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Snowflakes and fingerprints

No two snowflakes or fingerprints are alike; the same is true of healthcare

There is something that snowflakes and fingerprints have in common. And that is that they have nothing in common. No two snowflakes or fingerprints are alike. They are all different. In other words, they possess heterogeneity.

The same is true of healthcare. No two patients are the same. And no two doctors are the same. And diseases are not the same. In fact, even those diseases that we think are the same are different. Cancer, as an example, is not a single disease. Cancer is, in fact, a bunch of different illnesses - each one with its own unique form of presentation, progression, manifestation and conclusion. And of course the drugs we use to treat these diseases are not the same. And the side effects of these drugs we use to treat these illnesses are not the same for these different patients. And the efficacy of these therapies for these different patients is not the same. And the implementation of health policies around the world is not the same. And patent laws around drug molecules are not the same around the world. And opinion on how we ought to pay for healthcare is not the same. And opinion on who ought to pay for healthcare is not the same. And the role of regulatory agencies in drug and device approvals is not the same across (m)any jurisdictions. 

So nothing about healthcare is really the 'same'. And yet we act like it is. Or at least that's what it seems like to me. We act like there is a hand-in-glove solution to everything that ails the modern day health system. Don't let all this talk about precision medicine fool you. We talk about cookie cutter solutions. Every company is chasing the same Holy Grail at the core of its drug development pipeline. Every insurance company offers indistinguishable variations between its insurance plans. Every marketing campaign focuses on the same 'pillars.' Every doctor and allied healthcare practitioner talks about the same ailments (overworked, underpaid, over-regulated and under-resourced). Every policy wonk talks about the same levers that need to be pulled (access, cost, equity). Every politician and presidential wannabe promising untold riches directs us to healthcare as part of their pre-election promise (only to realise that the accounting for what they promised is impossible). And the band marches on.

Opinion on how we ought to pay for healthcare is not the same, [nor is] opinion on who ought to pay

We're stuck talking about (with rare exception) the same things we did 20, 30 and 40 years ago when it came to healthcare. How are we going to pay for all of this? Are we training enough doctors? Or training them the right way? Are insurance companies finding new ways to shift costs to the employers or to patients?  How do we maintain a level of innovation that encourages drug companies to discover new drugs? Are patent laws too strict? How do we motivate patients to increase their compliance?

The degree of some of these issues has changed over the last generation. Some have waxed in importance. Some have waned. But they're all still very much present. And, to be sure, there are new problems too. Don't let management buzzwords like 'disruption' fool you either. New drugs have been launched and new health policies implemented but they have not been disruptions. They are what I call localised eruptions. They are felt but not widely. Disruptions impact in an 'end-to-end' manner. Launching a new hepatitis C medication that effectively cures a disease only to have it priced out of reach of the vast majority of patients or to have insurance companies or pharmacy benefits managers restrict its listing and usage is not a disruption.

So, let's review. Nothing in healthcare is really the same (even though we think and act as though it might be). And nothing in healthcare problem-wise has really changed (even though we think and act as though it has). And then when we have a solution, we tout it as 'disruptive' (even though it's nothing more than a localised eruption that is narrow in focus and effect). Sounds depressing doesn't it? Actually it's not. It's quite liberating actually. Because the answer is right in front of us. Affordability of patented medicines is a problem you say? OK, why not different drug prices based on household incomes? Patent law? How about different patent laws for different classes of drugs?  Nobody looks for identical snowflakes or fingerprints. We simply accept that there are none.  Maybe we ought to accept that the solution to our healthcare problems is that there is no single solution to our healthcare problems. And then we can get on with it.

Article by
Rohit Khanna

19th September 2016

From: Healthcare



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