This is especially true for providers who aren't running the tests in-house. If your doctor takes a test and sends it out to an external lab like LabCorp, who is responsible if the complete process takes more than 24 hours?
In reality, your doctor would simply stop testing for Coronavirus and instead refer you to a LabCorp collection center, where they could keep you waiting in line until they had enough testing capacity to take your sample and start the 24-hour clock. Everyone loses.
Not to mention all of effort required to retool billing and accounting systems to account for time-based costing. This alone would drive the cost of testing upward by huge amounts. Or more realistically, providers would simply not offer tests unless patients paid in cash to avoid this mess.
This is a great example of how regulation can end up making the situation worse, despite good intentions.
This kind of sounds like a semi-win. Eliminate the middle man between the patient and the lab. Provide visible backpressure by refusing to accept requests that can't be serviced in a timely fashion, allowing those requests that are serviced to be timely.
It doesn't help the problem of more demand for tests than supply of testing (or at least, not directly). But it's better to have all (or substantially all) results in 24 hours, than to have all results in a pipeline for a week.
Also, maybe start at 48 hours, if 24 hours is too restrictive.
What worries me is this may be decades away.
> What worries me is this may be decades away.
First the good news: That day is here!!
Now the bad news: that medication isn't working out great for them. Apparently some wingnut told people that drinking bleach was a potential cure for some ills. Didn't go great.
And thats the problem with what you wish for - a popular facebooker, youtuber, instagrammer, president tells people that they can design their own medication, people are going to do it.
There one example
It lead to actual problems of US American citizens ingesting/consuming bleach which forced government agencies to put out warnings: https://www.forbes.com/sites/nicholasreimann/2020/08/24/some...
Never once does he mention the word 'bleach'. He uses the terms UV light and disinfectant. But I guess using disinfectant, to the average American reader, is synonymous with literally injecting bleach into your body or guzzling it down your throat...
Remember when NPR came out with this article entitled: "No, You Don't Need To Disinfect Your Groceries", and the media was outraged because millions of Americans were dumb enough to start soaking their food in bleach? Yeah, me neither.
https://www.npr.org/sections/health-shots/2020/04/12/8322692...
Interestingly, looks like he was right about it anyway:
https://www.nbcnews.com/nightly-news/video/using-uv-light-to...
Quackery is much easier than actual medicine. Quacks don't have to spend anything on R&D and quack medicines are a lot easier to manufacture (look up the synthesis pathways for popular pharmaceuticals!), and this means quacks can spend more on marketing and operate with much higher margins. This translates into a huge market advantage. Pretty soon you'll have nothing but quacks.
Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals.
"Do your own research" doesn't work at all in medicine unless you have a billion dollars burning a hole in your pocket and can assemble your own research lab. Excluding emergency medicine and the most instantly and dramatically effective drugs, it's really hard as an individual consumer of health care to tell whether a treatment is working over the short term. Check out gwern.net and how much work he's put into trying to tell if various nootropics work and how much uncertainty remains.
The fact that individual discernment is so hard in medicine means defrauding people is incredibly easy. It's a market that is inherently vulnerable to massive fraud, and there is no easy way (that we know of) to fix this. Even with the FDA there is still a tremendous amount of quackery. Without the FDA and strict licensing and supervision there would be only quackery.
BTW news seems to suffer from a similar problem. Actual investigative journalism is expensive, hard, and sometimes dangerous. (Old PI joke: How do you know if a conspiracy theorist might be right? They are missing and presumed dead.) Fake news is cheap and easy, and since it's fake you can craft your stories for maximum click bait appeal without having to be limited by pesky "reality" and "honesty" constraints. The reader meanwhile has neither the time nor the ability nor the expertise to really fact check anything.
In general markets where the consumer is unable or unwilling to discern tend to be flooded with and overcome by fraud.
It's extreme but not unique. Do you know what's running in any of your devices? Almost not, I believe. Yesterday I had the pleasure of needing to copy some medical reports of mine on a multipurpose printer I own. I shortly gave it a pause being not sure whether the contents would be sent immediately to the mothership. I then realized that when the printer was set up initially that I set up the router to prevent calls to the outside for this machine. But: although I configured the router, I would need to go to great lengths to actually verify that the printer can't phone home.
And don't get me started about quality (as in endurance and serviceability). It's a nightmare as price is not a deciding factor in my experience. Neither is brand.
Is that web cam sending pics of you to China? Is your fridge listening to your private conversations? Is your printer sending confidential PII to a poorly secured server somewhere? Is your car tracking you and selling the info to insurance companies? Is your home security device allowing a stalker to watch your every move?
It's pretty hard to answer any of those questions unless you are a security researcher with deep understanding of network protocols and systems and a good deal of time on your hands.
Right now most of the necessary equipment is siloed in research institutions and hospitals.
It seems medical quackery gets a disproportionate platform, I think in an attempt to educate people about how dangerous it can be. But go look online or even in a brick and mortar store: there's plenty of stuff designed to take your money that won't improve your life.
Yes, many more quacks would advertise services.
> Quackery is much easier than actual medicine. Quacks don't have to spend anything on R&D and quack medicines are a lot easier to manufacture (look up the synthesis pathways for popular pharmaceuticals!), so they can spend more on marketing and operate with much higher margins.
Good point!
> Pretty soon there will be little legitimate medicine left in the market.
I'm not so sure. Even the canonical example of this phenomenon, Gresham's Law, requires legal tender laws or some similar mechanism which requires the acceptance of the "bad" money on par with "good" money. It's not clear that a requirement would happen in laissez-faire medicine.
> Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals. > > "Do your own research" doesn't work at all in medicine unless you have a billion dollars burning a hole in your pocket and can assemble your own research lab. Excluding emergency medicine and the most instantly and dramatically effective drugs, it's really hard as an individual consumer of health care to tell whether a treatment is working over the short term. Check out gwern.net and how much work he's put into trying to tell if various nootropics work and how much uncertainty remains.
Agree. "Do your own research" in medicine doesn't work very well for a host of reasons. Chief among them: physicians don't understand the complexity of the body as a system. Microbiologists don't even understand the complexity of a single cell. We (humans) understand human life in certain aspects, and it's remarkable what competent physicians can do with the knowledge they do have. But if even they have no idea what is going on beyond essentially sophisticated educated guess-and-check, what hope does the layperson have?
> The fact that individual discernment is so hard in medicine means defrauding people is incredibly easy. It's a market that is inherently vulnerable to massive fraud, and there is no easy way (that we know of) to fix this. Even with the FDA there is still a tremendous amount of quackery. Without the FDA and strict licensing and supervision there would be only quackery.
I'm not sure the FDA is the only way. We could have stronger laws that punish fraud in civil court, or make practitioners liable financially (or in severe cases, criminally) for ineffective or harmful treatments. Things like the Internet make the information problems less daunting than in the bad old days of patent medicine salespeople roaming from town to town (though today we have unregulated MLMs).
I also think that the regulation to which I refer is much broader than simply FDA regulation. Billing, electronic records, purchasing, distribution of medical equipment, pharmaceutical distribution, laboratory testing and just about everything else in the US medical system are regulated beyond belief. Many of these regulations were introduced with the goal of "improving efficiency," and have instead resulted in protected, rent-seeking firms with zero gains in efficiency. They've resulted in the death of the private practice, and have siloed practitioners into Kafkaesque organizations, each of which is a single point of failure.
I'm skeptical that the FDA should do much beyond determining the safety of treatments, but there is a host of other regulatory nonsense in health care that could be innovated around, including many of the things GP was talking about.
There are of course also conspiracies that your brain gets damaged from the test...
His idea that no one should be paid for a test result if it takes more than 24 hours to result is not bad, but the existing system is not set up for it. Decades of regulation of all aspects of the US medical system, from billing codes even to electronic health records, would prevent that kind of change from being adopted overnight. If we adopted this change, you'd very likely see almost no one running any COVID tests at all - the risk and infrastructure investment would be too high, for too little payout. (Recouping the cost of lab tests is generally hard as is, since the costs of running a medical lab are almost entirely fixed, both in terms of labor and capital. Routine maintenance must be performed, the lab must have a certain contingent on duty to handle stat tests, etc.)
I'm not sure the US system can be improved unless we have some practitioners who want to make a clean break from the existing regime, and they get some cover from the government to actually innovate. I'm not holding my breath.