Arnold Kling  

Consumer Reports and the FDA

Martyrs and Gamers... Probability and Medicine...

Alex Tabarrok writes,

The FDA currently works on a paternalistic model: One choice to rule them all. But another approach, what I call the Consumer Reports model, would meet the needs of diverse health-care consumers much better. Consumer Reports doesn’t try to replace consumer choice. Instead, by carefully evaluating and testing new products and providing this information to readers, Consumer Reports helps consumers to make better choices.

For Discussion. Could the same approach be taken with regard to practicing medicine? That is, could someone who has not completed medical school be allowed to practice, as long as consumers are informed of that fact?

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COMMENTS (15 to date)
Randy writes:

This is happening now. I have on several occasions consulted the web instead of, or in addition to, a doctor. I have also taken actions as a direct result of web information. I am, in effect, practicing medicine without a license.

I estimate that 90% of medical practice consists of, "diet and exercise" or, "rest in bed, drink plenty of fluids, and take aspirin". I know that I still need trained professionals for the 10%, but they are way to expensive for the 90%. I don't think I'm alone now, and I expect the number to increase as the cost of health care rises.

jason writes:

of course- look at current practice. how many times does one have a doctor's appointment, and see only with the physician's assistant? answer: most of the time. and that doesn't even touch on chiropractors, physical therapists, nurse practitioners, herbalists, etc.; none of whom has a medical doctorate (MD). the AMA is one of (if not the) most successful supply-limiting unions in existence. as with every union, monopoly rent is its primary (and always unstated) purpose.

to add to the previous comment: "unlicensed" mothers medicate their children all the time. they treat injuries, colds, and myriad other infirmities. children have no control over their mothers' treatment decisions, so are we now justified in requiring any woman who wants to have a child to first earn a medical degree?

akatsuki writes:

But the reasons you are seeing PAs and such has nothing to do with consumer choice, rather it has a lot more to do with cost-cutting and cheapening of care. Don't think for a second you are getting near the same level of care. The Consumer Reports model is your typical naive perfect-information, rational-actor model which would never happen. It ignores a rights model that most American's think of as a core value.

jason writes:

that's exactly the point. because the supply of medical care is so strictly limited, these pseudo-black market treatment options have become unavoidable. "cost-cutting" measures always arise when the product or service is rendered artificially expensive by government supported monopoly.

do you assume perfect information when you see an MD? are they not humans? doctors are no more omnipotent or infallible than anyone else, and coercing every patient who desires to purchase treatment to pay for an AMA aproved medical provider runs afoul of any sensible "rights model". in principle, you insist on forcing everyone into a medical mercedes when a medical toyota might fit their needs (and budgets)better.

Milton Friedman used to tell the story of a speech he'd given to a group of MDs, in which he analogized that laws prohibiting unlicensed people from practicing medicine were like passing laws that the only cars allowed to be sold be Cadillacs. Thinking that his point would be very obvious.

Sure enough, the first time he used it, some physician responded: "Yes, that's right we can't have poor quality Chevrolets for medicine."

Al writes:

akatsuki mentions a rights model. In this context, what rights? whose rights? There is no such thing as a "right" to medical care--that would require enslavement of medical professionals (which is precisely the point of socialized medicine). Like many essentials of our lives, we may need various things, but the only rights we have are the liberty to pursue them.

Paddy Mullen writes:

We don't have a "right" to medical care. We do have a right to freely enter into contracts with who ever we want to, to provide what ever service we want to recieve. Well unless we want to recieve medical care I guess.

Mr. Econotarian writes:

I use the FDA in that way. Basic safety tests on the drug domperidone were performed for the FDA. However, the FDA never engaged with the manufacturer in the proper efficacy tests for an illness, thus domperidone was not approved for use in the US.

I performed my own efficacy tests on the subject of interest (my wife), and it worked. So we order it from offshore.

Domperidone shows the problem with FDA efficacy tests. The drug was tested for gastroparesis, specifically to enhance intestinal motility (gastroparesis implies lowered intestinal motility). It did not work. But it turns out that the most disabling effects of gastroparesis (continuous, horrific nausea) were later shown to be unrelated with degree of reduced gastrointestinal motility.

Moreover, every individual with gastroparesis appears to respond differently to a wide range of anti-emetic and pro-motilic drugs. It turns out that domperidone was right for my wife, but other people with gastroparesis do better on other drugs.

Meanwhile, the manufacturer is too scared to take domperidone back to the FDA, because they fear that any further negative results could result in a ripple effect of the drug being pulled by regulators worldwide.

Ashish writes:

Sometimes Consumer Reports does a better job than the Govt. agency charged with job. The consumer search report mentions that NTHSA does not do crash testing for Child seats but consumer report does.

jason writes:

tangentially, that's part of the problem. people treat doctors (and they in turn expect to be treated) as if they are sorcerers or deities instead of people. that reverence aggravates the "medical cadillac" problem because even patients buy into the ridiculous assertion that only certain special magicians are capable of learning about human anatomy and how to care for it.

although, if it's true, i guess that would explain why the AMA has not felt the need to accredit hardly any new med schools in the last 20 or 30 years.

jason writes:

sorry, my last comment addressed comment #5.

Lancelot Finn writes:

I thought this joke might be apropos:

Q: What do you call the person who finished last in his graduating class at medical school?

A: "Doctor."

Dan Boyd writes:
Consumer Reports helps consumers to make better choices.

place the following sentence bewteen Reports and consumers,
...,are used as a subtle brainwashing technique that,...

That is, if FDA will write those reports.

alasdair writes:

It would be nice, but ...
I think the problem with the CR analogy is that it is based on a model that addresses relatively simple objects for which relatively objective measures can convey useful information to a potential customer. Applying this to medical care raises the question (not well posed in the original post) is it the provider of the care that is being rated (doctor, nurse, whatever) or the treatment being provided (surgery, pharmaceutical intervention, other). CR reports on providers seems unlikely to be that useful. Getting reliable reports is likely to be fraught with difficulties. Good examples might be - Does anyone know a person with a bad dentist, the complete unreliability of student evaluations of teachers, and the inability to get letters of reference that convey useful evaluations of a persons abilities. Presumably it will be possible to get to the same point with medical care, but there is relatively little care that can be approached the same way at this point. One example might be the fiasco of dietary recommendations and diet plans that help people loose weight. The absence of any consensus of what works and why it works, other than the vaguest guidelines, and the inability to prevent nonobjective reports on fad diets becoming part of the gossip gospel suggests we are a long way from being able to create a useful market for medical care information.

nmg writes:

It practically self evident that the FDA should be abolished. It does little more than punish consumers.


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