tclAmockingbird

This sort of hostility is why I keep quitting this damned site. Thanks for reminding me.

Medical Science Liaison

> There are many very cheap ways of keeping physicians up-to date, such as a conference presentation of the drug, followed by a Q&A session, with a recording freely available online.

5 minutes of face time with a busy physician and supplying them with a useful article targeted to their specific needs can be far more effective.

> Which are covered in the already mentioned 20% that goes to R&D (source pending). Are you purposefully ignoring information you dislike?

The dev part was an honest error while I was editing, and I don't think the accusation is called for. Regulatory costs, and I think of quality also being in that group, is not an R&D cost and is substantial.

> FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing.

MSLs have advanced degrees in medicine or biomedical research. It's preferred that the traditional sales reps now have bachelor's degrees in the sciences and it is expected that, within the narrow scope of their product's science, they be well-informed regardless of prior academic background. It's preferred because they are more effective reps.

> You can't expect to get unbiased, quality advice from someone with such a strong incentive. The right way for doctors to stay up to date is for doctors to stay up to date! They need to read a damn book or journal article once in a while and takes responsibility for their own professional development. If doctors aren't doing that, regulators need to suspend their licenses.

Continuing medical education is a requirement to maintain licensure. I don't think I get your point here.

> > And no, the sales and marketing in that article is not advertising alone. It's mostly sales people who go and visit medical professionals to talk about their products.

> That's advertising.

It's also keeping physicians up to date on the current science, applicability, and best practices of their products. I think it's a good thing for sales reps and MSLs to inform or remind physicians that there are alternatives to writing a script for Epipens, for example.

> You mentioned 20% of their revenue is R&D - do you have a source, ideally listing what the other 80% goes to? That's a lot of unaccounted revenue, especially given how many drugs were shown to be dirt cheap to manufacture.

Many drugs are cheap to make, but that neglects the astronomical development and regulatory costs.

> So, since 2012 this is now a requirement.

It was a requirement before the Leahy-Smith America Invents Act, which is what is meant by "pre-AIA". You stated that "'best mode' is not a requirement for a patent at all" which was incorrect pre-AIA and remains incorrect in the AIA era. Disclosure of best mode remains a statutory requirement, even though it now lacks enforcement.

Your citation is of MPEP 2165, which is what I had referenced earlier. Thank you for sharing a direct link for others to review.

> The 'best mode' is not a requirement for a patent at all, you either have something patentable, or you do not

Disclosing the best mode in the specification of an application is a requirement, pre-AIA and now: see MPEP 2165.

> I would not be surprised if others in their respective fields take a similar approach in other cult of personality topics (Uber, Elon, Apple, etc.).

I no longer read the comments for things relating to medical testing, my professional field, and I try my best to avoid medicine generally.

It to me feels like many commenters are somewhat clueless on the topic, and many others have strongly held opinions that lack foundation. It's a frustrating environment to comment within: it takes a lot of energy to write a thoughtful comment that can fill in missing domain knowledge for an earnest reader, and subsequently demoralizing to have a popular frequent poster on this website to dismiss my comment with snark because they consider themselves to be informed in this area. My comments became gray. I deleted the password to my account when that happened and rarely post since, the frustration is not worthwhile.

Some who are vaccinated will still contract the disease. Some cannot be safely vaccinated because of preexisting medical conditions. For both groups, herd immunity provides additional protection; herd immunity is frustrated by those who choose to not vaccinate.

Yes, in my relative's case (being peds) it is Medicaid.

It's a really frustrating thing, as a physician you want to treat everyone, but accepting Medicare and Medicaid can really hurt the operation of your business.

Physician and staff salaries (outside of staff to manage insurance companies) are not what drive increasing medical costs. Most physicians don't make that much money, all things considered.

An insurer last month for a relative's pediatrics practice announced that they were having difficulties with their accounting system and so they would only be making a half payment on their outstanding AR (and naturally, they announced this problem right before the payment was due to be sent). My relative's practice has no practical recourse other than to wait for the full payment to be sent. This is not an uncommon occurrence. My relative's practice is regrettably not able to use the same argument for their bills that are due.

It costs my relative money to administer vaccines in their peds practice, i.e., most insurances pay less than what it costs to purchase and give the vaccine. My relative continues to offer many vaccines at a loss because they believe vaccines are one of medicine's greatest gifts and because they have good success in persuading unsure parents to vaccinate their children. From a pure numbers perspective, it is a mistake.

Insurance companies not paying physicians on time as agreed drives up costs. Insurance (Medicaid included) not paying what it actually costs for a procedure drives up costs. Insurance companies arguing against the best course of treatment for a patient, requiring additional staff to be hired in order to deal with the pushback, drives up costs.

Do you believe that you have or can quickly acquire the specialized domain knowledge and experience necessary to accuately describe your conditions for the expert system? Do you think you can sufficiently document your findings in your medical record? Do you foresee any problems in occupying both the patient and diagnostician role?

Automated triage systems are already used at intake for urgent care clinics. They suck, partly because GIGO.

One point not yet mentioned is that the Ferrari shape is assisted by the engine placement and drive configuration. A front-engine and front-drive Hyundai has too much packaged under the hood to shape similar to a Ferrari.

When you do your write-up, I'd be interested to hear more about the mismatch between what you thought your clients wanted and what their eventual actions demonstrated they wanted. Could this mismatch have been detected in the early planning of the company?

The US has stricter emission limits for NOx than Europe, which are difficult to meet with diesels given locally available fuels. Meeting the limits in the US tends to require adding onboard treatment systems, increasing initial purchase and recurring costs. The diesel engine is also more expensive here. Basically, it's frequently not cost effective.

The federal tax rebate is likely to phase out over the course of the Model 3 introduction: it isn't a given that the effective pricing will be be similar. It's also premature to compare pricing without the Model 3 specifications.

This might be a good starting place, "Software Patents: A One-Year Review of Alice v. CLS Bank" (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2619388)