Also, read these NYT pieces

From my Upshot colleagues, “The Drugs That Companies Promote to Doctors Are Rarely Breakthroughs“. Charles Orenstein andRyann Grochowski Jones rock it with a piece on pharma drug promoting behavior:

For more than five decades, the blood thinner Coumadin was the only option for millions of patients at risk for life-threatening blood clots. But now, a furious battle is underway among the makers of three newer competitors for the prescription pads of doctors across the country.

The manufacturers of these drugs — Pradaxa, Xarelto and Eliquis — have been wooing physicians in part by paying for meals, promotional speeches, consulting gigs and educational gifts. In the last five months of 2013, the companies spent nearly $19.4 million on doctors and teaching hospitals, according to ProPublica’s analysis of federal data released last fall.

The information, from a database known as Open Payments, gives the first comprehensive look at how much money drug and device companies have spent working with doctors. What it shows is that the drugs most aggressively promoted to doctors typically aren’t cures or even big medical breakthroughs. Some are top sellers, but most are not.

Instead, they are newer drugs that manufacturers hope will gain a foothold, sometimes after failing to meet Wall Street’s early expectations.

I’ve never seen a commercial for steroids. Or for chemo. Why? Cause those drugs work. When I see a kid with an asthma attack, we reach for the albuterol. It’s a no brainer – it works.

You advertise when you want to convince people to use a product that’s only marginally better, or perhaps no better at all. A truly miraculus drug will advertise itself. It’s a simple thing, but these guys break it down quite well. Go read.

Also, Zeke Emmanuel “Skip Your Annual Physical“:

WE all make resolutions and promises to live healthier and better lives, to make the world a better place. Not having my annual physical is one small way I can help reduce health care costs — and save myself time, worry and a worthless exam.

Around 45 million Americans are likely to have a routine physical this year — just as they have for many years running. A poke here, a listen there, a few tubes of blood, maybe an X-ray, a few reassuring words about diet, exercise and not smoking from the doctor, all just to be sure everything is in good working order. Most think of it as the human equivalent of a 15,000-mile checkup and fluid change, which can uncover hidden problems and ensure longer engine life.

There is only one problem: From a health perspective, the annual physical exam is basically worthless.

This is absolutely true, but unlikely to change anything. The entire health care system is set up around the yearly exam. I would be fine if we transitioned to a more efficient focused visit model, but that’s not the system we have at all. We have set up screening recommendations, vaccines, disease management – all around the idea that everyone is going to see the doctor at least once a year.

If we want to try and redesign the whole thing from scratch, I’m all in. Let me know when that starts.

Now I have to go back to Bar Mitzvah madness. See you on Monday.


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