Anyone working in healthcare will be all too familiar with the definition of malpractice. However, a phrase appearing in a recent article in the New York Times -- economic malpractice -- caught me by surprise (see: Cutting Dosage of Costly Drug Spurs a Debate). I thought that it would be worthwhile to explore the meaning of this phrase and some of the implications for lab professionals. Below is an excerpt from the article (boldface emphasis mine):
...Cerezyme is used to treat a rare inherited enzyme deficiency called Gaucher disease. Some experts say that for most patients, as little as one-fourth the standard top dose would work, saving the health care system more than $200,000 a year per Gaucher patient. “It is economic malpractice to give a much higher dose of an expensive drug than is required,” said Dr. Ernest Beutler, an authority on Gaucher disease at the Scripps Research Institute.... But all sides agree on one thing. “Nobody would even be wasting their time talking about this if it were a cheap drug,” said [another physician], In that sense, the dispute over Cerezyme could be a sign of the increased scrutiny that dosing will receive as drugs become more expensive. Pharmaceutical companies have faced complaints for years over prices, but now they might have to defuse efforts to use less of their drugs to cut costs, and to rebut accusations that doses are inflated to bolster profits....With Cerezyme, which is made by Genzyme, the profits are sizable. Gaucher disease, which can have complications like ruined joints, is rare; only about 1,500 people in the United States are on the drug and about 5,000 worldwide. Sales of Cerezyme totaled $1.1 billion last year, making it a blockbuster by industry standards.
I have a premonition that the term economic malpractice will become more common with regard to all of healthcare although the current target is the drug companies. Perhaps because of naiveté, I have always assumed that appropriate drug dosages were determined by scientific methods and medical research. However, I now fully understand that attention to the bottom line may cause the pharmaceutical company scientists and physicians to tweak the recommended drug dosages upward.
When I read this article, my thoughts did drift toward the general topic of inappropriate use of resources by physicians. Although articles commonly appear about unnecessary lab test ordering by physicians, most such criticism tends to stay submerged. The reason for this is that the cost of lab tests is relatively minor compared to the yearly cost of, say, some biotech drugs. However, this attitude is rapidly changing due to the rising co-payments for lab tests. Also, the cost of some of the newer esoteric genomic and proteomic tests can be substantial. That's why Myriad, the company that offers BRCA testing, provides a risk calculator on its corporate web site to determine which patients are most suitable for the test.
Economic malpractice may be a charge leveled in the future against clinicians for their lab test ordering practices. In anticipation of this, lab professionals need to provide clinicians with better tools to assess the need for various lab tests at the time of test ordering. I have discussed ways that this can be accomplished in previous notes about the use of algorithms to guide clinicians in appropriate lab test ordering (see: ARUP Offers Lab Algorithms for Disease Diagnosis Support; Static Versus Dynamic Lab Test Selection Algorithms).
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