Thursday, March 31, 2016

Hsieh Forbes Column on The Great Canadian Sperm Crisis

My latest Forbes piece is now up: "The Market Solution To The Great Canadian Sperm Crisis".

A couple of facts:

* There is an enormous shortage of donated sperm in Canada, such that infertile couples have to rely on (gasp) imported sperm from the US.

* The Canadian government outlaws paying Canadian sperm donors for their product.

Hmm....  Could there possibly be any connection between these two facts?

For more details, read the full text of "The Market Solution To The Great Canadian Sperm Crisis".

Tuesday, March 15, 2016

Catron Critiques Trump

David Catron of The American Spectator has a pretty harsh critique of Donald Trump's health care plan from the conservative perspective in his 3/14/2016 piece, "Trumpcare: A Hazy Plan From a Lazy Man".

From the opening of Catron's piece:
[T]ake a minute to peruse the health care proposal he has finally cobbled together and posted on his campaign website. And, rest assured, it won’t take more than a minute to read. Trump’s “plan” consists of seven random nostrums that appear to have been hastily cribbed from conservative and libertarian websites by his various flunkies. And it confirms yet again that neither “the Donald” nor his yes men are willing to do their homework...
(Catron also offers some broader commentary on Trump's campaign and isn't impressed.)

Thursday, March 10, 2016

Small Free Speech Victory

The 3/8/2016 New York Times reports, "FDA Deal Allows Amarin to Promote Drug for Off-Label Use".

This is a small but potentially important victory for drug company free speech rights.  As the articles notes:
The agreement settles a legal case between the agency and the company, Amarin, a small drug maker that sued the F.D.A. last year for the right to promote its only product, Vascepa, to a broader range of patients. In August, a federal district judge in Manhattan ruled that the F.D.A. could not prohibit Amarin from using truthful information to promote its drug, even for unapproved uses, because doing so would violate the company’s right to free speech.

The final settlement is still subject to approval by the court.

The agency on Tuesday downplayed the implications of the deal. In a statement, it said that the settlement applied only to the Amarin case and that its position on whether companies have a constitutional right to provide truthful information about off-label uses had not changed.

But some legal and drug-safety experts said the settlement could encourage other companies to seek similar arrangements and, ultimately, have profound implications for how drug makers sell their products...
Clearly, the FDA wishes to keep the scope of this as narrow as possible.  On the other hand, many free speech advocates would like to see this principle applied more broadly.

And if any companies would like to further pursue this kind of free speech fight, they should contact attorney Jim Manley of the Goldwater Institute. Manley and the Goldwater Institute have urged policy changes in this area and are exploring litigation.

(Related story from last year: "Free Speech 1, FDA 0".)

Wednesday, March 2, 2016

Patient Safety and Electronic Medical Records

A good report from Kaiser Health News on what doctors in the trenches deal with regularly: "EHRs In The ER: As Doctors Adapt, Concerns Emerge About Medical Errors".

Here's the introduction:
The mouse slips, and the emergency room doctor clicks on the wrong number, ordering a medication dosage that’s far too large. Elsewhere, in another ER’s electronic health record, a patient’s name isn’t clearly displayed, so the nurse misses it and enters symptoms in the wrong person’s file.

These are easy mistakes to make. As ER doctors and nurses grapple with the transition to digitalized record systems, they seem to happen more frequently.

“There are new categories of patient safety errors” in emergency rooms that didn’t exist before the push to use electronic record systems, said Raj Ratwani, who researches health care safety and is the scientific director for MedStar Health’s National Center for Human Factors in Healthcare in Washington, D.C.

Spurred by the 2009 stimulus package and the 2010 health reform law, the federal government has offered hospitals financial incentives to adopt electronic health records that, among other things, will add efficiency and reduce errors by linking physicians’ patient records, and coordinating and tracking how care is delivered across the health system. Hospitals that don’t meet those standards are hit with penalties...
In other words, EHRs were rammed down the throats of doctors and hospitals, rather than being allowed to be integrated organically according to the best judgments of the end users.

Imagine how user friendly your smart phones would be, if you had to buy one (rather than choosing whether or not to get one.)

Unfortunately, patients will pay the price:
The ER’s culture and pace, for instance, can amplify the risks of human error that stem from an already less user-friendly system. Think of the emergency physician who, reaching the end of a hectic 12-hour shift, looks for the record of a patient he just examined. He types in the man’s last name, clicks and writes medical instructions — not realizing that he’d accidentally pulled up the file of another patient with the same last name and similar age, who was admitted five minutes before.

While misidentifying patients in this way was hardly an issue before EHRs, it’s “becoming quite prevalent,” in this more digital era, Ratwani said.
For now, this means patients will have to be extra-diligent in confirming that the data in their health records is accurate. And that any prescriptions or treatments they receive actually make sense.

Most doctors try their best take good care of their patients. It's unfortunate when government technology mandates makes that job that harder, not easier.