tag:blogger.com,1999:blog-8573839334358190868.post3594309714754845926..comments2024-03-26T05:25:06.256-04:00Comments on The Apothecary: Why The Dartmouth Flap Matters For ObamacareAvik Royhttp://www.blogger.com/profile/17800177830841080188noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-8573839334358190868.post-83726992670768124122010-06-11T06:23:24.876-04:002010-06-11T06:23:24.876-04:00Hi Steve, thanks for your comment.
I'm not su...Hi Steve, thanks for your comment.<br /><br />I'm not sure where you are disagreeing with me -- I write in the piece that "it is a good thing for physicians to adopt the best evidence-based guidelines for clinical practice." I cite Mayo as an example of a place where, in spite of Medicare's disincentives, low-cost, high-quality care has been achieved (without government mandates).<br /><br />I'm not sure guidelines are the cure-all you think they are, though. Take the mammogram controversy: clearly, it's in the interests of women to get screened at age 40. However, some cost-oriented policy types suggest that women should only begin screening at age 50. Which should it be?<br /><br />Imatinib, a drug for chronic myelogenous leukemia, achieves complete cytogenetic response in 65-70% of patients. Second-generation drugs nilotinib and dasatanib achieve complete response in 80-85% of patients. Imatinib is going generic in 2015. When that happens, should patients be given the generic drug, or the branded drugs, which are clearly better, but will cost more than $100,000? Remember that this isn't hypertension -- you only get one shot. Again, patient care would suggest going with one choice; cost-control would suggest another.<br /><br />There may be situations where there is a concordance of cost-effectiveness and best medical practice. There are plenty of others where there is not.<br /><br />As to your biographical question: I come from a family of physicians; I myself went to medical school (at Yale); I deal with physicians and treatment protocols every day in my line of work. I attend around 20 scientific conferences a year; this month alone I am attending the annual scientific meetings of the American Society of Clinical Oncology, the European League Against Rheumatism, and the American Diabetes Association.<br /><br />I certainly hope to learn from you when I make mistakes -- but I also hope you would agree that I have a legitimate vantage point from which to comment on these issues!<br /><br />Thanks again,<br /><br />Avik.Avik Royhttps://www.blogger.com/profile/17800177830841080188noreply@blogger.comtag:blogger.com,1999:blog-8573839334358190868.post-82215692405131485702010-06-10T22:00:15.593-04:002010-06-10T22:00:15.593-04:00Medicare is also a primary payer at the Mayo, yet ...Medicare is also a primary payer at the Mayo, yet they do not overutilize.<br /><br />" Quite a bit of what we call “waste” is actually uncertainty: performing heart surgery, say, on someone who may or may not require it. As in war, sports, and courtship, the best medical decision is often more obvious in hindsight than it is in the heat of the moment."<br /><br /> I am a physician. Much of what you write here makes no sense, except at the extreme margins. If you do not set guidelines ahead of time, you can justify virtually any procedure at the time it is proposed. Do you know any doctors?<br /><br />SteveAnonymousnoreply@blogger.com