's part of the problem.

[birdog1960]

Actually, I think my doctor is great, and enjoy going to him. If I didn't like him and respect him, I would do as you have suggested. In fact, I did just that a few years ago with a doctor who's approach to patient care didn't meet my standards for what I expected from my physician. I think a good physician is a wonderful thing, but don't necessarily think every physician provides the exceptional level of care that you may indeed provide. No doubt some are in it for the good of the patient, some for the money they can earn, some are caring and some cold, some good, some bad. The point I was making was in regard to the process where government takes over drug development, eliminates the useless cogs you perceive to be in the wheel, and everyone wins. Since we likely agree that there are some physicians who should not be practicing medicine due to incompetence, why not take the discussion to it's logical conclusion? Why stop at drug development? Once government takes that over, we can solve the problem of allowing bad doctor's to practice by the government taking over all medical practices? This would save you the costs associated with running your practice, insurance, billing, salaries, utilities, drugs (they would be free in our new model), price maintenance, payroll and accounting costs~~~freeing you up to do what you love to do---provide exceptional care to your patients. in the meantime, since the government addressed all the underlying bs you deal with, it can save me the ever-increasing cost of care and pay you a modest stipend of $37,500 annually.

 

I'm a business owner, see the results of overregulation and excessive taxation everyday-----and believe it's a recipe for disaster. If you want to go that way, I humbly suggest that you don't overvalue your role in the food chain. Everyone is replaceable, even the exceptional. That's part of the problem.

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.

Edited January 27, 2011 by birdog1960

[leh-nerd skin-erd]

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.

 

 

interesting analogy. if i'm reading you correctly, you're resigned to the fact that some physician's have a crappy system to deal with, and we should use that as a model for pharmaceutial development? that sounds an awful lot like someone saying to me "I have to eat this big old crap sandwich so you should have to, too".

 

I'd hope for more, and it's nice to speak with a physician in the mix and hear that so I absolutely know I'm right!

 

By the way--I believe the government was playing politics with reimbursement amounts to physicians not too long ago. Seems to me they would temporarily extend what amounts to an inflation index to bypass the statutory limits on reimbursements to keep physicians on the plan. I also read that many physicians are beginning to refuse medicare/caid patients for that very reason. Well, substitute innovative molecular biologists for medicaid-accepting physicians and I'm quickly back to why the government isn't the answer.

 

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.

 

 

 

So?

 

Cost is only an issue in the absence of value. A person who worried less about the buck-twenty-five and more about the relationship with a human being sees value and is willing to pay the added cost.

 

The 1990's did an awfully good job of teaching us that it's pretty easy to throw a dart against the wall and earn 47% per year. By extension, the theory goes, anyone can do it. No load funds are the way to go....except for the fact that for many people, they haven't a clue. They chase hot money, act on emotion, they act on impulse, they have unreasoanble expectations ("Wait, the fund earned 47%, 36%, 18%, 52% and the year I bought it, it lost 67%??? How???").

 

I do agree dog, it's insulting if you're knowledgeable and they assume you are not--but many doctor's are accused of exactly the same thing. That's just dealing wuth people. You may not need the consultation, the advice, etc, but trust me when I tell you many people do.

[birdog1960]

 

 

interesting analogy. if i'm reading you correctly, you're resigned to the fact that some physician's have a crappy system to deal with, and we should use that as a model for pharmaceutial development? that sounds an awful lot like someone saying to me "I have to eat this big old crap sandwich so you should have to, too".

 

I'd hope for more, and it's nice to speak with a physician in the mix and hear that so I absolutely know I'm right!

 

By the way--I believe the government was playing politics with reimbursement amounts to physicians not too long ago. Seems to me they would temporarily extend what amounts to an inflation index to bypass the statutory limits on reimbursements to keep physicians on the plan. I also read that many physicians are beginning to refuse medicare/caid patients for that very reason. Well, substitute innovative molecular biologists for medicaid-accepting physicians and I'm quickly back to why the government isn't the answer.

 

 

 

 

So?

 

Cost is only an issue in the absence of value. A person who worried less about the buck-twenty-five and more about the relationship with a human being sees value and is willing to pay the added cost.

 

The 1990's did an awfully good job of teaching us that it's pretty easy to throw a dart against the wall and earn 47% per year. By extension, the theory goes, anyone can do it. No load funds are the way to go....except for the fact that for many people, they haven't a clue. They chase hot money, act on emotion, they act on impulse, they have unreasoanble expectations ("Wait, the fund earned 47%, 36%, 18%, 52% and the year I bought it, it lost 67%??? How???").

 

I do agree dog, it's insulting if you're knowledgeable and they assume you are not--but many doctor's are accused of exactly the same thing. That's just dealing wuth people. You may not need the consultation, the advice, etc, but trust me when I tell you many people do.

no, not sour grapes except the yearly extensions to forgo the mandated cuts in medicare reimbursement do get old. the formula does need to be permanently fixed. they always come through with patches, however. for the most part, the threat to stop seeing medicare is bravado...most physicians can't afford to do that and survive, especially those with a large geriatric population. i suppose they could retire but i haven't seen a mass exodus. i was just pointing out the fact that most of us already are de facto gov't employees. mdeicare would be in even deeper trouble if this were not the case. not complaining..it's been like this for a very long time...just the way it is. but, yes, the drug companies should play by the same rules. what percentage of their revenue do you suppose comes from the gov't via medicare? i don't hear folks yelling "government pharma" like they recently did with "government motors".

 

1.25% was insulting and bordering on theft since i can gain access to the same funds through another firm for 0.5% plus relatively low expense ratios (those are of course the same in both instances).

[Nanker]

I think we can all understand better now thanks to birdog1960 why a patient's wait is so long in a Doctor's waiting room.