Dear clients and friends: Given your interest in health and medicine, we would like to share with you our collection of the most interesting perspectives on our industry's trends and developments. We are happy to share them with you — and hope you share your thoughts with us.

1. Innovation Reduction Act

Writing on the blog Marginal Revolution, Alex Tabarrok laments how the Inflation Reduction Act will create many, sprawling “negative effects of price controls” for innovative pharmaceuticals. To wit:

Fewer drugs for Medicare market.

Less research on post-approval indications and confirmatory trials.

Reduced incentive for generics to enter quickly.

Most importantly: Less R&D spending leading to fewer new drugs, a reduced pharmaceutical armory, lower life expectancy and higher morbidity. By one calculation, ~135 fewer new drugs through to 2039 (see also here and here and here and here).

“A classic example of political myopia,” Tabarrok contends, where “everyone wants the great new pharmaceuticals without paying for them.”

2. As I Lay Clinical Trialing 

Read and weep. An ER doctor writes of her husband’s cancer diagnosis and awful experiences they have with clinical trials. The long blog is part of a three-part series, with contributions from her husband sharing the patient’s perspective. The tone is established from the outset: 

Despite the stakes, from the patient’s perspective, the clinical trial process is impressively broken, obtuse and confusing, and one that I gather no one likes: patients don’t, their families don’t, hospitals and oncologists who run the clinical trials don’t, drug companies must not, and the people who die while waiting to get into a trial probably don’t. I guess the dead don’t have preferences, but I’m going to assume they’d rather be living. Per Judy Seward, head of clinical trial experience at Pfizer, only 8% of adult cancer patients take part in trials. Given our recent experience, I’m amazed it’s that many.

3. How to Make Medicine Work Better

“Bed rest, fresh air, or a sanatorium in the mountains.” Writing in The New Yorker, Dr. Dhruv Khullar argues that convalescence isn’t antithetical to innovative medicine, but essential to it:

 The decline of convalescence may be rooted, in part, in the immense progress we’ve made in treating disease. This is a sad irony: as medicine has gained new tools, it seems to have forgotten the value of old ones. Hippocrates is said to have argued that the “healing force within each of us is the greatest force in getting well”…Sleep empowers us to fight infection; good nutrition allows us to repair wounds; time in nature has been shown to lift moods, alleviate pain, and lower blood pressure. “A doctor who sets out to ‘heal’ is in truth more like a gardener who sets out to ‘grow.’ 

4. London Calling

As the British NHS buckles, the Bobby steps back. 1843 outlines how the London police will create a void if they no longer answer the call for mental health emergencies:

It is not certain what will happen to Londoners suffering from mental-health crises when the Met stops going out to deal with them. There will be no additional funding for the NHS to cope with the extra workload. Mental-health teams, whose workers are often burnt out, are already unable to meet demand from the anxious, depressed and suicidal. Ambulances take twice as long as the target time to reach patients suffering from heart attacks or strokes. Ideally the police should not be the first responders to medical emergencies, but without them, people in distress may suffer worse fates than otherwise.

5. Probed

 Great news! A European study recently found that colonoscopies aren’t the best method of screening for colon cancer. 

But wait: the American GI establishment disputes the findings, claiming that, however foul, colonoscopies work. 

Asterisk Magazine investigates the debate and offers a conclusion that has implications beyond the bowel. The scientific disagreement may not be a question of statistical analysis, but of perspective:

Regulators in Europe basically give two reasons that they continue to recommend fecal blood tests [instead of colonoscopies]:

1. It’s hard to get Europeans to do any colorectal cancer screening, and exceedingly hard to get them to agree to colonoscopies.

2. Colonoscopies have not yet been proven to be cost-effective.

In America, neither of these apply.  When setting recommendations, the U.S. Preventative Service Task Force explicitly does not consider costs. And since we expect colonoscopies to be effective, it would be too risky not to do them. Americans are probably more open to colonoscopies simply because doctors have told them for decades how important they are. (Note: None of these things are obviously bad!)