Wednesday, May 6, 2009

Lots to recap today.

First, in support of Francis Collins' efforts. I am a God believing scientist/physician. Why? Can you explain "spooky science" of photons? No? Are there some things in this world which are a mystery? Yes. I choose God to explain that mystery for me.

Because as a human it is beyond my ability to conceive of it. Maybe someday Singularity will "save me" but I doubt it.

Second, To explain Germany's move without resorting to "It's designed to make doctors money"

Which BTW is the stupidest argument I have ever heard coming from a country with Nationalized Medicine. Doctors make what they make and that's all. Why try to find new revenue streams for someone who's salary is capped? Do they really think this would bring Doctors to their country? Wrong!

Here's why they are outlawing this and why comparative effectiveness research in the US will end up costing some useful therapies their market.

Think that the person is not an individual, instead it is a money making machine for the largest company in your country. The government. The government makes its money through expends its capital supporting people who aren't so good at paying taxes as well as a whole host of other things, like defending you from nasty people looking to destroy your way of life. Why do they support those who don't have jobs and aren't healthy? They do this in hopes to get them stable enough to pay taxes again. Thus a new revenue stream is created.

If they can keep you healthy so you pay taxes, that is a big win. If they can do that with minimal amount of cost, that is a huge win. So when the government, which controls the doctors in a Nationalized Healthcare Country BTW, sees a demand for a test, which has unproven benefit and is likely to increase demand for further healthcare services: "I have a 9p21.3 SNP and now I think I have chest pain"........They look for ways to stem the tide of this cost.

Thus they expend less to keep you as healthy as physicians are scientifically capable of doing TODAY......maybe someday this testing will be clinically useful....but not yet. At least not for most of it.

In fact, I chuckled when 23andME went to Davos to woo, Europeans. Their healthcare is even more pragmatic than ours in the US. So this move by Germany is aimed at stemming costs not to make more money for doctors.......Which BTW, if everyone was acting on this SNP info, we would have a ton more procedures.....which would in the end make more money for MDs in the US.....which is why this whole, gatekeeper business is about the most ignorant argument I have ever heard......

Lastly, Medicare has opted to not pay for CYP2C9 and VKORC1 testing for warfarin dosing. I am certain you may have read about it, but here's the spin......despite having good evidence behind its benefits, it wasn't ENOUGH benefit for the US Government to pay......Despite being ENOUGH for the FDA to put it on the box.....

Do you see where I am headed? Yes, despite an article in the New England Journal saying Comparative Effectiveness Research will be a good thing for Personalized Medicine(article to come out tomorrow), we may actually have the opposite effect. At least until the costs of sequencing comes down to less than a Chest Xray.

Ah yes, everyone would like to know that they get the Maximum Benefit to Cost ratio, but sometime you just have to ask yourself..........are leeches that much cheaper than phlebotomy? That is the problem with Comparative Effectiveness when you put cost into the mix. Which is precisely what the government is paying for........Why wouldn't they? I just told you why they would be interested in this. I am interested in this. Who wouldn't be?

I guess the people who bid for the KNOME GENOME on Ebay, that's who....

The Sherpa Says: Congrats to the girls at 23andMe who managed to get listed on the same top beautiful people list an Sully. That is a PR feat, to get them listed alongside someone who actually saved lives of people in a tremendously heroic feat........I hate marketing and fluff journalism! Shame on you Tonic....You actually listed them ABOVE Sully! Maybe that's why MDV Divested from 23andME.

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