Out, out, brief candle! Life's but a walking shadow, a poor player That struts and frets his hour upon the stage And then is heard no more; it is a tale Told by an idiot, full of sound and fury, Signifying nothing.--Macbeth by Shakespeare
Commercialization of disease has become a huge profit motive for shareholders. I have no problem if you are owning your decision to hedge the bets in favor of expanding market shares but I also see where patient as a buzzword has become like an awkward "comma" in the overall story. "What is that doing there and is it really necessary--It disturbs the flow of the narrative".
My shareholders expect me to make the most profit. That's the ugly, dirty truth.--Martin Shkreli
I have been painfully unsuccessful in talking about pharmaceuticals in a vacuum that does not include health policy, health law, health economics, and clinical research data. It bugs some people. I work as a consultant that views my role as being truthy and delivering perspectives often over-looked in the Google economy. The majority of calls I am on include a C-suite type masquerading as an expert without ever exhibiting doubt in the science or wanting engagement on other perspectives.
I recognize discussion topics from the first pass on what loads on page 1 of an online search. What I don't hear is the granular discussions from well-designed trials that add a depth to pre-clinical decisions or moiety designs.
Attempts to vilify the pharmaceutical industry without transparency of health law, policy, and economics underlying the framework continue to be short sighted. In our big data lives, there are now infinite data libraries and resources for query and analyses. Was it Martin Luther King that warned us all, "Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity"?
Upstream from diseases we can discover how laws influence health. No matter what side of the aisle you are on--changes to federal law, reversal of executive orders, changes to federal agency policy (ask yourself how Alex Azar, Health and Human Services Secretary, ended up with jurisdiction over immigration) and appointment of judges impact public health.
The Southeastern Association of Law Schools 2018 conference featured a session on health law:
WORKSHOP ON HEALTH LAW
Healthcare in the Era of the Trump Administration
The 2016 election has already ushered forth dramatic changes to our healthcare system, in efforts to repeal and replace the Affordable Care Act, in deregulation, in executive orders that alter the effects of the ACA, and in numerous other ways. This panel will focus on the state of healthcare in America in the era of the Trump presidency. What are the enduring effects of the Trump presidency on the state of healthcare delivery and healthcare finance (both in private and public insurance programs) now and into the future?
Moderator: Professor Deborah Farringer, Belmont University College of Law
Speakers: Professor Jennifer Bard, University of Cincinnati College of Law; Professor Zack Buck, The University of Tennessee College of Law; Professor Nicole Huberfeld, Boston University School of Law; Professor Nicolas P. Terry, Indiana University, Robert H. McKinney School of Law
I recommend listening to This Week in Health Law podcast if you want to access a wide variety of legal scholar discussions outside of the typical journalistic soundbites and tantalizing ledes. These are a few of the graphics from the event. The broad discussions include the role of trade tariffs on the cost of medical equipment, the fight against global guidelines on livestock antibiotics, suggested bans on CDC employees using words like "evidence-based, science-based, vulnerable, entitlement, diversity, transgender, and fetus", the phrase "climate change", sexual discrimination and Title VII protections, use "religious liberty" to deny medical care, and on and on...
Harvard scientists say current and proposed environmental policies could lead to an extra 80,000 deaths per decade. Think of losing the entire audience from the MetLife Dome --where the New York Giants and Jets play--every decade because of changes in policies that impact our clean air and water. Requiring raw data from landmark cases to be released to the public or risk overturning of established science.
Context is king. We will not be able to out "Innovate" our way out of global and national priorities that minimize the role of social determinants, health policy, social policy, economics, and the environment.
time to get our hands dirty...
I for one do not accept Shakespeare's existential nihilism from Macbeth. We just need to look at more data. Dirty hands get things done.
Find more data--not just the data that supports our objectives, bottom line, or shareholder interests.
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”