Obviously Woken up on...

[longhoc]

... the wrong side of bed this morning. It's just that I've got a nagging sense of unease that I'd like to get off my chest by writing it here. How do I start ? Okay... here goes...

Most people have never heard of a chap called George Akerlof (http://en.wikipedia.org/wiki/George_Akerlof). Some people might though have heard of “lemons” when applied to the used (or even new!) car market. For those not familiar with Akerlof’s work, a “market for lemons” can occur when consumers are unable to distinguish product quality. The used car market is the ripe for such practices, since the dealer has a much better idea than the buyer of whether a particular car is any good. Unscrupulous rouge dealers can dump a lot of hapless customers with overpriced bangers. However, as crooked car sellers become more common, buyers wise up a bit and are no longer willing to pay as much for cars they cannot evaluate. So while the prices buyers are now willing to pay are probably still too high for dodgy motors, they are too low for the decent cars. People with good cars to sell start to look for other channels. Akerlof suggests that the market will eventually fall apart and need to be replaced by another system of distribution.

Note that used cars dealers did not set out to create lemons; the cars were bad deals by being overpriced and their benefits not being what they claimed to be (presumably, if they had been presented, warts and all, they still would have found purchasers, also presumably people who thought they could repair them and those who wanted them for parts and scrap).

I know very little about medicine and the pharmaceutical industry. But I do know a great deal about risk, specifically investment risk, and its causes. I try to apply what I know to what I don’t. And I sometimes get quite concerned that we who are looking for treatment for our Keratoconus might end up being susceptible to making a potential “bad investment” in our treatment choices – or, worse, even mis-sold.

The reason we might be at risk is that it is conceivable that the organisations we touch (private companies offering treatment, suppliers of medical devices, the NHS), are – like any other organisations – potentially subject to bad incentives, information asymmetry, and even corporate predatory behaviour.

This could result from the systematic exploitation of monopoly rights by a supplier of a treatment and the production of partial, biased information about the efficacy and safety of new drugs or procedures. Companies could design and run their clinical trials to minimise evidence that their treatments cause adverse reactions and maximise evidence that they are not inferior to or are better than a sham-procedure for the target indication. And companies will also learn from the regulatory bodies and statutory approvers (e.g. NIHCE) how to rig the system to ensure accelerated approvals and conditional approvals with studies by cutting corners and submitting partial evidence in order to get procedures approved faster and put the regulator under pressure to approve and not to later rescind that approval.

Which is my usual long-winded way of saying “be careful when considering what is your best treatment option”. And we should really try to become educated consumers.

I’m not deliberately trying to be negative here. I’m all for genuinely improved treatments for Keratoconus. It’s only that I do want them to be just that – genuine improvements. The danger for us is that we might latch onto something that isn’t. As I always find when I’m down the supermarket… “hungry people make poor shoppers”.

Chris

[Andrew MacLean]

With far greater eloquence than I, you make a point to which I have returned often within these pages. Just because something has a high price tag does not mean that it will be effective, or that it is even necessary.

Andrew

[mikkey3023]

Excellent post , could not agree more ... to sum it up , consumerism taking over in this day and age , everything over inflated especially where i live in London, when it comes to health this shouldnt be the case , but unfortunately now there are more private hospitals than NHS hospitals , like Andrew says , because its more expensive doesnt make it better . It is all down to marketing and profit for shareholders of companies in all walks of life .
Take for example GPs giving out certain brands of medicines , all the same products , just sold by different pharmacutical companies.
In my opinion Kerataconus isnt funded properly by the NHS as they are well aware that private medicine are in on the act and now have as much treatment and information on Kerataconus as the NHS , unfortunately its all about choice these days , nobody had the choice though when they discovered they had Keratoconus did they though ..