Episodes

  • America's drug problem

    America's drug problem
    Dec 18 2024
    We dive into the pharmaceutical industry, so buckle up! As a side note, we reference Karendia (finerinone) as an expensive drug (around $800 a month list price) with minimal benefits. It provides 3-4% reduction in people having decreases in their GFR (a measure of kidney function) over 4 years, but no benefits in death, kidney failure, hospitalizations, heart attacks, strokes or any of the other things they measured. This is one of the medications that is being pushed on everyone with kidney disease but really is far too expensive to make sense with that little benefit. It would cost over $1,000,000 over 4 years for 1 person in 30 to not have a 40% reduction in the GFR with no other appreciable benefits. Here's the trial - https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 References: https://repository.si.edu/bitstream/handle/10088/97768/Daemmrich%20PharmaMfg%20PharmHist%202017.pdf?sequence=1 - history of pharmaceutical manufacturing https://pharmaphorum.com/r-d/a_history_of_the_pharmaceutical_industry - more history https://jamanetwork.com/journals/jama-health-forum/fullarticle/2811344 - PBMs https://www.help.senate.gov/imo/media/doc/big_pharmas_business_model_report.pdf - profits in Pharma https://www.fda.gov/drugs/special-features/manufacturers-mouth-your-ears-direct-consumer-advertising - DTC advertising https://www.propublica.org/article/doctors-prescribe-more-of-a-drug-if-they-receive-money-from-a-pharma-company-tied-to-it - Doctors’ prescribing patterns https://lowninstitute.org/more-than-half-of-doctors-receive-industry-payments-with-some-making-millions/ - industry payments https://jamanetwork.com/journals/jama-health-forum/fullarticle/2804378 - drug research money source https://www.raps.org/news-and-articles/news-articles/2019/4/how-biopharma-companies-use-nih-and-vice-versa - NIH royalties https://www.gao.gov/prescription-drug-spending - Govt prescription spending https://oig.hhs.gov/reports-and-publications/featured-topics/drug-spending/ - Govt drug spending https://www.aafp.org/pubs/afp/afp-community-blog/entry/will-the-high-price-of-gene-therapy-for-sickle-cell-disease-put-this-cure-out-of-reach.html#:~:text=The%20approval%20of%20Casgevy%2C%20which,distributional%20cost%2Deffectiveness%20analysis%20standards. - sickle cell example https://www.fiercepharma.com/pharma/top-20-pharma-companies-2023-revenue - Pharma Revenue https://www.npr.org/2024/04/12/1244509038/u-s-drug-makers-see-big-profits-but-many-pay-taxes-far-below-the-corporate-rate - drug company taxes https://www.gao.gov/products/gao-18-40 - drug company profit margins https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690298/ - History of drug advertising https://www.pharmacytimes.com/view/are-pbms-downplaying-their-profits - PBM profits https://www.nbcnews.com/health/health-news/gaming-us-patent-system-keeping-drug-prices-sky-high-report-says-rcna47507 - “Evergreening” and patent thickets
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    1 hr and 34 mins
  • Follow the money

    Follow the money
    Oct 23 2024

    Tatumn, Krista and Matt cover a broad overview of the perverse incentives in American healthcare and the many parties involved in making it happen.

    Resources:

    https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024?utm_source=twitter&utm_medium=social&utm_campaign=Improving+Health+Care+Quality - America vs peer countries

    https://data.worldbank.org/indicator/SP.DYN.LE00.IN?end=2022&most_recent_value_desc=true&start=1960&view=chart - world bank life expectancy

    https://www.pgpf.org/blog/2024/08/how-does-the-us-healthcare-system-compare-to-other-countries#:~:text=In%202022%2C%20the%20United%20States,per%20capita%20across%20similar%20countries. - US spending per capita

    https://www.definitivehc.com/blog/the-difference-between-non-profit-and-for-profit-hospitals - non-profit vs for-profit hospitals

    https://lowninstitute.org/the-rising-danger-of-private-equity-in-healthcare/ - private equity

    https://www.jabfm.org/content/early/2024/08/30/jabfm.2024.240187R0 - EHR burnout

    https://www.reuters.com/legal/litigation/healthcare-software-giant-epic-hit-with-lawsuit-over-us-patient-records-2024-09-23/ - Epic lawsuit

    https://www.pgpf.org/blog/2023/04/almost-25-percent-of-healthcare-spending-is-considered-wasteful-heres-why - waste in healthcare

    https://www.ama-assn.org/press-center/press-releases/ama-studies-show-continued-cost-burden-medical-liability-system - malpractice burden on physicians
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/ - costs of litigation
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    1 hr and 11 mins
  • The doctor can't see you now

    The doctor can't see you now
    Oct 23 2024

    Dive into the primary care crisis with Tatumn, Krista and Dr. Matt. We discuss why it's so hard to get in to see a doctor and things fueling the primary care crisis in America.

    Links to research/resources: https://www.ecgmc.com/insights/whitepaper/the-waiting-game-new-patient-appointment-access-for-us-physicians - appointment waiting times

    https://www.jucm.com/pros-and-cons-of-urgent-care-vs-primary-care-billing-for-urgent-care-services/ - Cost of Urgent Care

    https://www.debt.org/medical/emergency-room-urgent-care-costs/ - Urgent care vs ER costs

    https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-of-primary-care-workforce-2023.pdf - Primary care shortage

    https://link.springer.com/article/10.1007/s11606-022-07707-x - time for primary care visits

    https://www.jabfm.org/content/29/4/496.full - panel sizes

    https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802144 - appointment times


    https://www.usnews.com/news/best-states/articles/2020-03-17/10-states-with-the-longest-emergency-room-wait-times - ER wait times
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    50 mins