Well, we're boned
Jun. 15th, 2011 10:46 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
pktechgirlbackupIf it were up to me, the FDA would be run completely differently. For one thing, I really don't care how much pain medicine you take. I would allow adults to purchase heroin over the counter. Chemo? Well, I don't recommend taking it without a doctor's prescription, but sure, knock yourself out. And this whole drug approval process is insane: to get approval, you have to prove your drug is strictly better than other drugs in the class on the market. This is stupid. Humans are highly variable, just because something is worse on average doesn't mean it's not The Drug for one particular person- I'm eternally grateful for the fact that 3 or 4 different allergy drugs went on the market at the same time, because I built up an immunity to each of them in a year or two. At my peak I was taking three and my allergies still weren't under control (the eventual solution turned out to be non-pharmaceutical). If the FDA had only approved the best in class drug, I literally may not have been able to finish high school; my allergies were that bad. And I'll decide if the pain relief I get from Vioxx is worth the potential heart attack, thank you very much*.
The FDA doesn't even do what it does very well. Did you know you don't submit a study to the FDA until after it's complete? So you can just not report a particular study and it doesn't count. What the fuck? If my world, the FDA would by and large be a data collection agency: the drug companies would register their studies before they even started, and report the results at the end. The FDA would collate those results to make them accessible to doctors, possibly also providing comparisons to similar drugs, and let doctors and patients make informed decisions.
But the FDA's real failure is in antibiotics. A government agency tasked with controlling access to drugs doesn't give a fuck about the overuse of the only drugs that have genuine negative externalities. And it's going to kill us if they don't stop.
That's probably alarmist. There are many decision points between now and death by superbug. We've gotten lazy about hygiene in the absence of insects and the presence of antibiotics. But the FDA's priorities are so very wrong in this case.
The solution isn't actually obvious though. As long as doctors are the gatekeepers, they have an incentive to give antibiotics to patients with viral infections to make them shut up. You could make them more expensive, but the middle class and above won't notice unless you make very specific laws about the insurance, and it has obvious repercussions for the poor. My usual answer to issues like that is "price things appropriately and give the poor more money", and maybe that works in this case too (antibiotic use has a negative externality, so it is good candidate for taxation), but it's not the same as a gas tax. You can force people to get N sick before giving them antibiotics, but that might actually make the problem worse. Ditto for making people afraid of superbugs- they'll ask for stronger antibiotics before they stop taking them needlessly.
The fact that most viable option I can think of is lacing antibiotics with something with unpleasant side effects is not a good sign. On the other hand, there is precedent: vicodin has ibuprofin in it not for the theraputic effects, but to give you liver damage if you take too much. Thanks FDA.
The FDA doesn't even do what it does very well. Did you know you don't submit a study to the FDA until after it's complete? So you can just not report a particular study and it doesn't count. What the fuck? If my world, the FDA would by and large be a data collection agency: the drug companies would register their studies before they even started, and report the results at the end. The FDA would collate those results to make them accessible to doctors, possibly also providing comparisons to similar drugs, and let doctors and patients make informed decisions.
But the FDA's real failure is in antibiotics. A government agency tasked with controlling access to drugs doesn't give a fuck about the overuse of the only drugs that have genuine negative externalities. And it's going to kill us if they don't stop.
That's probably alarmist. There are many decision points between now and death by superbug. We've gotten lazy about hygiene in the absence of insects and the presence of antibiotics. But the FDA's priorities are so very wrong in this case.
The solution isn't actually obvious though. As long as doctors are the gatekeepers, they have an incentive to give antibiotics to patients with viral infections to make them shut up. You could make them more expensive, but the middle class and above won't notice unless you make very specific laws about the insurance, and it has obvious repercussions for the poor. My usual answer to issues like that is "price things appropriately and give the poor more money", and maybe that works in this case too (antibiotic use has a negative externality, so it is good candidate for taxation), but it's not the same as a gas tax. You can force people to get N sick before giving them antibiotics, but that might actually make the problem worse. Ditto for making people afraid of superbugs- they'll ask for stronger antibiotics before they stop taking them needlessly.
The fact that most viable option I can think of is lacing antibiotics with something with unpleasant side effects is not a good sign. On the other hand, there is precedent: vicodin has ibuprofin in it not for the theraputic effects, but to give you liver damage if you take too much. Thanks FDA.
