> The last thing on earth that the US
> pharmaceutical industry wants is anything that even slightly resembles
> standardization of prescribing habits.
Pharmas are caught between a rock and a hard place, I suspect.
To begin with, if you are the manufacturer of the currently accepted 'best
practice' drug, then I'm sure you would be delighted to support a desktop
gizmo that made sure clinicians only prescribed your product. Your
competitors, of course, would not be so keen - but what can they do ? Argue
that fallible clinicians should be given the freedom to do what by common
agreement and best evidence is the wrong thing ?
Now, of course, in all this there is a presupposition that determining which
is the best treatment is actually an objective and unarguable process. I
would assume that the pharmas will respond to attempts to build desktop
prescribing support tools in various ways, ranging from discrediting the
whole process to flooding the decision making bodies with inconclusive trial
results that make it harder to decide what's best.
But even if the pharmas did conclude that their vested interests are best
protected by killing prescribing support dead, this must be counterbalanced
to some extent by the HMOs and, ultimately, the insurers. Both have a
significant interest in bringing prescribing support into existence. And the
HMOs have the singular advantage of actually controlling what goes on the
desktop.
At the end of the day there's always been a battle between the suppliers,
who want to increase healthcare spending and also their market share of it,
and the insurers who want to do the opposite. The mechanism in the past to
arbitrate between these two competing interests was to invite the clinician
to use the magic of 'clinical judgement' to decide who should be treated at
all, and what with. The evidence, however, suggests clinicians' choices are
now so complicated that their behaviour has become manifestly illogical and
inconsistent as a group or even as individuals. This must be worrying the
insurers, and I find myself wondering how much longer they will be willing
to let clinicians have a completely free hand with their money. Plus, I
think clinicians already know that they are sinking under the load, and
would welcome a way out.
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Dr Jeremy Rogers MRCGP
Clinical Research Fellow
Department of Computer Science
Manchester University, Oxford Road
Manchester, United Kingdom, M13 9PL
Tel: (+44) 161 275 6239
Fax: (+44) 161 275 6204
[EMAIL PROTECTED]
http://www.cs.man.ac.uk/mig/people/jeremy/
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