> > And no, the sales and marketing in that article is not advertising alone. It's mostly sales people who go and visit medical professionals to talk about their products.
> That's advertising.
It's also keeping physicians up to date on the current science, applicability, and best practices of their products. I think it's a good thing for sales reps and MSLs to inform or remind physicians that there are alternatives to writing a script for Epipens, for example.
> You mentioned 20% of their revenue is R&D - do you have a source, ideally listing what the other 80% goes to? That's a lot of unaccounted revenue, especially given how many drugs were shown to be dirt cheap to manufacture.
Many drugs are cheap to make, but that neglects the astronomical development and regulatory costs.
FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing.
You can't expect to get unbiased, quality advice from someone with such a strong incentive. The right way for doctors to stay up to date is for doctors to stay up to date! They need to read a damn book or journal article once in a while and takes responsibility for their own professional development. If doctors aren't doing that, regulators need to suspend their licenses.
> FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing.
MSLs have advanced degrees in medicine or biomedical research. It's preferred that the traditional sales reps now have bachelor's degrees in the sciences and it is expected that, within the narrow scope of their product's science, they be well-informed regardless of prior academic background. It's preferred because they are more effective reps.
> You can't expect to get unbiased, quality advice from someone with such a strong incentive. The right way for doctors to stay up to date is for doctors to stay up to date! They need to read a damn book or journal article once in a while and takes responsibility for their own professional development. If doctors aren't doing that, regulators need to suspend their licenses.
Continuing medical education is a requirement to maintain licensure. I don't think I get your point here.
Hah. I've actually spent months of my life working with drug reps - including going with them on doctor's visits. They will get five minutes max to go through their spiel, and they are very focused on selling the specific uses or differences to get doctors to switch.
What is also amazing is that it is easy to get doctor level data on your drugs market share in their prescription patterns. So you can target very effectively. Then it's all discipline of frequency and hitting the right docs.
Why do you think so many drug reps are blonde girls? Because the doctors will make time to see 'em.
And what is doubly amazing is how effective this brute force sales technique is. I have graphs of visit frequency vs market share and it is DEADLY effective if you get it right. (Of course there are diminishing returns. Drug reps will game their visit stats by overvisiting friendly docs. So you can't give them credit for those visits.)
Source: I'm a healthcare sales management consultant
> It's also keeping physicians up to date on the current science, applicability, and best practices of their products. I think it's a good thing for sales reps and MSLs to inform or remind physicians that there are alternatives to writing a script for Epipens, for example.
There are many very cheap ways of keeping physicians up-to date, such as a conference presentation of the drug, followed by a Q&A session, with a recording freely available online.
> Many drugs are cheap to make, but that neglects the astronomical development and regulatory costs.
Which are covered in the already mentioned 20% that goes to R&D (source pending). Are you purposefully ignoring information you dislike?
> There are many very cheap ways of keeping physicians up-to date, such as a conference presentation of the drug, followed by a Q&A session, with a recording freely available online.
Because most doctors are happy to spend hours watching recordings of drug presentations.
For better or worse, doctors are just people and if you want them to understand the benefits of your new drug, it will fall to you to convince them. Most doctors are not going to thoroughly study every new drug.
> Because most doctors are happy to spend hours watching recordings of drug presentations.
And yet somehow I am supposed to be overjoyed at spending hours watching conference talks, reading blog posts and documentation, and doing other things to evaluate new tech and learn new languages/libraries that are not my direct job just to keep up to date on my rapidly-changing industry?
Welcome to the 21st century doctors. I would unpack and play the worlds tiniest violin for you, but I have a few more confreaks youtube videos to plough through right now.
I don't know, honestly, but hand waving and saying doctors should all take the initiative to self educate won't do it. Maybe they should, but many likely won't.
The only thing I can think is to make it mandatory continued education. But even that is iffy. Part of the problem is that there's just not that much additional data on new drugs. By definition the FDA thinks the drug is safe (relatively) and effective so what's the education going to look like and who's going to put it together?
> There are many very cheap ways of keeping physicians up-to date, such as a conference presentation of the drug, followed by a Q&A session, with a recording freely available online.
5 minutes of face time with a busy physician and supplying them with a useful article targeted to their specific needs can be far more effective.
> Which are covered in the already mentioned 20% that goes to R&D (source pending). Are you purposefully ignoring information you dislike?
The dev part was an honest error while I was editing, and I don't think the accusation is called for. Regulatory costs, and I think of quality also being in that group, is not an R&D cost and is substantial.
That has a critical and hard to prove caveat: that at the time of the filing it was known what that 'best mode' was. And since parameters (such as the ones under discussion) are subject to change that could be very difficult, it involves the 'state of mind of the inventor at the time of filing'.
So, since 2012 this is now a requirement.
I've found two examples of this successfully used in litigation, they are referenced here:
It was a requirement before the Leahy-Smith America Invents Act, which is what is meant by "pre-AIA". You stated that "'best mode' is not a requirement for a patent at all" which was incorrect pre-AIA and remains incorrect in the AIA era. Disclosure of best mode remains a statutory requirement, even though it now lacks enforcement.
Your citation is of MPEP 2165, which is what I had referenced earlier. Thank you for sharing a direct link for others to review.
> I would not be surprised if others in their respective fields take a similar approach in other cult of personality topics (Uber, Elon, Apple, etc.).
I no longer read the comments for things relating to medical testing, my professional field, and I try my best to avoid medicine generally.
It to me feels like many commenters are somewhat clueless on the topic, and many others have strongly held opinions that lack foundation. It's a frustrating environment to comment within: it takes a lot of energy to write a thoughtful comment that can fill in missing domain knowledge for an earnest reader, and subsequently demoralizing to have a popular frequent poster on this website to dismiss my comment with snark because they consider themselves to be informed in this area. My comments became gray. I deleted the password to my account when that happened and rarely post since, the frustration is not worthwhile.
Some who are vaccinated will still contract the disease. Some cannot be safely vaccinated because of preexisting medical conditions. For both groups, herd immunity provides additional protection; herd immunity is frustrated by those who choose to not vaccinate.
Physician and staff salaries (outside of staff to manage insurance companies) are not what drive increasing medical costs. Most physicians don't make that much money, all things considered.
An insurer last month for a relative's pediatrics practice announced that they were having difficulties with their accounting system and so they would only be making a half payment on their outstanding AR (and naturally, they announced this problem right before the payment was due to be sent). My relative's practice has no practical recourse other than to wait for the full payment to be sent. This is not an uncommon occurrence. My relative's practice is regrettably not able to use the same argument for their bills that are due.
It costs my relative money to administer vaccines in their peds practice, i.e., most insurances pay less than what it costs to purchase and give the vaccine. My relative continues to offer many vaccines at a loss because they believe vaccines are one of medicine's greatest gifts and because they have good success in persuading unsure parents to vaccinate their children. From a pure numbers perspective, it is a mistake.
Insurance companies not paying physicians on time as agreed drives up costs. Insurance (Medicaid included) not paying what it actually costs for a procedure drives up costs. Insurance companies arguing against the best course of treatment for a patient, requiring additional staff to be hired in order to deal with the pushback, drives up costs.
When you say insurance isn't paying what it costs for a vaccination, what determines the cost of the procedure? Is it the vaccine itself? Office overhead? Liability insurance? I know pediatricians are generally overworked and underpaid. But, it seems we desperately need innovation on the cost side.
Maybe we need to drop kiosks into pharmacies that can read biometric markers, get doctor approval, and deliver vaccines.
> When you say insurance isn't paying what it costs for a vaccination, what determines the cost of the procedure? Is it the vaccine itself?
The vaccine itself. Medicare and Medicaid are notorious for this, as they have no mandate to cover marginal costs of supplies (and they have the ability to force providers to accept less than that).
So, depending on the practice, those providers could very well be losing money on every Medicare patient they treat before they even have a chance to think about paying for their office space, paying their staff, etc.
Yes, in my relative's case (being peds) it is Medicaid.
It's a really frustrating thing, as a physician you want to treat everyone, but accepting Medicare and Medicaid can really hurt the operation of your business.
Do you have any idea of the distribution of vacine prices between providers (ie hospital networks vs private practices)? Is there a large discrepancy, or do hospitals use this as a 'loss leader'?
> Practicing physicians are the most highly paid workers in America. In what way do they not make that much money?
Doctors take home a lot less than people think.
The "salary" numbers you usually see cited aren't comparable to salaries in fields like software engineering, because doctors still have to cover their own business costs (the big one is malpractice insurance, but other expenses like CME, etc. are all on their own dime). And these are almost invariably not tax-deductible, because AMT doesn't allow for deductions for business expenses.
In any case, physicians' earnings account for only about 10% of total medical spending in the country. In other words, even if every doctor decided to work for free and pay for all their business expenses out of their savings... we'd still be spending 90% of what we currently are.
Do you believe that you have or can quickly acquire the specialized domain knowledge and experience necessary to accuately describe your conditions for the expert system? Do you think you can sufficiently document your findings in your medical record? Do you foresee any problems in occupying both the patient and diagnostician role?
Automated triage systems are already used at intake for urgent care clinics. They suck, partly because GIGO.
One point not yet mentioned is that the Ferrari shape is assisted by the engine placement and drive configuration. A front-engine and front-drive Hyundai has too much packaged under the hood to shape similar to a Ferrari.
When you do your write-up, I'd be interested to hear more about the mismatch between what you thought your clients wanted and what their eventual actions demonstrated they wanted. Could this mismatch have been detected in the early planning of the company?
The US has stricter emission limits for NOx than Europe, which are difficult to meet with diesels given locally available fuels. Meeting the limits in the US tends to require adding onboard treatment systems, increasing initial purchase and recurring costs. The diesel engine is also more expensive here. Basically, it's frequently not cost effective.
The federal tax rebate is likely to phase out over the course of the Model 3 introduction: it isn't a given that the effective pricing will be be similar. It's also premature to compare pricing without the Model 3 specifications.
> That's advertising.
It's also keeping physicians up to date on the current science, applicability, and best practices of their products. I think it's a good thing for sales reps and MSLs to inform or remind physicians that there are alternatives to writing a script for Epipens, for example.
> You mentioned 20% of their revenue is R&D - do you have a source, ideally listing what the other 80% goes to? That's a lot of unaccounted revenue, especially given how many drugs were shown to be dirt cheap to manufacture.
Many drugs are cheap to make, but that neglects the astronomical development and regulatory costs.