Angry Doctor

Wednesday, December 14, 2005

Health Economics

There is no such thing as health economics – only socio-politico health economics.

- Hobbit’s Nonsensical Guide to Health Economics


I don't actually know who Hobbit is, but I suspect I may have worked with him before...

Anyway, I was searching for stuff on health economics because of this question raised by Dr Oz Bloke:


Why doesn't the government give these tests free to the public anyway?


There are actually several un-asked questions there.

What would be the objective of such free tests?

To reduce healthcare burden by early detection and treatment? To win votes?

If the first, is universal screening of asymptomatic individuals is a cost-effective way to reduce healthcare burden in Singapore? What disease should be screened for?

If the second, why hasn't it been done yet?

I'm sure you have your own your answers to the questions above, and can come up with more questions too...

In any case, here's a rather technical site on health screening that you might find useful. Enjoy.

posted by angry doc at 8:14 am

38 Comments:

  • Reading that "technical" site, I realised it is mainly about

    1) acceptance by the medical community of new ideas/conditions to screen/tests used to screen

    2) acceptance by the public of new ideas/conditions to screen/tests used to screen

    There is a saying when it comes to the acceptance of new things and ideas.

    The sceptics and critics will always start by saying "It's not true, and it's not important".

    Then they will say "It's true, but it's not important"

    Then finally they will say "It's true, it's important, but it's not new"

    Which is why new scientific discoveries always take such a long time to get into mainstream medicine.

    Take for instance H. pylori and Peptic Ulcer Disease. It is mainstream now. Robin Warren and Barry Marshall have won the Nobel Prize for Medicine this year for their work on H. pylori. But back in 1982 they were constantly ridiculed by the medical community for their "preposterous" claims.

    I feel that the public has a bigger role to play in "Health Economics". People are well educated today. Information is easily available on the internet. If the public take an active interest and further educate themselves on health matters, they can decide for themselves what they want.

    Of course they can also then decide which tests they would be willing to pay for. Otherwise, they should be content with letting some senior doctors and politicians in some room decide for them what is suitable for them. Surprisingly, they may STILL have to pay for that themselves.

    By Blogger Dr Oz bloke, At December 14, 2005 9:27 am  

  • I have no problem with medicine advancing slowly. Sometimes you need to ask yourself why some people want it to 'advance' quickly.

    Vioxx?

    By Blogger angry doc, At December 14, 2005 9:49 am  

  • Why do some people want it to advance quickly?

    Well last I checked I only have about 70-80 years to live.

    Time may run out for me if medicine advances too slowly.

    Vioxx was a drug, manufactured by a pharmaceutical company. I hardly count new drugs from pharmas as an advance in medicine.

    But again it's all subjective. And that is just my personal opinion. It doesn't mean that I'm right.

    By Blogger Dr Oz bloke, At December 14, 2005 10:01 am  

  • The pharma industry is one big giant conspiracy abetted by secondary crooks.

    The perps and the suckers are you know who.

    Again, this is how the world works....

    By Blogger uglybaldie, At December 14, 2005 10:05 am  

  • "Vioxx was a drug, manufactured by a pharmaceutical company. I hardly count new drugs from pharmas as an advance in medicine."

    Why was new drugs not considered advance in medicine? Then what is?

    "The pharma industry is one big giant conspiracy abetted by secondary crooks."

    Why? Why is pharma companies viewed in such bad light? Sometimes I think it's a lose-lose situation for these firms. No matter what they do, they will be criticised.

    By Anonymous Anonymous, At December 14, 2005 10:40 am  

  • Dear Anonymous,

    I'd say that the pharmas are purely in this business of drugs for profits.

    During the Tsunami disaster, my clinic sent a doctor to Indonesia to help. We also donated about 500 bottles of pediatric amoxicillin. We tried asking the drug company to sell it to us at a cheaper rate and they refused, even when we told them it was for the Tsunami victims. We paid for it out of our own pocket.

    No where during the disaster did I hear of any pharmas coming out to donate medicine. Never. Even in this current time of bird flu risks, the pharmas are still standing their ground about their patents, profits and losses.

    Advances in medicine are first made by researchers. If you read the current literature, you will find that many new discoveries have nothing to do with drugs. In fact on the pharmaceutical front, we have had a stagnation of new advances that do make a difference in patient outcomes. Many of the "new" drugs are actually not new at all. They are just rehashes of what we already have.

    Uglybaldie wrote "The pharma industry is one big giant conspiracy abetted by secondary crooks.

    The perps and the suckers are you know who.

    Again, this is how the world works.... "

    I would say that the pharmas are merely running a business. Strangely they control a lot more of the health care sector and costs than people realise. Yet when it comes to ethics, the charge is usually made against doctors, but not the pharmas. I feel that is unfair.

    But like uglybaldie said that's how the world works.

    And stockbrokers are some of the many "crooks", "perps" and "suckers" who abet the pharmas in what they do; business.

    If that's evil to you, then you might as well say the world is evil.

    I agree with uglybaldie that unfortunately that's the way the world works.

    So then why do people get so angry when doctors earn money? Aren't we just following the world order?

    By Blogger Dr Oz bloke, At December 14, 2005 11:18 am  

  • Didn't you read somewhere that the cure for cancer was discovered long ago and that the cover up for this was necessary to protect the drug industries.

    Didn't you also read somewhere that Aids was licked the minute it leaked out of Africa via the apes? They were cured by chomping on plants and leaves right in their own backyards. Do you hear anymore of apes being infected with Aids? Only stupid man needs to take drugs to stamp the onset of full blown aids.

    And as for cardiac disease, can you for a moment.....for a moment, believe that all the world's legend of cardiac specialists cannot wipe this acknowledged killer of man off the face of the earth if they pooled their resources together and get solid results instead of gerrymandering, endless medical conferences,publishing theories, debating on their differences, in short doing nothing conclusive to achieve something?

    Food for thought isn't it?

    By Blogger uglybaldie, At December 14, 2005 11:23 am  

  • "No matter what they do, they will be criticised."

    There is nothing wrong with running a business as a business, but even businesses are subject to ethics and laws.

    When you bribe doctors to sell the drug to patients who don't need them (like Serono did), that's wrong.

    When you wilfully suppress information that a drug may kill patients so you can get it onto the market (as Merck is charged with now), that's wrong.

    They are being criticised for specific things which they have done, not 'no matter what they do'.

    By Blogger angry doc, At December 14, 2005 11:29 am  

  • Dear uglybaldie,

    So can find all these "cures" from Dr google or not?

    Or is even Dr Google incompetent?

    Wah eat leaves to cure AIDS. Sounds good man. You should write a proposal to MOH! Really no kidding.

    Can you educate us doctors on all these "cures" on your blog?

    By Blogger Dr Oz bloke, At December 14, 2005 11:34 am  

  • Go and ask King Kong, he can fill you in with all the details.

    Then you can call the MOH and henceforth become famous!

    Hey, today I am in T-I-C mode!

    By Blogger uglybaldie, At December 14, 2005 11:55 am  

  • Unfortunately that's how the world works.

    But :

    I don't see anything wrong in being in the drugs biz purely for profit. It would be unfair to expect pharma companies to be generous and put biz aside just bec they are drugs manufacturers. Just like it would be unfair to expect all doctors to volunteer whenever there is a tsunami disaster. Or healthcare companies to start donating vitamins and stuff every time there is a flu pandamic.

    Btw, there are pharma companies that donated to the tsunami victims. But I know most are hesistant to donate in kinds like medicine cos of lawsuit and legal implications. Like I mentioned before, it's a lose lose situation no matter what they do. Cos, if they donate in kinds ie Medicine, they stand the risk of being criticised of making use of the situations to dump their drugs ( which happened before) , and other risk of misuse of these drugs , side effects, and subsequent bad press again link to their brand. Or either that, the quantity will be questioned. With drugs comes the responsibility of other things . It's a lot more complicated than what people think. Perhaps we are not able to appreciate what goes on behind all these rationale.

    I just wish that people are not so fast to judge. Cos there are really passionate people in these industry as well. It's just unfortunate that there are a lot unethical bastards around that give it a bad name.

    Or perhaps it's the expectation from the rest of us, that because they are in the biz of medical and health care, their business objective must be different from the rest of the other companies 's biz objectives??!

    Then my take would be:

    What about Fast food restaurant for selling food that damages people's health in the first place?! Why not try to go after them first. Instead of critising the new oncological drugs of being too expensive? These people probably spent tens of thousands on fast food before they even get ill in the first place. But these "bad" food was never termed expensive. And with deli choice and salads, they think they have escape the trial. But then again, it was purely driven by biz that these so called "healitier choice" came into the menu in the first place!

    What about the IT companies that come out with all sorts of technology that they claim to improved lifes and provide solutions to your everyday needs? Do they really do that? Or does it cause more health problems too? PS2, internet, handphones, online gaming etc etc. Think backache, dry eyes, eye strain, headache that results from this. Why are these company spared? Aren't they "evil" too? For polluting our lifes with unnecessary "solutions"?

    Unfortunately that's how the world works.

    By Anonymous Anonymous, At December 14, 2005 12:29 pm  

  • Dunno what you talking about. Non coherent stuff from you.

    I won't even bother to ask what T-I-C is.

    By Blogger Dr Oz bloke, At December 14, 2005 12:37 pm  

  • "What about Fast food restaurant..."

    "What about the IT companies..."

    That other industries are not above blame does not mean we cannot criticise pharmaceutical companies.

    The 'what about them' argument can be applied to anything.

    'Why arrest me for stealing? Other people are committing murder!' isn't a valid argument.

    By Blogger angry doc, At December 14, 2005 12:38 pm  

  • Dear anonymous,

    the non coherent stuff I was referring to was not you, just to clarify :)

    I agree with your comments.

    As a matter of fact, lawsuits do occur with regard to fast food, drug companies, etc.

    It's part of life I suppose. Whether something is "evil" or not is highly subjective.

    For example the islamic extremists are saying that capitalism is evil.

    We of the free world say they are "evil" and the list goes on.

    Is multi-level marketing (MLM) evil? I don't think so. What do you think? Just to illustrate a point.

    This argument would never end really.

    By Blogger Dr Oz bloke, At December 14, 2005 12:43 pm  

  • You cited fast food companies and IT innovations causing some of the ills of mankind.....

    Well, in those instances, you had a choice. You can choose to eat only organic food and avoid fast food like the plague. You can also choose to be a vegetarian. In the case of IT innovations, you can also choose not to take advantage of technology. You can for example still type out your letters with your trusty Olivetti typewriter or send snailmail instead of email. Your son in the States and you want to see him and talk to him? Fine, get an air ticket and go see him instead of doing a video conference on your computer.

    Now, herein lies the difference. In the case of those ills of modern civilization you just cited, you have a choice. The price you pay is the life you choose. In the case of the Pharma companies, very often, you don't have a choice because Dr. Quack says that taking this drug is your only chance of a normal life perhaps even survival. But unbeknownst to you and possibly with the connivance of Dr. Quack, the Pharma company is palming to you an unneccessary dud so called "evidence based" medicine. These companies will also cited impressive clinical trial figures to back up their claim and Dr. Quack and you are hooked.

    Now it is no secret that doctors are nothing without medicine. So they will also use you as as a kind of genea pig to see whether the drug they administer to you works or not.
    They're not sure. They have only listened to the pharma detailman and cursorily read some literature.

    See the difference?

    By Blogger uglybaldie, At December 14, 2005 1:19 pm  

  • Dear Dr Oz Bloke

    For a moment I thought you were referring to my comments . haha .. Abt the non coherent stuff I mean

    Yeah, argument will never end. That's why we argue in the first place i guess.

    And btw, MLM is not evil. Unless you are selling vitamins at exhorbitant price or make claims that your aromatherapy oil can cure cancer or refusing to donate them to natural disaster victim etc etc ... ;P

    By Anonymous Anonymous, At December 14, 2005 1:25 pm  

  • Uglybaldie wrote In the case of the Pharma companies, very often, you don't have a choice because Dr. Quack says that taking this drug is your only chance of a normal life perhaps even survival. "

    Eh? I thought you said there was always Dr Google and how you can trust your good self?

    What happened to that?

    By Blogger Dr Oz bloke, At December 14, 2005 1:46 pm  

  • Oinkle OZ,

    How can you compare me with your average patient?

    It's like comparing an apple with an orange.

    And can you also please focus on the issue at hand instead of indulging in nonsensical diatribe. This is a serious blog. At least we owe Dr. Angry some respect huh?

    By Blogger uglybaldie, At December 14, 2005 1:55 pm  

  • Yeah you're right.

    Sorry Angry Doctor. Don't get angry ok? :)

    I forgot that uglybaldie is species homo superior.

    By Blogger Dr Oz bloke, At December 14, 2005 2:16 pm  

  • Modesty was never my strong point.

    Guess I have to go on an ego trip now and then to make up for the lack of hair. Please pardong....


    :-))

    LMAO

    By Blogger uglybaldie, At December 14, 2005 2:22 pm  

  • It's ok. We are doctors, we of course understand how alopecia affects your psyche.

    Were you previously hairy? Must be tough on you.

    As a consolation, some women find bald sexy though. Having luck on that front? :)

    By Blogger Dr Oz bloke, At December 14, 2005 2:36 pm  

  • Ha,

    come to think of it, in retrospect, I made the best of my "shortcoming". My plate is as shiny as Yul Brynner's. I have a ring in my left ear and sport tattoos on both my upper arms. No need for all those propecia shit.

    When I go to China, you don't know...

    They said I was the sexiest SOB that came out of a little country like Singapore.

    So in a way, I have turned adversity to advantage.

    You must be envious of my lifestyle huh?

    No work, no medico bullshit to read, go anywhere I please, do anything I like. In short, no worries man.

    Looking back at my photographs when I was younger, I wished I had been bald earlier.

    God as you know, works in wondrous ways.

    By Blogger uglybaldie, At December 14, 2005 3:20 pm  

  • Hmm uglybaldie are you confused?

    If it sounds so good why do you have to "go on an ego trip now and then to make up for the lack of hair. Please pardong...."

    ???

    By Blogger Dr Oz bloke, At December 14, 2005 4:32 pm  

  • Hi Bro.

    Just woke up from my afternoon siesta.

    The part about the ego trip? Just something to placate you and end the subject but since you brought up the sexy baldie comment, just couldn't resist the temptation to tell ya who I am and what I look like ;0

    Come to think of it, I should have picked my nick as sexybaldie instead of uglybaldie. At least more girls will visit my blog and view my profile. Funny how we view balding men as lacking in self confidence and ugly. And muslims as terrorists. There is a new term for it now. It's called profiling. At least that was my original perception too, that's why the ugly in baldie. I think I am going to change my nick and morph back into who I really am.......

    By Blogger uglybaldie, At December 14, 2005 6:26 pm  

  • Yeah sexybaldie really sounds good.

    You should change your nick. Uglybaldie is really just so derogatory.

    You should never do that to yourself. No matter how true it is, always have pride in yourself.

    Sexybaldie! Yeah!

    By Blogger Dr Oz bloke, At December 14, 2005 6:38 pm  

  • Uglybaldie: "I'd say that the pharmas are purely in this business of drugs for profits".

    -> As a company, yes, the profits as a means to survival. But why is this a problem? Will it be possible for these co to operate purely outta charity?

    A single drug entity will require billions of $; research and clinical trials. That is Y a new drug is relatively more expensive than those off patent, and Y a patent is granted to each new drug entity; for recovery of losses and profits.


    Dr Oz Bloke: "Even in this current time of bird flu risks, the pharmas are still standing their ground about their patents, profits and losses."

    -> If these big co like Roche has got funding in billions that cover their research/CT costs, then donating Tamiflu wouldnt be a pro.In the case of Roche's Tamiflu, their patent rights shld be respected. Threatening the co with the patent is unfair to the co. They had paid for and researched for the drug.

    "Strangely they control a lot more of the health care sector and costs than people realise. Yet when it comes to ethics, the charge is usually made against doctors, but not the pharmas. I feel that is unfair."

    -> Charges have been made agst pharm co, esp in US.

    With Pharm Co, their CTs and various impt data submitted to FDA and regulatory bodies are subjected to regulation. There are ethics to be observed with re to the way/ standards of CTs conducted and the integrity of data submitted.

    If a regulatory body approves the drug for marketing, den in terms of ethics, they wld have been 'approved', so to speak...

    The rest will be left to the professionals who are in contact with the public... eg pharmacists,doctors,nurses.


    "So then why do people get so angry when doctors earn money? Aren't we just following the world order?"
    -> Some doctors offer svcs and charge diff rates fr others. It is hard to judge the level of competence and experience etc of the doctor, and decide if the rates are 'ethical'. Ppl shld understand dat this cannot be homogenous/uniform.

    Just like how one experienced lawyer can charge higher den another less experienced one.

    Whether it is ethical for one doctor to charge a particular amt shld be left to the govt regulatory board to decide.

    Anyhow, anyone is free to enquire of the rates and decline tx if he wants.

    Uglybaldie:
    "The price you pay is the life you choose. In the case of the Pharma companies, very often, you don't have a choice because Dr. Quack says that taking this drug is your only chance of a normal life perhaps even survival..."

    For watever illnesses, I dun think anyone will tell a pt a particular drug is the only way to leading a normal life or survival. But I must say that frequently, for many illnesses, taking medications are better den not.

    A particular med approved for use shld demonstrate satisfactory efficacy for use...

    Perhaps U can trust yr doctor more now... They wouldnt tell U to take med for placebo effect.

    "Now it is no secret that doctors are nothing without medicine. So they will also use you as as a kind of genea pig to see whether the drug they administer to you works or not."

    Medicine is also an art. It uses more den medications... technology, the physicians own perceptions and judgements are also impt factors.

    In real life, human guinea pigs are unnecessary since during clinical trials, they wld have used all kinda trial animals they needed.

    Have U read and watched too much 'mad scientist' movies?? Have more faith in doctors!



    Drugged

    By Anonymous Anonymous, At December 14, 2005 8:14 pm  

  • "As a company, yes, the profits as a means to survival. But why is this a problem?"

    The problem is when a company allows the pursuit of profits to compromise patient safety, as is alleged of Merck now.

    "With Pharm Co, their CTs and various impt data submitted to FDA and regulatory bodies are subjected to regulation."

    FDA is now also accused of failing in its role in the Vioxx case:

    http://content.nejm.org/cgi/content/full/351/17/1707

    "Have more faith in doctors!"

    While uglybaldie had not been entirely accurate, he statements have an element of truth.

    We doctors didn't know Vioxx could cause cardiac death. We were told it was safe and we believed it because we trusted a system put in place to safeguard patients.

    I have prescribed COX-2 inhibitors in my practice. While I don't know if any of my patients have died from using them, it still makes me feel used.

    By Blogger angry doc, At December 14, 2005 8:32 pm  

  • Dr. Angry,

    Even if complications to your patients developed after you prescribed the dud, you needn't have to worry too much about it.

    Remember, we are in Singapore. No singaporean, as far as I know has joined a class action against Vioxx.

    Why? Because our population aren't very educated in medical matters, specifically their rights against doctors, pharma companies and assorted villians selling snake oil to them.

    The fellows who should be taking a lead, meaning CAS, don't seem to have any bite except noise.

    Often times, I have personally taken recalcitrant professionals and retailers to court instead of relying on the CAS to take action on my behalf as a consumer.

    By Blogger uglybaldie, At December 15, 2005 8:10 am  

  • "The problem is when a company allows the pursuit of profits to compromise patient safety, as is alleged of Merck now."

    Yes. This is one of the cases that illustrates the problem.
    There will always be crooks around...


    "FDA is now also accused of failing in its role in the Vioxx case"

    This is where the regulatory body fails in its vigilance and where 'individuals' fall thru' the loopholes in the system...


    "While uglybaldie had not been entirely accurate, he statements have an element of truth.

    We doctors didn't know Vioxx could cause cardiac death. We were told it was safe and we believed it because we trusted a system put in place to safeguard patients."
    Thats right... I agree that there are exceptions, and doctors arent always aware of the absolute truth.

    And some co used marketing techniques that can make their clinical data more impressive if taken at mere face value.

    To readers:
    It is impt to know that occurrences of 'unfortunate circumstances' shld be considered in context... members of the public shld be aware that these 'unfortunate events' are minorities and not distrust their doctors.

    Drugged

    By Anonymous Anonymous, At December 15, 2005 9:22 am  

  • uglybaldie wrote :"Often times, I have personally taken recalcitrant professionals and retailers to court instead of relying on the CAS to take action on my behalf as a consumer. "

    Wah you fierce ah?

    By Blogger Dr Oz bloke, At December 15, 2005 10:58 am  

  • Dear drugged,

    I think that the "in" thing in Singapore is to hate and distrust doctors.

    At least that's the general message I get from the newspapers in Singapore. Again a big reason is cos doctors don't bite back so it's safe to beat them up.

    We're not fierce like the stockbrokers! :P

    By Blogger Dr Oz bloke, At December 15, 2005 11:00 am  

  • Dr Oz Bloke,

    Guess this is the 'natural' progression of the media and society... Can U imagine local health professionals having to fight court cases like those in US? I wld really not want to see that state of litigations happening here.

    In recent times there had been an upward trend in reporting medical news (eg diseases, quack drs, ill pract) in local major newspapers. Guess thats wat our ppl are eager to read abt and also wat presses in other places are writing abt.

    There shld be free press. But not all kinda freedom in media...

    Hmm... doctors dun bite?? I think anyone with $ can bite back if they want.


    drugged

    By Anonymous Anonymous, At December 15, 2005 2:09 pm  

  • To annonymous,

    One exception is TOO MANY.

    Remember, we are talking about people's lives and we patients depend on you fellas to make an expert decision on our behalf because we are the ones ingesting the drugs. You should not be hookwinked by smooth talking pharma salesmen peddling snake oil.

    Frankly, if I were prescribed a dud, I would sue the doctor and the Pharma company severally and jointly because the possibilities of them being in cahorts with each other cannot be ruled out.

    To Dr. Angry,

    "We doctors didn't know Vioxx could cause cardiac death. We were told it was safe and we believed it because we trusted a system put in place to safeguard patients."

    This excuse is morally and professionally indefensible. If in doubt, err on the side of safety. Use something that has been proven through decades of known efficacy with benefits far outweighing the risks. Don't go for the fancy "wonder" drugs. Wait for the real "evidence" to roll in after a period of use before being sure of the risks. It is a known fact that any drug that works MUST have side effects. The question is WHAT.

    To Annonymous signing off as "drugged"

    Yeah, you're right, money bites alright. As it is, there isn't enough law suits against doctors here in Singapore. Most cases are arbitrated and settled out of court because patients do not want to sue the pants off these doctors. Call it Eastern values or whatever because we have been taught from young to minimize trouble instead of expanding it.

    By Blogger uglybaldie, At December 15, 2005 4:51 pm  

  • Uglybaldie wrote "Don't go for the fancy "wonder" drugs. Wait for the real "evidence" to roll in after a period of use before being sure of the risks. "

    Well the problem is that the "real evidence" probably does not exist.

    There is no such thing as a totally safe drug. You know that. Secondly with technological advancements, if you saw a doctor who only gave you drugs that have been around since the 1970s- early 1980s, would you be impressed?

    Probably not.

    I think in this instance it is important for patients to be educated to a certain extent. I am very cautious about proper use of medication, whether there is a real indication ot use them etc. If possible don't need to use any drugs!

    Unfortunately in Singapore the culture is very pill-popping happy. And patients can be besotten by a particular doctor's "brand" of medicine which they may have no idea what it is.

    Not everyone is as intellectual superior like you. You should call yourself Braniac. He's the guy who could give Superman a good fight just using his brains!

    By Blogger Dr Oz bloke, At December 16, 2005 1:49 pm  

  • To Uglybaldie:

    "This excuse is morally and professionally indefensible. If in doubt, err on the side of safety...Wait for the real "evidence" to roll in after a period of use before being sure of the risks."

    The Vioxx case is one case whereby the co had not been fully accountable to FDA.

    Hence, at the time of apporval, NO ONE (except the co itself) knows it can cause serious cardiovascular side effects.

    Alot of data comes fr trials that usually span 8-10 years.

    I must say that it is difficult for non-health professionals to understand Y physicians, pharmacists, nurses etc etc arent totally at fault when things go wrong...

    Drugged

    By Anonymous Anonymous, At December 16, 2005 2:50 pm  

  • Dr Oz Bloke,

    Farnie. Ive met more patients who absolutely detest popping pills den those U said. Often, I had to explain Y the amt of pills a day and encourage compliance.

    I guess its the level of optimism they have.

    When faced wif a no-cure disease, the amt of pills they hav to take (even if its not considered polypharm; >5 chronics) can be discouraging.

    drugged

    By Anonymous Anonymous, At December 16, 2005 2:55 pm  

  • Dear Drugged,

    you are a pharmacist if I guessed correctly?

    Perhaps one reason why your clients are reluctant to take the pills is because they have to pay extra for it? In the clinic sometimes the medicine is really really cheap (if you get what I mean?)

    But strangely enough I get patients who keep asking me "What no medicine? Nothing to take ar? Er cannot be lah. Should have some medicine for my farting problem right?"

    By Blogger Dr Oz bloke, At December 16, 2005 3:32 pm  

  • Dr Oz Bloke
    "Perhaps one reason why your clients are reluctant to take the pills is because they have to pay extra for it? In the clinic sometimes the medicine is really really cheap (if you get what I mean?)"

    I presume U meant the pharmacies sell drugs at higher prices den do clinics? "Extra" is uncalled for. They can always purchase meds fr hospitals/ polyclinics. No one is forcing em to buy fr pte pharmacies.

    I will not comment on prices of drugs sold in clinics.

    But for the case of govt polyclinics, there will be diff in prices for med sold in pte pharm and polyclinics becoz the govt subsidize certain drugs when pts receive tx at polyclinics.

    But honestly, the retail price of drugs are always reasonable in Singapore.

    It is also true that pill burden can be overbearing for some, esp those who are jobless and those who require chemotx. But there is always help.

    "But strangely enough I get patients who keep asking me "What no medicine? Nothing to take ar?""

    I know which grp of pts U are treating that'll respond that way... esp parents who insist on antibiotics for children.

    For inpatients who have chronic progressive illnesses like renal failure, they pop dozens of pills everyday.

    Its not only the price of the meds or that they have to purchase so much meds chronically, that cause them to be reluctant to take med.

    Many of the chronic meds they take are priced at less den 10cents each tab after subsidization.

    Illnesses affect the pt in many ways and Ive seen many pts who arent optimistic abt their conditions and expressed lack of faith in med/tx.

    drugged pharmacist in training

    By Anonymous Anonymous, At December 16, 2005 6:59 pm  

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