This Wall Street Journal story from April 3 is a difficult article to read, despite the optimistic title. Let it speak for itself.
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Clinical Issues
Little Pricey Pill
Arrgh. This article from April 12, 2010 Forbes ought to raise the ire of many a reader who needs a simple example of how our health care system is sick! You might even want to swallow a couple of the pills described, as they are used to treat ‘heartburn’.
It outlines what happens in a system when one is spending other people’s money. One is willing to have other people pay a lot more for something perhaps marginally more effective than a drug available over the counter ($165 per month vs. less than $20.00). Some companies and government payers wisely stopped paying altogether, saving millions with the stroke of a pen, and likely having zero impact on the health of their insured.
In fact, as a physician and an occasional patient, I find myself asking a question not raised in the article: How many of these pills ought to be taken at any price, rather than living with the occasional discomfort, or altering one’s diet or other lifestyle changes. A focus on cost of care ought to be combined with attention to need for care.
A side issue in the article is that mention is made of a panel to oversee effectiveness of treatments to determine Medicare disbursements being eliminated due to lobbying. The article I posted yesterday appears to reference a similar panel being in place. If any reader knows the distinction between these two, please comment.
The Nothing Cure
By Matthew Herper and Robert Langreth, From Forbes Magazine, Issue Date March 29, 2010
Instead of ignoring the placebo effect, doctors should try to enhance it, says a Harvard Medical School professor.
This interesting discussion on the placebo effect is worth a read. The presence of the placebo effect is well-known and generally accepted in medicine, though it may be frequently argued as to when it is taking place or not – especially when one’s own treatment is being questioned.
From a policy standpoint, a legitimate question is whether those treatments that have a significant placebo component are ethical to the degree there may be conscious deception on the part of the practitioner – on behalf of helping their patient. In addition, should third parties such as insurance or government be asked and expected to pay for placebo interventions?
