Gyroscopic Investing

Both would be a dream compared to our current mess.

In addition to figuring out how $ should be allocated and spent, I wish we could devise a way to make coverage details less complicated.
(and maybe we are. I'm still reading through the plan).

A quick example: A friend of mine recently suffered a concussion. I urged him to see a doctor and he finally relented. Besides the basic care and diagnostics, the hospital wanted him to take a hearing test. He was reluctant until both an insurance rep and the hospital assured him that he was fully covered for the test. He doesn't have great insurance and thus made many phone calls on both sides to reconfirm this.

You can guess the ending: he received a large bill for the test, and after a great deal of protesting, begging and pleading he is ready to succumb to the collection agency and pay up.

I'm impressed with both.

Unfortunately dualstow, that kind of bait and switch by insurance companies is very common.  When that happens, the hospital or physician usually agrees to eat part or all of the cost.  Sending to collections after an insurance pre-approval is a big red flag that your friend is not going to a reputable place.

Back to the original thread topic:  I'm truly amazed that this group is behind a "single payer" style proposal!!  It sounds great, but it wouldn't do all that much to lower costs.  Most health care dollars are spent on sick people, who would still have to rely on Medicare/Medicaid.

Also, it remains to be seen how much capping high end risk would really lower premiums, if it's only a small part of the insurance company's expenses.  If it does, though, this would certainly reduce the impact on businesses and self-employed.  If that's the goal rather than cost savings, then ....definitely this would get my vote!

WiseOne wrote: Unfortunately dualstow, that kind of bait and switch by insurance companies is very common.  When that happens, the hospital or physician usually agrees to eat part or all of the cost.  Sending to collections after an insurance pre-approval is a big red flag that your friend is not going to a reputable place.

But it was Jefferson University Hospital.

TennPaGa wrote:.Everyone gets 5,000 on January 1 each year to spend on health care.

Where does the money to fund this come from?

I figure $5,000 x 250,000,000 (eligible population) = $1,250,000,000,000 EVERY year.

Issue T-Bonds?

Mdraf wrote:

TennPaGa wrote:.Everyone gets 5,000 on January 1 each year to spend on health care.

Where does the money to fund this come from?

I figure $5,000 x 250,000,000 (eligible population) = $1,250,000,000,000 EVERY year.

Issue T-Bonds?

It would be paid for by the fact that we're not paying insurance premiums to insurance companies via our employers.  It could just be a tax instead.

The question is would it be less or more expensive than what we're paying now.

moda0306 wrote:

Mdraf wrote:

TennPaGa wrote:.Everyone gets 5,000 on January 1 each year to spend on health care.

Where does the money to fund this come from?

I figure $5,000 x 250,000,000 (eligible population) = $1,250,000,000,000 EVERY year.

Issue T-Bonds?

It would be paid for by the fact that we're not paying insurance premiums to insurance companies via our employers.  It could just be a tax instead.

The question is would it be less or more expensive than what we're paying now.

A huge new bureaucracy to administer with another government program to be defrauded with false claims, false identities etc.
MediumTexcare would only add bureaucracy for the first $1000 to those in need. The $>50K could just be handled by the existing Medicare.

dualstow wrote:

WiseOne wrote: Unfortunately dualstow, that kind of bait and switch by insurance companies is very common.  When that happens, the hospital or physician usually agrees to eat part or all of the cost.  Sending to collections after an insurance pre-approval is a big red flag that your friend is not going to a reputable place.

But it was Jefferson University Hospital.

??
Somebody blew it.  Have your friend talk to Patient Relations (may also be called "Liaison").

I've been involved in many such cases personally at two separate institutions.  We've always quietly cancelled the bill.  It's really bad PR for the hospital to have this kind of case go to collections.  Your friend might be able to say something about going to the local newspaper with the story if they don't settle up.

WiseOne,

Is it really a single payer system if 90% of individuals never have any claims that aren't either paid out of pocket (under $1,000) or by their insurance provider ($1,000-$50,000)?

As far as the $50,000 figure, it could be $40,000, $30,000 or whatever.  The key is to make it a number that will drive down policy premiums, while still keeping the government out of most health care situations.

I'm not terribly concerned about the government's total outlay on health care, because realistically the government is going to spend a TON on whatever program is adopted.  That's just the way it is and I can't change that.  What I could potentially do, though, is reduce the bureaucracy that accompanies the government expenditure by having the government only focus on health care situations where the total expense is above the thresholds I am describing, and for supplementing the cost for poor people.

IMHO, one legitimate piece of health care reform is creating a regulatory structure in which everyone can buy coverage at a reasonable price.  If I make $37,000 per year and it would cost $9,000 to cover my health insurance premiums for me and my family, I'm simply not going to buy insurance (because I can't).  But my family and I will still get sick, and if we get too sick we aren't going to be able to pay the bills, so it just makes more sense to me to set things up so that people pay what they can in the form of a premium and don't get hit later with costs they can't pay at all.  I recognize that this will make coverage more expensive for healthy people, and I'm okay with that for the same reasons that I'm okay with paying a little more for a hamburger at McDonald's because the government requires them to make their facilities accessible to people who are in wheelchairs.  The alternative would be a world in which the people in wheelchairs would have dramatically fewer choices of where to eat (such as "Crippled Pete's Burger Shack"), they could eat their hamburgers out in the parking lot of McDonald's, or they could leave their wheelchairs outside of McDonald's and just crawl around inside the restaurant.  I don't want to live in a society that makes disabled people do that sort of thing or just stay home to eat, and I assume that many businesses would not take on the expense of making their facilities fully accessible to disabled people if they weren't required to do so.  They might, but I don't know why they would, given all the other areas in which they cut costs where they can at the expense of their customers--look at the quality of meat that McDonald's uses for a great example.

PointedStickCare, a market-based solution:

• All health care providers are required by law to publicly and clearly disclose their prices in their office, on their website, and anywhere else their services can be purchased.
• All government entities at all levels are prohibited from requiring that health insurance cover non-emergency, non-catastrophic care.
• Drug patents are eliminated.
• The prescription system is eliminated; anyone can buy anything over the counter.
• For people who require emergency care, insist on not purchasing the much cheaper insurance, and still cannot afford the much lower out-of-pocket costs, the government will reimburse the patient's incurred costs with a decreasing percentage that starts high (like 80%) but reimburses a lower percentage of the costs the more times you request reimbursement.

How this would fix the problem of skyrocketing premiums for private health insurance purchased by reasonably healthy people:
With insurance no longer forced to be a weird sort of cost-sharing health club membership, it resumes its role of protecting against risk. Prices plummet and people have an incentive to adopt healthier diets and lifestyles. Meanwhile, non-emergency care becomes an actual market subject to normal market forces, and prices plummet.

How this would fix the problem of prescription drugs being outrageously expensive:
The market for drugs is transformed into an actual market subject to normal market forces, and prices plummet.

How this would fix the problem of uninsured poor people requiring emergency care that they can't pay out-of-pocket for:
With premiums for insurance covering emergency care much cheaper, fewer people will be uninsured to begin with. And with price transparency and actual competition, out-of-pocket costs will be much lower. The decreasing government reimbursement scheme means that poor people are incentivized but not forced to purchase private insurance, and eased gradually into it through the decreasing reimbursement rate so they don't get hit with sticker shock, but the rate eventually drops to zero so they can't use the emergency room for free forever like they do now.

How this would fix the problem of already-sick poor people needing expensive care:
Most of this is non-emergency care, which will be much, much cheaper due to normal market forces existing. And any emergency care follows the rules above for uninsured emergency care. As a result, people with "pre-existing conditions" will mostly be able to afford their own treatment, and are strongly incentivized to improve their health. Again, those chronic conditions that are expensive to deal with out-of-pocket would become steadily cheaper over time due to market forces and competition.

How this would fix the problem of end-of-life care being ridiculously expensive:
With conventional insurance not paying for any of this, there would be an actual market with real prices, so people could choose what makes sense to purchase. Those who wanted heroic end-of-life care that extends the their life for every possible extra minute could purchase end-of-life-care insurance. Those who wanted heroic end-of-life care but did not purchase end-of-life care insurance, save enough money to pay out-of-pocket for it, or ingratiate themselves enough to their children to get them to pay for it are out of luck. Turns out that you need to actually prepare for the future, imagine that.

Pointedstick wrote: PointedStickCare, a market-based solution:

• All health care providers are required by law to publicly and clearly disclose their prices in their office, on their website, and anywhere else their services can be purchased.
• All government entities at all levels are prohibited from requiring that health insurance cover non-emergency, non-catastrophic care.
• Drug patents are eliminated.
• The prescription system is eliminated; anyone can buy anything over the counter.
• For people who require emergency care, insist on not purchasing the much cheaper insurance, and still cannot afford the much lower out-of-pocket costs, the government will reimburse the patient's incurred costs with a decreasing percentage that starts high (like 80%) but reimburses a lower percentage of the costs the more times you request reimbursement.

How this would fix the problem of skyrocketing premiums for private health insurance purchased by reasonably healthy people:
With insurance no longer forced to be a weird sort of cost-sharing health club membership, it resumes its role of protecting against risk. Prices plummet and people have an incentive to adopt healthier diets and lifestyles. Meanwhile, non-emergency care becomes an actual market subject to normal market forces, and prices plummet.

How this would fix the problem of prescription drugs being outrageously expensive:
The market for drugs is transformed into an actual market subject to normal market forces, and prices plummet.

How this would fix the problem of uninsured poor people requiring emergency care that they can't pay out-of-pocket for:
With premiums for insurance covering emergency care much cheaper, fewer people will be uninsured to begin with. And with price transparency and actual competition, out-of-pocket costs will be much lower. The decreasing government reimbursement scheme means that poor people are incentivized but not forced to purchase private insurance, and eased gradually into it through the decreasing reimbursement rate so they don't get hit with sticker shock, but the rate eventually drops to zero so they can't use the emergency room for free forever like they do now.

How this would fix the problem of already-sick poor people needing expensive care:
Most of this is non-emergency care, which will be much, much cheaper due to normal market forces existing. And any emergency care follows the rules above for uninsured emergency care. As a result, people with "pre-existing conditions" will mostly be able to afford their own treatment, and are strongly incentivized to improve their health. Again, those chronic conditions that are expensive to deal with out-of-pocket would become steadily cheaper over time due to market forces and competition.

How this would fix the problem of end-of-life care being ridiculously expensive:
With conventional insurance not paying for any of this, there would be an actual market with real prices, so people could choose what makes sense to purchase. Those who wanted heroic end-of-life care that extends the their life for every possible extra minute could purchase end-of-life-care insurance. Those who wanted heroic end-of-life care but did not purchase end-of-life care insurance, save enough money to pay out-of-pocket for it, or ingratiate themselves enough to their children to get them to pay for it are out of luck. Turns out that you need to actually prepare for the future, imagine that.

Here's my solution to solve the malpractice crisis, which is the cause of many of the unnecessary and excessive tests:

Doctors would have the right to opt out of the malpractice insurance racket, but they would have to inform their patients that they (the patients) are responsible for purchasing "bad medical result" insurance, that would pay if they were injured in some way by the provision of medical care.

As soon as the patients were buying their own insurance against bad medical results, they would be informed of the relative risk of various doctors' practice.

That is, the insurance company would provide quotes for the same procedure when done by various doctors; the doctors that had the highest rate of bad results would have the highest associated premiums.

This would drive incompetent doctors out of business, thus saving lives as well as money.

(By the way, I mentioned this to someone in an elevator many years ago and he almost had a stroke. He was a malpractice attorney.)

MediumTex wrote: Is it really a single payer system if 90% of individuals never have any claims that aren't either paid out of pocket (under $1,000) or by their insurance provider ($1,000-$50,000)?

In my book, yes.  It's the risk that's the issue, not the number of claims.  Your plan would transfer the most expensive/high risk to a single payer (government), which is in effect a government run single payer plan with an extremely high deductible, and room for a private market to diddle around in the small window below that deductible.  $50,000 (or whatever the final number is) would quickly be overwhelmed by almost any serious health problem requiring either any time in an intensive care unit, more than a week of hospitalization, or any surgical procedure beyond a simple day surgery.

I really like the plan because I think people SHOULD be paying out of pocket for routine care, with no interference from either insurance companies or government.  Medicare's onerous documentation/paperwork requirements wouldn't apply, the ridiculous billing/coding overhead would vanish, and the unbelievable mind games played by private insurance companies that make it impossible to know what a given person will be charged for care, would be taken entirely out of the equation - IF there was a simple menu of cash prices posted at the door!  And, having insurance companies shoulder risk when it's so uneven and unpredictable for relatively small populations is just silly.  Their premiums are high because their patient pool is too small to ensure that a small number of huge bills won't come along and destroy their finances.  It makes the most sense for risk to be spread out to as large a group as possible.

MediumTex wrote: IMHO, one legitimate piece of health care reform is creating a regulatory structure in which everyone can buy coverage at a reasonable price.

Sounds like a thumbs up for insurance exchanges.  My self-employed brother is all excited about the one in California.  It's quite possible that startup businesses will get a huge boost from Obamacare, because it will be less frightening to quit a job with health insurance.

Pointedstick wrote: PointedStickCare, a market-based solution:

• All health care providers are required by law to publicly and clearly disclose their prices in their office, on their website, and anywhere else their services can be purchased.
• All government entities at all levels are prohibited from requiring that health insurance cover non-emergency, non-catastrophic care.
• Drug patents are eliminated.
• The prescription system is eliminated; anyone can buy anything over the counter.
• For people who require emergency care, insist on not purchasing the much cheaper insurance, and still cannot afford the much lower out-of-pocket costs, the government will reimburse the patient's incurred costs with a decreasing percentage that starts high (like 80%) but reimburses a lower percentage of the costs the more times you request reimbursement.

I love this thread, have I mentioned????

OK let's check out the PointedStick Plan:

1.  Check.  Cash prices posted at the door, awesome.  If it were legal for providers (hate that word btw - did I really go through 19 years of post-high school training in order to be a "provider"???) to tack on surcharges for insured patients to reflect the higher costs involved, that would be even more wonderful.

2. A bit fuzzy on this one.  Financially catastrophic = different things to me and, say, Warren Buffett.  I prefer the method of making it clear via premium pricing that high deductible plans are a better deal for healthy folks, with premium subsidies based on income.  For people without good math skills this can be hard to figure out though.  Also, if you pay cash it should count toward your deductible.  Currently that wouldn't be the case.

3. I hate the pharmaceutical companies as much as you do, but unfortunately if you disallow drug patents you also remove any incentive for those companies to develop drugs.  In which case you would need to boost NIH funding and have them take over the role.  And kick the FDA in the pants to make them reduce the cost of drug trials, because nobody would be able to afford them.

4. I DREAM of the day when prescriptions are eliminated.  It's almost a form of physician slavery, and it's just completely ridiculous.  The only class of drugs I would reserve for script writing and strict control are antibiotics.  Tell the DEA to go take a hike and tax morphine all you wish.  People who want to be high all the time have no trouble getting the stuff anyway.  Making them pay for it would probably do more than all the punitive drug laws and schedule X controls to limit usage.

On that note, NY state just passed a rule that any time we prescribe a schedule II-IV drug, we first have to log into a web site, enter the patient's name and info, and view some "educational material."  I don't prescribe the heavy duty pain meds, but some epilepsy medications are schedule IV.  Yes, people have died from NY's vendetta against benzodiazepines, and more will die from this one.

5.    Too late in the week for me to figure out how that might work.

WiseOne wrote: It's quite possible that startup businesses will get a huge boost from Obamacare, because it will be less frightening to quit a job with health insurance.

That's exactly right.

I have always thought that the inability of many people to get affordable coverage outside of a group plan setting probably reduced the overall productivity of the U.S. economy because there are likely thousands or tens of thousands of would-be entrepreneurs who would be very successful on their own, but who never get started just because they can't leave the safety of an employer provided group plan, especially people between 55 and 64, who are often in the most productive phases of their lives.

And for people like me with mild scoliosis and a bicuspid aortic valve, I wouldn't be able to purchase a policy directly from any company at all without paying ridiculous premiums, even though the current treatment costs associated with these conditions for me is ZERO.  The scoliosis hasn't progressed at all in 25 years and the bicuspid aortic valve may require valve replacement surgery at some point in the future...maybe.

What is ironic when it comes to the bicuspid aortic valve is that it would never even have been diagnosed if I hadn't been getting regular checkups from a good doctor who had a good ear.  If I had simply never gone to the doctor, I would never have known I had it, and since it wouldn't show up in a blood or urine test and would probably never be detected in a routine physical, I wouldn't have been penalized for it when shopping for insurance.  In other words, under the current system because I have had subtle health problems diagnosed in the process of going to the doctor regularly in order to stay as healthy as I can, I am penalized far more than a person who doesn't care about their health at all.

WiseOne wrote: 4. The only class of drugs I would reserve for script writing and strict control are antibiotics. 

Doctors routinely prescribe antibiotics in situations where the data says they aren't warranted (like sinus infections), so does the strict control you are talking about really exist?

(Not a doctor, just someone who gets sinus infections and uses google).

notsheigetz wrote:

WiseOne wrote: 4. The only class of drugs I would reserve for script writing and strict control are antibiotics. 

Doctors routinely prescribe antibiotics in situations where the data says they aren't warranted (like sinus infections), so does the strict control you are talking about really exist?

It does in tertiary care hospitals, where antibiotics typically require approval from the infectious disease service beyond the first 24 hours.  But in most places antibiotics are given out like candy.  IMHO this is a far more dangerous practice than freely prescribing oxycodone to everyone who wanders in with back pain.

MediumTex's observations about subtle diagnoses being a double edged sword is right on the money.  It's the sort of weird dilemma that can only come up in our screwed up medical system.  One area where one must be very careful is genetic testing, especially because there are implications for family members and even future children.  Unless there's the possibility of an intervention that would be better than standard treatments, it's probably better not to do it.  I prefer to send people for research studies, because the results have to be deidentified before they're disclosed to anyone except the patient.

Hopefully that provision of Obamacare will survive, and these things won't be a consideration henceforth.

Thanks for the reply, WiseOne. It's great to get some feedback from an actual doctor!

WiseOne wrote: 2. A bit fuzzy on this one.  Financially catastrophic = different things to me and, say, Warren Buffett.  I prefer the method of making it clear via premium pricing that high deductible plans are a better deal for healthy folks, with premium subsidies based on income.  For people without good math skills this can be hard to figure out though.  Also, if you pay cash it should count toward your deductible.  Currently that wouldn't be the case.

I'm basically thinking that it should work like car insurance. I don't use my car insurance to pay for gas, oil changes, a tune up, etc. Those I can plan for, shop around for, and maybe even do myself. But I sure will use my insurance when I crash the car. Even if I'm rich enough that I could just say, "screw it!" and buy a new car, that's in the "catastrophic" bucket because it's like moda says: rare but with extremely high potential costs.

Essentially, I'm saying that health insurance should only be used for unexpected emergencies--especially time-sensitive ones where you pretty much can't take it coolly, negotiate, or shop around. Kinda late to compare ambulance services when you're lying on the ground bleeding profusely!

WiseOne wrote: 3. I hate the pharmaceutical companies as much as you do, but unfortunately if you disallow drug patents you also remove any incentive for those companies to develop drugs.  In which case you would need to boost NIH funding and have them take over the role.  And kick the FDA in the pants to make them reduce the cost of drug trials, because nobody would be able to afford them.

Sorry, I don't buy that! The argument that patents are crucial is common, but I've yet to see any actual evidence of patents fostering innovation. I actually work in an industry where the lack of patents in some cases and lack of patent enforcement in other cases has resulted in a ridiculous explosion of innovation, entrepreneurship, and productivity.

If there were patents involved I probably couldn't have entered the field of 3D printing, in fact. Mostly I see them being used as a weapon against competitors or exploited to grant a de facto monopoly. The argument made by pharmaceutical companies that they need the monopoly rights during such-and-such many years to defray the absurd costs of FDA approval sounds an awful lot like another way of saying, "The FDA shouldn't suck so much." I'm in total agreement with you that the FDA's drug trial process is a huge problem.

notsheigetz wrote:

WiseOne wrote: 4. The only class of drugs I would reserve for script writing and strict control are antibiotics. 

Doctors routinely prescribe antibiotics in situations where the data says they aren't warranted (like sinus infections), so does the strict control you are talking about really exist?

(Not a doctor, just someone who gets sinus infections and uses google).

Apparently some countries in Europe have really cracked down on antibiotic use and have seen a significant drop in drug resistant bacteria as a result.  Don't expect the gravy train of easily accessible antibiotics to last, or expect the ones you can get to be useless coupled with flesh eating unstoppable strains of superbugs everywhere (hello staphylococcus...).

Those of us who raise livestock have to fight this problem with deworming medication.  If we overuse it, the worms become resistant and our available medications no longer work.  Our animals die or become much less productive.  So we have to only medicate when necessary and only those animals that are very sick as opposed to dosing the entire herd (all grazing animals carry parasites at all times, it's a matter of the number that's the issue).  Why most of our doctors in this country haven't managed to figure this out yet and put it into practice when every hillbilly that I know with a few goats has, boggles my mind.

notsheigetz wrote: Doctors routinely prescribe antibiotics in situations where the data says they aren't warranted (like sinus infections), so does the strict control you are talking about really exist?

Perhaps pt expectations/ requests have something to do with this (and perhaps it is more common in docs not as up on the current literature).    Oh and sinus infections can make one quite miserable, so I understand the desire for an intervention.

RuralEngineer wrote: Why most of our doctors in this country haven't managed to figure this out yet and put it into practice when every hillbilly that I know with a few goats has, boggles my mind.

It's probably because the hilbilly with goats is directly hurt if his goats catch antibiotic-resistant superbugs and die. Doctors don't own their patients, so they're fungible.

TennPaGa wrote:

Benko wrote:

notsheigetz wrote: Doctors routinely prescribe antibiotics in situations where the data says they aren't warranted (like sinus infections), so does the strict control you are talking about really exist?

Perhaps pt expectations/ requests have something to do with this (and perhaps it is more common in docs not as up on the current literature).    Oh and sinus infections can make one quite miserable, so I understand the desire for an intervention.

Seriously?  The person with the 6+ figure salary doesn't know how to do his job and it is the patient's fault?

Unless, of course, he views his job as making money, not making people healthier.  Then it all makes sense.

I would love to be able to look inside the mind of a typical GP and observe the decision making process used to determine which medications to prescribe.  Something tells me that the drug reps who frequent his office have a huge influence on these decisions.

The whole doctor/drug rep thing is a really peculiar arrangement.  It's sort of the medical equivalent of the relationship between male football fans and the chicks in beer commercials.

MediumTex wrote: I would love to be able to look inside the mind of a typical GP and observe the decision making process used to determine which medications to prescribe.  Something tells me that the drug reps who frequent his office have a huge influence on these decisions.

The whole doctor/drug rep thing is a really peculiar arrangement.  It's sort of the medical equivalent of the relationship between male football fans and the chicks in beer commercials.

MediumTex you are second to none with your literary analogies!!!  Can I borrow that one???  Of course you are spot on with this.  It should be outlawed, along with TV ads for drugs (don't you love the one where the voice-over mutters something about a 4 hour erection being a side effect at the end of the commercial?)

From an MD's point of view, it's like being subjected to a never-ending barrage of commercials during your work day.  I try to duck away every time I see a drug rep, but they're good at blocking escape routes.  Since I'm in academia I see less of them than a private physician would, since technically they're not allowed in unless invited.

They're often welcomed for two reasons:  1) free samples, and 2) source of $$ for drug-company sponsored research, mainly drug trials.  Of course it's a double edged sword.  There are established studies demonstrating that physicians prescribe a lot more of the drugs for which free samples are available.  In my specialty I saw this in action:  a new drug came out recently that I (and the others in my group) quickly realized is not as effective as the older drugs, and has worse side effects than some.  We thus use it as the fifth or sixth option in combo with an older drug, and consider it inappropriate to use alone or as first line therapy.  Yet, when I see patients coming from private practices, nearly all of them are on the new drug.  It's just easier to prescribe the med that sitting in the sample closet, and for which the name & dosage has been drilled into you all day so it's on your mind.

I hate that when I have to disrobe at the doctor's office and sit on what used to be noisy but ad-free white paper.
Still noisy, now it says CIALIS all over it. That's right, the paper covering the examination cushion I sit on was brought to you today by Cialis! 

WiseOne wrote:
From an MD's point of view, it's like being subjected to a never-ending barrage of commercials during your work day.  I try to duck away every time I see a drug rep, but they're good at blocking escape routes.  Since I'm in academia I see less of them than a private physician would, since technically they're not allowed in unless invited.

They're often welcomed for two reasons:  1) free samples, and 2) source of $$ for drug-company sponsored research, mainly drug trials.  Of course it's a double edged sword.  There are established studies demonstrating that physicians prescribe a lot more of the drugs for which free samples are available.  In my specialty I saw this in action:  a new drug came out recently that I (and the others in my group) quickly realized is not as effective as the older drugs, and has worse side effects than some.  We thus use it as the fifth or sixth option in combo with an older drug, and consider it inappropriate to use alone or as first line therapy.  Yet, when I see patients coming from private practices, nearly all of them are on the new drug.  It's just easier to prescribe the med that sitting in the sample closet, and for which the name & dosage has been drilled into you all day so it's on your mind.

Industry sponsored medical research is laughably bad.

But...even if a doctor is aware of this, there can be a lot of pressure from patients, colleagues, consultants, and the medical community in general to accept a lot of this dogma and implement it in practice. 

A good example is TPA ("clotbuster") for stroke.  There's no good evidence to support it, but b/c of industry funded studies (with conclusions that contradict the actual data supplied), this dangerous treatment, which can cause a patient to develop a brain hemorrhage and die, is now recommended by supposedly authoritative sources.

The American College of Emergency Physicians (of which I am a member), for example, has guidelines recommending TPA's use for ischemic stroke.  I don't believe it works, and think that it's probably dangerous, but, of course there are now lawsuits popping up in cases wherein this drug is not given. 

The even bigger problem is that even if I'm willing to ignore the legal risk of not giving this medication (which I am), when I try to admit this patient, you can almost guarantee that whoever is taking over care is going to make a huge stink about the fact that I didn't give it. 

Any argument I make for not having given it will seem dubious in the risk management meeting that ensues wherein my own college's guidelines are projected in giant, bolded letters onto a movie screen during the Powerpoint presentation about what an idiot I am.  (For the record, there is a very strong minority opinion in the Emergency Medicine community supporting this anti-TPA for stroke point of view.  It's not just me).

I could make a long list of similar examples.

Sorry to rant...touchy subject  .