patrick.net

curious2 says

This pattern has been so widely reported for so long that I wonder how long it's been since you've been in this country.

What pattern do you see here exactly? There are 3 reports that there are doctors are paid to speak for drug companies. So what, shilling for the drug companies isn't prescribing to patients. I notice any mention of the number of doctors involved is very lacking. There aren't a lot and I've never met one. The hhs report is from 1991 for christ sakes. Almost everything mentioned in it hasn't been allowed for 10 years or more. Try to focus on what is actually happening in today's world, not what happened 2 decades ago. The other 2 are about how drug companies data mine to make more focused pitches to doctors. That's news? Drug companies are marketing, shocking to hear that I tell you, just shocking. So how does any of this relate to your concept of profitable prescribing? Where in any of this does it show what doctors prescribe has any affect what they earn?

curious2 says

The #1 complaint of general practitioners is patients lying to get prescriptions for drugs they saw on TV but that would be bad for them.

Ding, ding, ding. Wow, you finally got a winner after all that. Yes THE BIGGEST PROBLEM is drug companies advertising to consumers. It should have never been allowed. Patients demand what they have seen advertised. Doctors go along if it isn't counterproductive. Why not, patients are the customer. If they want to spend a lot on drugs that won't do any better job than cheaper drugs then that's their right. This goes directly against your assertion that doctors are forcing expensive pharma on poor unwilling uninformed patients to line their pockets. What you are saying is patients are sophisticated enough to mis describe their symptoms to get expensive drugs they want because they saw them advertised, but are so unsophisticated they can't say hey doc could you to prescribe a generic if they want to pay less. Which is it, you can't have it both ways.

So again how does this amount to profitable prescribing? Where is the profit for the doctor in any of this short of owning pharma stock or working for a drug company? I used to do a lot of practice management/accounting work and I don't understand how it's done. Explain the accounting ins and outs of "profitable prescribing" in an average practice to me instead of throwing up a lot of basically irrelevant articles. Debits and credits I understand.

Sorry I missed the part where you talked about how you acquired all your extensive day to day experience in the operation of physicians practices. Could you post it again perhaps.

Since you are so curious, I've been overseas 5 years. As hard as it is for the average American to understand even in the wilds of uncivilized countries like NZ there is mail service, phones, emails, even "gasp" internet. Even harder to believe, you can get on a jet plane and go back sometimes. I do keep up with what people are doing in the states. My wife spends 2-3 weeks a year at conferences in the states and spends a lot of time asking about what is going on. Keeping up on what is happening in medicine and practice management is of great interest for when we return.

Maybe you should give up on this whole profitable prescribing collusion idea and look at real problems. Start with doctors that refer to labs and diagnostic centers they have ownership in. Now that's a conflict of interest and pretty unethical in my opinion but it's legal in most states. Or why the area's that have the most doctors per capita have the highest medical cost per capita. Didn't you say licensing more doctors would make costs go down? Doesn't look like that works out in real life. So many real problems yet you are fixated on one that isn't.

This exchange does not relate directly to the OT but I do appreciate learning more about the subject so I will reply.

bob2356 says

why the area's that have the most doctors per capita have the highest medical cost per capita. Didn't you say licensing more doctors would make costs go down?

You seem to be confusing correlation and causation. In a free market, increasing the supply will reduce the price, all else being equal. But, in a distorted market with restricted supply (AMA cartel etc.) and artificially inflated demand (PhRMA ads on TV, mandatory insurance), many distortions can happen. A market that has a large population of sick people who watch TV all day may attract more doctors who prescribe the pills advertised on TV, resulting in higher costs. You didn't mention specific areas, but it's easy to guess that retirement destinations in Florida would have high concentrations of doctors and high costs. That doesn't change the fact that making it easier for doctors to get licensed (e.g. foreign doctors immigrating) or stay licensed (e.g. doctors retiring because they're tired of CME and other regulatory overhead) would reduce prices.

You react negatively to articles; I enjoyed these two dueling blog posts so you might prefer their candor and wit:

http://www.sciencebasedmedicine.org/index.php/bought-and-sold/

http://pharmamkting.blogspot.com/2011/05/physicians-are-concerned-about-pharma.html

Also this academic paper reports on the same issue:

http://www.scu.edu/ethics/publications/submitted/morreim/prescribing.html

Nevertheless, professionally edited newspapers continue to report the same pattern connecting prescriptions and PhRMA payments:

http://articles.courant.com/2012-07-30/health/hc-doctor-prescribers-20120730_1_second-highest-prescriber-top-medicaid-prescribers-pharmaceutical-companies

Sometimes the physicians sell the drugs directly, eliminating the added step of kickbacks:

http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?pagewanted=all&_moc.semityn.www

Other times, it's kickbacks:

http://www.usatoday.com/money/industries/health/drugs/story/2012-07-02/glaxosmithkline-pleads-guilty-3B-fine-illicit-promotion-prescription-drugs/55979616/1

I certainly agree there are other problems, and I do not fixate on this one. It's just that you keep asking about this one, so the exchange gets more words on the page. I'm also concerned about doctors losing their independence because most of them are working directly or indirectly for insurance companies, e.g. 70% work for hospitals or large practice groups, which the largest insurers are buying. And we have exchanged comments before about C-T scans being marketed to healthy people as "preventive care" despite there being no benefits to anyone other than the revenue recipients.

I am surprised that APOCALYPSEFUCK is Shostakovich is ignored so much. Half of the fun of reading this blog are his posts about the coming cannibal anarchy. Hell I enjoy reading his posts.

thenuttyneutron says

Half of the fun of reading this blog are [AF's] posts about the coming cannibal anarchy.

I agree, and in fact there may be a real estate opportunity: AF fans should look into real estate in AF's neighborhood, so we can all band together to defend against the zombies.

Cloud has gone. Soon to return as drizzle, no doubt.

The Trolls are coming. The Trolls are coming.

Politicofact says

The Trolls are coming. The Trolls are coming.

Call it Crazy says

I would be careful... when you point out these negative FACTS about Obama's record, they don't like that here..... your posts will get deleted by the forum Nazi....

Fuck you.

I don't delete anyone for posting facts, just for relentless racist infantile propoganda.

Please post a picture of Obama in a grass skirt or as an evil clown so I can blow your account away in clean conscience.

Bumped for posterity. Imagine how wonderfully ordinary and sanguine this place would be had Patrick followed through on his threats. The housing bubble was a real and legitimate issue that deserved all the attention it got.

As the bubble resolved, most other sites went out with a bang as formerly priced out people bought and moved on with their lives. This site, unable to recognize that it was over changed focus and went out with a (cockeyed arm, obamas the devil, murica is doomed) whimper.

The world is interesting because of the competing narratives.

APOCALYPSEFUCKisShostikovitch says

I went to user list and sorted by likes and clearly AF is the most loved persona on PatNet.

I agree with your conclusion, but not your reasoning. Counting likes and dislikes is meaningless because fanboys will like every post in their clique and dislike every post by someone in an opposing clique.

The correct way to measure popularity is to calculate a popularity matrix based on likes/dislikes using the following algorithm.

1. Person A's opinion of person B is the number of likes of B by A minus the number of dislikes of B by A divided by the number of posts of B.

opinion(A, B) = (like(A, B) - dislike(A, B)) / postCount(B)

This value will be in the range [-1.0, +1.0].

2. The opinion of a set of users S of person B is the sum of the opinions of each member in S divided by the number of users in S.

opinion(S, B) = sum(opinion(S[i], B)) / order(S)

This value will also be in the range [-1.0, +1.0].

This formula works for any set of persons in the community including the entire community. So you can ask how the entire community feels about a person, and in most cases that will be neutral since most community members won't express an opinion of person B.

However, you can also ask who are the people who like B and who dislike him. For example, you can partition the community into groups based on the value of S[i] as it falls into the ranges
[-1.0, -0.5] venomously hate
(-0.5, -0.2] hate
(-0.2, -0.1] dislike
(-0.1, -0.01] disapprove
(-0.01, 0.01) neutral
[0.01, 0.1] approve
[0.1, 0.2) like
[0.2, 0.5) friends
[0.5, 1.0] harmony

If you partition the entire community based on the above criteria for all users B to form a set of partitions P, you can generate the cliques in your community by forming sets C where C[i] is a set formed by P in which includes persons who were in the same P[i] for many i's. Many can be throttled like 10% or 20%.

Come on, sbh. With CiC gone, you will be like Sherlock Holmes without Moriarty.

Call it Crazy says

We already have someone here that fits that description

http://www.youtube.com/embed/Cs4Gj7JsET4

*baited

dodgerfanjohn says

*baited

SBH's spelling was correct.

I am just a vessel of venomous love for all Mankind. That is why I am beloved of Patnet.

sbh says

after which I will still be here with no loss.

It was not the grandfather paradox we were talking about. :-)

APOCALYPSEFUCKisShostikovitch says

You loves me long time, PatNet!

I win!

You could stand for the Patnet Presidential elections.
I would like to know your stand on the following important issues:
1. How do you intend handling Kim Jon, when he tells us what movies we cannot watch?
2. How would you handle ISIS, the nice guys who take women for sex slaves?

Thank you Mr. President.

Call it Crazy says

What this means to me, honestly, is there are a bunch of liberals on here who find it neccesary to "dislike" everything posted by one of these guys.

Point taken: In all fairness, liberals are indeed the only ones with a knee-jerk "dislike" reflex here.

Dan8267 says

I think we can all admit that we come to PatNet solely to bitch at other users and get our daily recommended value of AF, and the later is the more enjoyable of the experiences.

sbh says

CDon says

the captain & CIC have somehow vaunted from under CLs 380 to well over 12K each, with CIC blowing the doors off everyone breeching the 14K dislike plateau.

Yeah, that's because shit stinks.

dodgerfanjohn says

*baited

I know you had to try, but usually you're better than this.

Hey, how come you guys, with your skills, are nowhere near the top? If I was you I would crawl into a hole and hope no one finds me.

APOCALYPSEFUCKisShostikovitch says

Strategist says

APOCALYPSEFUCKisShostikovitch says

You loves me long time, PatNet!

I win!

You could stand for the Patnet Presidential elections.

I would like to know your stand on the following important issues:

1. How do you intend handling Kim Jon, when he tells us what movies we cannot watch?

Log splitter! To the Kimfucks little head!

2. How would you handle ISIS, the nice guys who take women for sex slaves?

Log splitter! to the ISISfucks little gonads!

Thank you Mr. President.

I feel safer already.

Strategist says

If I was you I would crawl into a hole and hope no one finds me.

Leave your mother out of this.

Dan8267 says

Strategist says

If I was you I would crawl into a hole and hope no one finds me.

Leave your mother out of this.

It doesn't take make much to stoop to the gutter. But it takes class not to.

Top Trolls

Me.

sbh says

It doesn't take make much to stoop to the gutter. But it takes class not to.

Is that more of your crap we're supposed to believe? You can't keep up with your own mindlessness.

He who shows the most class, wins the game. I won. :)

It's time to impanel some judges for an ad hominem hoe down.

The best dirt tossing, foul mouthed mud slinger wins and is officially the most beloved delovely troll on Patnet.

Ceffer says

It's time to impanel some judges for an ad hominem hoe down.

The best dirt tossing, foul mouthed mud slinger wins and is officially the most beloved delovely troll on Patnet.

I fucked your mother in her pussy one time and she had to shit.

So I told her to go ahead. I than took her turd and used it for lube while I fucked her pussy.

9 months later; came out a little shit like you that originated from feces, semen and human waste.

APOCALYPSEFUCKisShostikovitch says

Was that supposed to be funny?

No, it was supposed to be disgusting.

Strategist says

It doesn't take make much to stoop to the gutter. But it takes class not to.

Anyone who is pro-torture cannot take the moral or class high ground on any subject matter.

You can be pro torture and still be a nice person.

wow I didnt make that list.

surprising.

Gee, I'm disappointed I didn't make the list.

Guys, that list is more than two years old. Nothing you will now can change history. :-)

bgamall4 says

Ceffer says

You can be pro torture and still be a nice person.

No you can't. That is a trollish statement. You said that trollingly. :)

Yes, but is it a troll that makes me most beloved of Patnet?

I think this is a false flag, but I never glanced up the flagpole...

bgamall4 says

I think this is a good thread. I didn't look at the thread.

I was thrown out of college for trolling my Liberal teacher in my test answers.

I seem to have an uncanny knack of trolling by merely standing up for what I believe in. It's more a talent than a curse really.

CaptainShuddup says

I was thrown out of college for trolling my Liberal teacher in my test answers.

That's called "failing", and it differs from trolling. It means that you are a fuckup.

HydroCabron says

CaptainShuddup says

I was thrown out of college for trolling my Liberal teacher in my test answers.

That's called "failing", and it differs from trolling. It means that you are a fuckup.

Damn that was funny!

Is it a surprise that if so much creativity and imagination is involved in his interpretation of current events, that this would even be even more the case in the way he spins his own personal history ?

My teachers told me I was wasn't even good enough to be designated a fuckup, so they called me a fuckdown.

I'm just kidding y'all I didn't even go to college I make 6 figures and am not in debt up to my eyeballs for it.
I was smart enough to teach my self my passions in life.
I've got better things to do with my time than to sit 6 to 8 hours a day in a classroom listening to some politically confused loser who couldn't cut it in a real world industry vertical trying to tell me what's up. Not on MY dime!

and not today uh uh uh!