> Alex Bokov wrote:
>
> >I agree that the medical industry would be better off with less
> >regulation, but there must be an open, public accreditation standardhat
is
> controlled by the consumers-- a combination of >standardized
> >exams for practitioners and summaries of what has been observed about
> >the effects of every existing drug and intervention in a language
> >readable by the lay public. This can be a private effort, and a
I wrote:
> I would agree with first part of this paragraph (curbing the power of the
> FDA, making their approval a non-binding accreditation, awarding a seal of
> approval, rather than the compulsory application for the right to market
and
> use) but I also think that gathering information about the efficacy of
drugs
> would do poorly without governement funding - there are some types of
> information, like the results of extensive clinical trials, (e.g. WARSS, a
> recent comparison of aspirin and warfarin in stroke) which are extremely
> expensive to obtain
Alex responded:
Couldn't this kind of studies be funded commercially? I see several
possible sources of income. First, private health information services
would like to be first with useful decision heuristics, especially if they
can gain from people referring to these studies (a reliable information
service would likely have to give literature citations to remain accredited
and convincing, so even when competing services refer to "drug X is better
than Y" they would have to include links to the originating/sponsoring
service).
#### The cost of obtaining useful, reliable medical information is huge. How
much would a private medical information service have to charge to be able
to pay for all the studies it wants to inform people about? I would think
that that access to the information would be very expensive and at the same
time it would be too easy to freeload - unless you want to impose and
enforce gag rules on the users of the service (doctors, nurses), a study
result, worth 1 000 000 dollars (nothing unusual nowadays) could be
communicated in less than a minute of talking during morning rounds, even
spreading as gossip - and all the nonpaying residents, patients, would use
it to their advantage. So the persons who wanted to get newest results would
pay enormous sums, while anybody willing to wait a few days (literally),
would get it free.
Those nice, informative LEF news bulletins would cost you 1000$ apiece if
not for the NIH.
-------
Second, many drug companies would be interested in efficacy
trials (sure, they might risk having the worse drug, but not supporting a
trial could be even worse PR).
##### I doubt it. Drug companies avoid head to head comparisons like the
plague, unless they are sure they win (and before actually doing the study,
usually you don't know). Also, they don't fund studies on drugs in the
public domain, like warfarin and aspirin, which are the mainstay of
treatment now.
--------
Third, of course all the current non-profit
organisations would still likely be interested in funding some of these
studies: everything from the NIH to patient organisations. The testing
could be handled by a third party testing organisation to minimize bias,
perhaps with standardized oversight and procedures.
##### NIH is not a nonprofit. It's a government agency, one of the very few
that save lives but still a government, tax-funded unit.
Rafal Smigrodzki MD-PhD
Dept Neurology University of Pittsburgh
smigrodzkir@msx.upmc.edu
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