ArchivesEvidence Based Medicine

United States of Pharma: Why Drug Marketing Rules American Healthcare

I often hear medical and pharmacy directors at public and private health plans express frustration over how physicians prescribe. These payers feel forced to use prior authorization to combat irrational prescribing. ”Why,” they ask, “do doctors ignore the evidence? Why don’t they follow guidelines?” Read more → →

Why Falling Cholesterol Trumps Cancer Rising – The Galileo Factor and Pharma Marketing

Today, we take it for granted that high cholesterol is a risk factor for coronary heart disease. This medical wisdom is so pervasive that USA statin sales were $14.5 billion in 2008, according to IMS.

I don’t plan to use this blog to debate cholesterol risks or statin benefits. However, based on my experience, the pharmaceutical industry was a contributing factor to the worldview that believes high (LDL) cholesterol is bad regardless of age, sex, race, and/or personal or family medical history. Read more → →

Type 2 Diabetes, Evidence-Based Medicine & The Reign of Confusion

Evidence-based medicine (EBM) is getting a lot of attention these days. Like most topics, it has its ardent fans and die-hard opponents. To some, EBM is cookbook medicine, with too many rules and too little room for individual clinical judgment. On the other side of the controversy are EBM proponents who feel that arming physicians with guidelines, best practices and protocols brings a much needed dose of standardization into the Wild West world of healthcare decision making. Read more → →

Cash For Tickers – What Would You Pay for Your Heart Attack Treatment?

When it comes to health care, most consumers worship the newer, the more technologically advanced, and the most expensive. If an X-ray is good, an MRI is better. If three Advil relieves your knee pain, arthroscopy may eliminate it completely. As long as someone else is paying, why restrict your choices? In other words, we don’t want rationing, we want everything fully loaded.

We are like folks set free at the auto mall with someone else’s credit card. We may be content with a Honda Civic, but wind up demanding the most expensive car on the lot because someone else is picking up the tab. No wonder we spend $2 trillion a year on healthcare. [Update: By 2011, the figure was $2.7 trillion, as noted here.] Read more → →