Doctors, lack

The pharmaceutical market is large and complex, new products being introduced at a very brisk pace, and it is difficult for doctors to judge which is the best possible alternative without some sort of help. One example of these information problems is the fact that doctors make their decisions on the basis of effectiveness and attach little importance to price. Caves et al.18 state that doctors lack information on comparative effectiveness and the risk of substitute pharmaceutical products. 

To illustrate how patients must sometimes take drug matters into their own hands because of doctors lack of comprehension, Mike detailed what he had to do to discontinue Klonopin, a highly habituating medication in a family of drugs called benzodiazepines, which also includes Ativan, Xanax and Valium. He began to realize that the Klonopin, which he had been taking for anxiety, ultimately had a boomerang effect The first Klonopin of... 

Another error is the prescription that goes wrong for the patient even when, from the classical medical perspective, the prescription should have been fine. To put things in perspective, medical errors claim 44 thousand to 98 thousand lives in hospitals alone, and this makes hospitals a more dangerous killer than motor vehicle accidents. Even more disturbing is the fact that out of the 119,000 deaths caused by fatal mistakes by 700,000 US physicians in 2001, a large percentage of these deaths were unavoidable because the doctors lacked critical data and analysis tools. 

To sum up, the factors that enable the supply side to fix prices above the marginal cost are (a) the imperfect agency relationship between the doctor (the agent) and the insurer (the principal) the prescriber may prefer the brand product, about which he or she has acquired knowledge and experience during the patent period (risk aversion), (b) the patient, and sometimes also the doctor, may have imperfect information on the quality of cheaper alternatives, and (c) the lack of incentives to change prescription habits (moral hazard). 

These comments were made near the end of a talk at a meeting of the Society of Public Analysts, a group composed principally of analytical chemists and medical doctors. During the discussion which followed, almost no reference was made to Hopkins new ideas and remarks, in itself a measure of the newness of such ideas along with the inability or ignorance or lack of attention paid to such comments by the group in attendance. 

See, Sellv. United States, 539 U,S, 166,213 (2003) [ [e]very State provides avenues through which, for example, a doctor or institution can seek appointment of a guardian with the power to make a decision authorizing medication - when in the best interests of a patient who lacks the mental competence to make such a decision ,]... 

Jacopo, Domenico said sharply, is the second reason we came to see you. Doctor. To warn you, in effect. Jacopo Fauro is completely incapable of separating truth from fiction, even concerning inconsequential trivia. He s a pleasant enough lad and quite useful at times. We are fond of him or he would have been sent packing years ago, but he has this infuriating lack of veracity. Nothing he told you can be trusted. ... 

Requests for confirmation of treatment despite apparent lack of effectiveness may be expression of the fact that the patient has already tried to stop the drug but became subjectively worse due to withdrawal rather than the re-emergence of the original symptoms. On the other hand requests for repeat prescription may also indicate a dependence in a therapeutic relationship, the patient needing support and contact. The prescription of a drug is then merely a vehicle which the patient finds acceptable as a reason for approaching the doctor. This may be particularly true for elderly, lonely patients. 

The Supreme Court rules in Upjohn v. Finch that the FDA properly removed Panalba and other similar antibiotic drugs from the market because of a lack of scientific evidence of their effectiveness and that past use by doctors and patients does not demonstrate the drugs work as purported. The FDA requires a PPI for birth control pills, first approved for public use in 1960. 

Aidan Hollis continues the discussion about neglected diseases and illuminates how research can foster R D for neglected diseases. He makes the important point that poor countries not only face the problem of neglected diseases, but also must usually contend with a number of other problems, including a lack of doctors, nurses, clinics, hospitals, and equipment. 

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