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Christmas Potpourri

By December 25, 2009Commentary

A study has cast further light on whether doctors often order tests, perform procedures or prescribe drugs out of fear of being sued if they don’t.  The research found a correlation between number of attorneys, prescribing of antibiotics and the presence of drug-resistant bacteria.   The researchers first compared the number of physicians per capita and the number of attorneys per capita with antibiotic prescribing and cases of drug resistance, finding a correlation between attorney density and drug resistance but not between physician density and drug resistance.  The researchers also surveyed physicians and found that medical liability concerns were a factor in antibiotic over-prescribing.   (Liability Release)

The Personalized Medicine Coalition submitted comments to the Food & Drug Administration regarding its regulation of companion diagnostics to prescription drugs.  (PMC Comments) The growth in understanding of human biochemistry, particularly its genetic roots, has played an increasing role in drug development and use of diagnostics to either determine the appropriateness of a drug for a specific person or to monitor a drug’s impact on the patient’s disease or the patient’s condition.  The FDA has been slow to give consistent, comprehensive guidance to the makers of either drugs or tests on how it will regulate these aspects of personalized medicine.  The PMC paper gives the agency a good agenda which needs to be pursued quickly.

The New York Times ran a story regarding OptumHealth’s offering of a service that connects doctors and patients through phone or internet.  Increasingly insurers are looking for methods to increase access to medical services for their members, often in ways that lessen cost.  OptumHealth’s service is called NowClinic and is supported by American Well.   (NY Times Story) This is yet another example of creative use of communications technology to overcome distance barriers and distribute a sometimes scarce resource.  The service will be rolled out first in Texas and as might be expected, not all physicians there are thrilled.  In addition, the regulators have been skeptical about the permissibility of non-face-to-face visits.  These kinds of services are likely to have good patient acceptance and can lower costs and improve access.  Policymakers should ensure that regulatory barriers are eliminated.

Another New York Times article casts a little doubt on the certainty that generic drugs are always as effective as the brand name product they copy.  Given the spread of generics, which now account for the vast majority of prescriptions, this is disconcerting.    (NY Times Article) The article reports on patients who perceived they encountered side effects or symptom return when switched to a generic.  While there is little scientific evidence to suggest there could be or are significant problems, the article cites an analysis of one generic by an independent lab which showed a differential release rate in the bloodstream of the generic compared to the brand name product.  The FDA may need to be a little more careful in what they require from generic makers.

The Wall Street journal has yet another story regarding the use of wireless in health care.  (WSJ Article) The article focuses on use of smartphones to track chronic health-related measures, such a blood sugar for diabetics, breathing issues for asthmatics, etc.  It is as yet unclear how many consumers will want to or will use such applications, how useful health care providers will find this patient-collected data or how the companies making the applications will create a viable business model.  But right now there is a lot of visibility and buzz.

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