The scientific side is also slave to the financial side. That’s why new antibiotics and vaccine research are sidelined. But constantly-tweaked treatments for chronic incurable conditions that stay one step ahead of patent expiration (I’m looking at you, restless leg syndrome) are high priorities.
If you aren’t rich they want you to die. The whole purpose of the industry has switched from treating disease to rent seeking. Saying “But they scientists they hire are competent” is irrelevant. The scientists do as they are instructed which is what maximizes profit.
That is absolutely true. Antibiotics are not very effective profit generators (you take it for 10-14 days and hopefully never again) and vaccines are even worse. Behavioral health meds, lipid meds, “lifestyle” meds (like the little blue pill) will generate income pretty much for the life of the patient. Even though the overall impact on public health is much greater for the former, the economic impact of the latter will make that the emphasis of the finance guys, who call the shots. As a guy on the public health frontlines, I throw things every time I read about a new psych med tweaked from a preexisting one, knowing that there are essentially no new antibiotics in the pipeline despite the onrushing “superbug” crisis.
“Title of a short story by Bruce Sterling about a man and two of his former lovers (who are now lesbians), trying to smuggle RU-486 into Utah sometime in the not too distant future. They are pursued at every turn by religious anti-abortion fanatics. This, along with several other intellectually stimulating short stories by Bruce Sterling can be found in his compilation called Globalhead.”
Exactly. US healthcare is like an big airplane where you are only allowed to pay for and sit in first class. Many of us would do well of we could go research our own health issues and self prescribe. I generally do that by going to the local doc in the box and telling them what I need. It ends up costing 200 dollars for the doctor and 15 dollars for the prescription. Any doctor shortage is manufactured. Nurses do most of the heavy lifting while the doctor signs off on it.
Assuming they can figure it out, and given enough time and money it’s possible, there is one serious hurdle: FDA regulation of medicine. They are tasked with making sure pharmaceuticals are safe and efficacious. If you are thinking of some sort of shortcut, it will always come back to increased risk around safety and efficacy. The FDA are just enforcing a minimum.
And proving you’ve met that minimum is EXPENSIVE and slow. It takes a tremendous amount of work and resulting data to prove safety and efficacy. If anything kills this, it will be lack of money to meet FDA requirements.
So I would approach this differently. Make a non-profit company to develop, prove, manufacture, and sell the mini-labs. Then go to your customer for crowd source funding: Insurance companies. If you can show them a path to reduce costs, they may be inclined to fund the work.
I would target a pharmacy level machine at first. You’d have it run and maintained by someone who at least handles chemicals and sterile products daily. Pharmacies would love it, and would likely sell at or below cost just to get people in the door to buy their other medicines and diabetic disposables (needles are neither DIY nor something you use many times).
After that, assess how things are going and decide which is the best way forward: home version, different drug system, etc.
Having patients “research and self prescribe” is a fast track to even worse overuse of antibiotics and medicine interactions than we already have. And, while it is true enough we do not have a doctor shortage, we sure as hell have a primary care doctor shortage. And, yes, this is manufactured by the pay differential between specialists and primary care, and the crippling levels of student debt carried, pressuring the vast majority of med students to specialty fields where they can earn “the big bucks.”
“A doc in a box” is for us USians what we call the medical doctors who work in walk-in clinics often found in strip malls, grocery stores, free-standing buildings that are clearly not part of a hospital or a medical office park. The term freely references fast food “Jack in the Box” and implies a similar level of convenience, with a sly implication about possible quality of service.
Sometimes called “urgent care clinic” or “walk-in clinic” or “no-appointment clinic.”
I shudder when I think of all the people who got their MD at Google U and Just Know what’s wrong with them and the right treatment. For every canny, educated layperson there’s a thousand dangerously ignorant.
One of my students got me a coffee mug that says “please do not confuse your Google search for my medical degree.” She said she thought that could cut my discussions with some patients in half.
On the other hand, I got policies changed at OHSU from actually spending a solid week in their library. They had claimed my infertility couldn’t possibly be caused by the I-131 treatment I had had. A moderate dive into the Nuclear Med and Endocrinology literature was pretty clear the other way. Now guys with thyroid cancer are told about the risk and offered a chance to bank sperm before taking the radioactive iodine pill. It was too late for me, but other couples will be able to have kids as a result.
[Too be clear, I was demonstrably fertile just a couple months before the I-131]
