Hsieh Forbes Column: The Positive Value of Negative Drug Trials

My latest Forbes piece is now out: "The Positive Value of Negative Drug Trials".

I discuss the unfortunate bias against publishing "negative" scientific results that show a drug doesn't have much clinical benefit, and why it's in the self-interest of drug companies to still report these.

In particular, I highlighted two interesting facts:

1) Most drug trial results are still not being reported to a central registry.

2) Negative results funded by private industry (e.g., pharmaceutical companies) are more likely to be reported than from government-funded research.

Fortunately, free market incentives are driving more drug companies towards full disclosure of both positive and negative study results -- which will benefit patients.

For more details, read the full text of "The Positive Value of Negative Drug Trials".

("Fluoxetine 20 mg capsules" by Tom Varco - Own work. Licensed under CC BY-SA 3.0 via Commons; source: Wikipedia.)

New Push To Regulate Personal Trainers

An interesting (but not very surprising) consequence of ObamaCare -- a new push to regulate personal trainers. This is gaining traction in the District of Columbia, but expected to spread soon to all 50 states as well.

From the 8/23/2015 Washington Post article, "In the nation’s capital, a new business to regulate: D.C.’s personal trainers":

The new regulations, being written by and for the nation’s capital city, will create a registry of all personal trainers in the District only. But they are expected to become a model that winners and losers in the fight believe will be replicated elsewhere.

The credit — or blame — for the newfound urgency can be traced in part to President Obama’s Affordable Care Act. A variety of workplace wellness programs and preventive health-care initiatives called for in the law could soon translate into rivers of billable hours for those with credentials to keep American waistlines in check.

And that means the race is on to be eligible for those credentials, which could eventually lead to the ability to bill insurance companies for services, much like such professionals as dieticians and physical therapists. With billions of dollars potentially at stake, lawyers and lobbyists are engaged in a no-holds-barred fight to shape the nation’s first-ever rules over who has the right to tell someone else how to exercise.

Personally, I find the idea of an agency deciding "who has the right to tell someone how to exercise" to be deeply disturbing.

The article also discusses some of the controversy within the CrossFit community. (I don't do CrossFit, but this part might be interesting to my friends who do.)

Dinosaurs Are Dangerous!

Today's not-an-Onion story, "The day I removed a toy dinosaur from a woman's vagina".

There are very few jobs in which one gets paid to say things like, "I don’t advise inserting children’s toys during sexual activity, however if you do choose to masturbate with a toy dinosaur, I recommend buying your own, and perhaps putting it in a condom, or tying a leash to its foot."

"Never Events" and Unintended Consequences

Doctors (like all people) respond to incentives. Here's one "unintended consequence" of the policy of "never events", as explained by orthopedic surgeon Dr. Thomas Guastavina:

"The sad story of how “never events” prevent obese patients from getting new hips"

Uber For Health Care

WSJ: "Startups Vie to Build an Uber for Health Care".

There are some interesting business models in play:

Heal is one of several startups putting a high-tech spin on old-fashioned house calls—or “in-person visits,” since they can take place anywhere. The services provide a range of nonemergency medical care—from giving flu shots to treating strep throats and stitching lacerations—much like a mobile urgent-care clinic.

The companies use slightly different models. Pager, in New York City, dispatches doctors or nurse practitioners via Uber, for $200. Heal, in Los Angeles, San Francisco and Orange County, Calif., promises to “get a doctor to your sofa in under an hour” for $99. (A medical assistant goes along to do the driving and parking.)

RetraceHealth, in Minneapolis, has a nurse practitioner consult with patients via video (for $50), and only comes to their homes if hands-on care like a throat swab or blood draw is necessary (for $150)...

Most of the services don’t accept insurance, but they say patients can pay with health savings accounts or submit out-of-network claims. 

The article also notes that for some customers, it's cheaper to pay for this at-home service than to take time off from work to go to the doctor's office.

It's also a win-win for participating doctors:

Such ventures are fueled by a confluence of trends, including growing interest in the so-called sharing economy, where technology connects providers with excess capacity and consumers who want on-demand services. Many doctors and nurses who work for hospitals are eager for extra work in their off-hours, the companies say. The services carry malpractice insurance, but say overall low overhead keeps prices down.

And thanks to the boom in mobile-medical technology, providers can carry key equipment with them, from portable blood analyzers to hand-held ultrasounds.

I just hope the government doesn't impose onerous regulatory burdens on this growing sector.

 

Catron Takes Down Trump On Health Care

In his latest American Spectator piece, David Catron does a thorough take-down of Donald Trump on health care policy: "Trump Is No Friend of Free Market Health Care".

Here is the opening:

Most of Donald Trump’s public statements include the rote declaration that Obamacare is a disaster. This is true, of course, but it doesn’t tell us anything new. It’s only when he starts elaborating on his objections that one gets a sense of what he believes, and he doesn’t talk like a friend of the free market. During last week’s Republican debate, for example, he was asked about his past praise of single-payer health care and replied, “As far as single-payer, it works in Canada, works incredibly well in Scotland.” This answer was both antithetical to free-market thinking and profoundly ignorant...

For more details, read the full text of  "Trump Is No Friend of Free Market Health Care".

Hsieh Forbes Column: Free Speech 1, FDA 0

My latest Forbes column is now out: "Free Speech 1, FDA 0".

I discuss a breaking update to my earlier Forbes piece on drug company Amarin's fight to engage in free speech in the form of off-label marketing of one of its products.

Basically, Amarin wanted to give truthful medical information to doctors which would allow them to more effectively use one of their drugs in a way that was legal, but not FDA-approved. The FDA forbade Amarin from engaging in such speech, and Amarin sued the FDA.

This past Friday, Amarin won an important legal victory in federal court. Judge Paul Engelmayer came down firmly on the side of free speech.

For more details see the full text of, "Free Speech 1, FDA 0".

(Earlier Forbes piece, "Drug Company Amarin Stands Up For Free Speech Against FDA", 5/8/2015.)

Update: Related commentary from Alex Tabarrok, "FDA Loses Another Free Speech Case"

UK Health Coverage

From EP Monthly:

"Man in Great Britain mugged, had his bicycle stolen, and had his leg broken in the process. He called emergency services, but was told that his injury 'wasn’t serious enough' to send an ambulance. Three police officers gave him a ride home where he had to book an Uber ride to get him to the hospital. Good thing he had medical 'insurance,' though."