Don't Assume Your Doctor Is Practicing Evidence-Based Medicine
Had a busy few days -- unpleasantly so -- last week and this week. But I'm moving things along. I'll have more on this soon, but the latest, from my tweets:
Don't Assume Your Doctor Is Practicing Evidence-Based Medicine
Had a busy few days -- unpleasantly so -- last week and this week. But I'm moving things along. I'll have more on this soon, but the latest, from my tweets:
What drug(s) are we talking about here?
Isab at August 10, 2017 10:53 PM
I work as a manager at a pharmacy. We deal with PBM's(Prescription Benefit Management) which are third party middle men between patients, pharmacies and insurance. If you look on your insurance card you will see names like Express scripts, Optum, Medco. These companies are not your insurance but they routinely make decisions on what drugs your insurance will pay for. If the medication is not on their formulary, they will not cover it. Depending on what tier the medication is you will pay more for it or be forced to do step therapy (where you try a preferred formulary medication first before the med your doctor actually prescribed).
Now the part that you are probably dealing with now is how do certain drugs make it onto a formulary and how do certain drugs become preferred? Best no to know how the sausage is made but I'm pretty sure there is a lot payoffs and politicking between drug manufacturers and insurance to get drugs on their formularies. In your case I'm guessing that evidence was a secondary factor on why or if the med you doctor prescribed is being covered.
I don't know where I'm going with this. Its pretty annoying when bureaucrats instead of your doctor are making decisions about your health. But this is where we are and I thought you might want a little insight on how these things work.
Shtetl G at August 11, 2017 6:48 AM
I understood the point you were making Shteltl. Since Amy isn't the one directly paying the bills she doesn't get to chose how that money is spent. And no, 'science' or 'evidence based' are not the metrics used. Economics and politics are.
Solution: If people want control over their health care dollars they need to be the ones spending those dollars. You can't farm the job out to insurance.
Ben at August 11, 2017 7:42 AM
Amy, why did you use screenshots of your twitter "conversation" rather than use actual words, sentences, and paragraphs? In that way the casually interested reader (me) might be able to follow your line of thought, instead of having to decipher
"Luckily journo skills. I fig out."
to mean something like
"Luckily, I have journalistic skills. I figured it out."
You are better than this.
Art the Nerd at August 11, 2017 8:23 AM
Why is a journalist informing Doctors on various attributes of drugs? Isn't that what Pharmacologists or even drug sales reps are for?
Stormy at August 11, 2017 10:21 AM
> You are better than this.
God, I hate ninnies who cluck.
What's it like to be a twaddle-minded fucktard who tumbles through the company of thoughtful adults every day, with his thumb up his own asshole, trying with naked, cloying desperation to affect a posture of coherent grace?
I'll never know what it's like to that kind of person/fucktard.
Neither will Amy Alkon.
Neither will almost any United States citizen with a library card and three dendrites to ruffle.
Why are you such a dorkasaures?
No you aren't.Grr. Friday morning.
Crid at August 11, 2017 11:00 AM
Art, I didn't write this because I am, frankly, exhausted beyond belief from fighting Kaiser and reading a huge pile of studies -- in addition to the work on my book and my column.
Just getting my prescription right was an all-day struggle -- twice. And I only got through to get it corrected because I'm a sneaky pain in the ass and I searched for that time a doctor was careless in giving out his/her phone number at Kaiser (the one that gets through and doesn't go to Member Services to leave a message for the doctor). Getting a nurse on the phone allowed me to tell them the problem and get the prescription corrected. The first time and then after nearly all day struggling to get it corrected yesterday.
I'm writing an op-ed on this in hopes of changing things for women. I'm also filing a grievance with the state of California to try to force Kaiser to give the non-cancer-promoting drug to all female patients.
I'll disclose the particulars of the situation after the op-ed comes out.
And thank you, Crid, that brightened my day.
Amy Alkon at August 11, 2017 12:34 PM
"You're better than this" is thermonuclear condescension. It's Silly Internet Newbies Being Obnoxious. There's no reason on the surface of our wretched little globe to put up with it.
Crid at August 11, 2017 3:36 PM
"Solution: If people want control over their health care dollars they need to be the ones spending those dollars. You can't farm the job out to insurance."
Hmm. Where have I seen this before?
Radwaste at August 11, 2017 3:54 PM
You are better than this. - Art the Nerd
Sure she is, but Twitter sure aint. And Twitter doesnt allow for effusive elocution in the electronic ether
lujlp at August 11, 2017 4:25 PM
Just a quick question. If there was any real evidence that drug number 1 (whatever it is) actually caused cancer don't you think it would have been pulled off the market by now?
Or do you have some overarching theory about some kind of big pharma/ medical industrial complex plot designed to poison people with a dangerous drug while refusing to cover the "perfectly safe" alternative?
Isab at August 11, 2017 11:04 PM
Isab: When we say something "causes cancer," it doesn't mean that as soon as you use it you start sprouting tumors. It means that it causes an increased chance of getting cancer. In some cases it's high, a Google search says that a heavy smoker has a 30% chance of cancer vs. 1% for a non-smoker. So even though we say smoking causes cancer, 70% of smokers don't get cancer. We use the term for much lower percentages, but that doesn't mean there's not a risk. It's just that Kaiser has determined that the increased risk of cancer for one drug is within an acceptable level, and is outweighed by the extra cost, or whatever, for the other drug. I'm just speculating here, but I'd say that Amy probably wants to be able to make the determination for herself. It's easy to say that a 2% additional risk of cancer is not that much, unless you're the one who's going to need chemo.
clinky at August 12, 2017 11:56 PM
I dont think Amy's has either the math skills or the access to the medical study original data to determine this. Clinky.
AND Unfortunately a lot of medical studies are bogus.
Meanwhile she can have the second drug, (all she has to do is buy it)
If she really believes the second drug is that much better and safer than the covered one, she should be willing to do this.
All drugs have side effects, every damn one, and until you are taking it, usually long term, you never know if you can tolerate them or not.
Chemo is another set of drugs which often cause cancer as well as treating certain forms of it. and is not the best treatment for a number of different cancers although it works wonders for some types and some people.
I have no objection to people playing the odds with life, but most people are clueless as to what *those odds* actually are.
Especially in a game with 100 percent ultimate mortality.
Isab at August 13, 2017 5:29 AM
Leave a comment