There’s one piece here that I don’t understand. Why exactly do we expect doctors to prescribe this medication that doesn’t work, thereby wasting resources? Is it a situation where we expect patients and patient representatives to demand the medication, due to being scientifically illiterate (or because they are doing Hanson-esque signalling that they care) and then doctor-shopping until they can get it? Or is there some kind of pay-per-treatment incentive that will make doctors want to prescribe it? Or something else?
There is a whole hierarchy of incentives to medical people at different levels in the system.
At the bottom 1. Free samples 2. Free education. 3. Cute/good looking drug reps...
The free education comes with a nice meal and convivial company. You just need to sit through the drug company propaganda, which is duly accredited as good for mandatory training hours. What happens if your prescribing fails to conform to the desired profile? You don’t get invited to the next “free” training.
At the top (influential professors): 1. Funding for studies 2. “Speaking fees”. 3. “Consultancy fees”
As with the lucrative “speaking fees” paid to ex politicians and the highly paid and often made-up jobs provided to ex-politicians and bureaucrats and their families, everyone knows the score. If you make trouble the “speaking fees” and the like dry up. Completely by coincidence of course.
Or is there some kind of pay-per-treatment incentive that will make doctors want to prescribe it? Or something else?
Given that the treatment is administed intravenously doctors will get money for administrating it to their patients and monitoring the patients so that they don’t get too much brain bleeding/swelling.
Most of that work can be done by a nurse that the doctor employs so the doctor can bill something for which he doesn’t have to do much work himself.
Or is there some kind of pay-per-treatment incentive that will make doctors want to prescribe it?
(This isn’t a response about this particular drug or its manufacturer.) I think that generally, large pharmaceutical companies tend to use sophisticated methods to convert dollars into willingness-of-doctors-to-prescribe-their-drugs. I’m not talking about explicit kickback schemes (which are not currently legal in most places?) but rather stuff like paying doctors consulting fees etc. and hoping that such payments cause the doctor to prescribe their drug (due to the doctor’s expectation that that will influence further payments, or just due to the doctor’s human disposition to reciprocate). Plausibly, most doctors who participate in such a thing don’t fully recognize that the pharmaceutical company’s intention is to influence what they prescribe, and their participations is materialized via cognitive biases rather than by them acting mindfully.
Also, not all doctors are great at interpreting/evaluating research papers/claims (especially when there are lots of conflict-of-interest issues involved).
There’s one piece here that I don’t understand. Why exactly do we expect doctors to prescribe this medication that doesn’t work, thereby wasting resources? Is it a situation where we expect patients and patient representatives to demand the medication, due to being scientifically illiterate (or because they are doing Hanson-esque signalling that they care) and then doctor-shopping until they can get it? Or is there some kind of pay-per-treatment incentive that will make doctors want to prescribe it? Or something else?
There is a whole hierarchy of incentives to medical people at different levels in the system.
At the bottom
1. Free samples
2. Free education.
3. Cute/good looking drug reps...
The free education comes with a nice meal and convivial company. You just need to sit through the drug company propaganda, which is duly accredited as good for mandatory training hours. What happens if your prescribing fails to conform to the desired profile? You don’t get invited to the next “free” training.
At the top (influential professors):
1. Funding for studies
2. “Speaking fees”.
3. “Consultancy fees”
As with the lucrative “speaking fees” paid to ex politicians and the highly paid and often made-up jobs provided to ex-politicians and bureaucrats and their families, everyone knows the score. If you make trouble the “speaking fees” and the like dry up. Completely by coincidence of course.
Given that the treatment is administed intravenously doctors will get money for administrating it to their patients and monitoring the patients so that they don’t get too much brain bleeding/swelling.
Most of that work can be done by a nurse that the doctor employs so the doctor can bill something for which he doesn’t have to do much work himself.
(This isn’t a response about this particular drug or its manufacturer.) I think that generally, large pharmaceutical companies tend to use sophisticated methods to convert dollars into willingness-of-doctors-to-prescribe-their-drugs. I’m not talking about explicit kickback schemes (which are not currently legal in most places?) but rather stuff like paying doctors consulting fees etc. and hoping that such payments cause the doctor to prescribe their drug (due to the doctor’s expectation that that will influence further payments, or just due to the doctor’s human disposition to reciprocate). Plausibly, most doctors who participate in such a thing don’t fully recognize that the pharmaceutical company’s intention is to influence what they prescribe, and their participations is materialized via cognitive biases rather than by them acting mindfully.
Also, not all doctors are great at interpreting/evaluating research papers/claims (especially when there are lots of conflict-of-interest issues involved).