FDA recommends that doctors supervise genetic testing

[sandorski]

The problem is that medical professionals don't have expertise in the subject of genetics, either. The typical doctor likely couldn't tell you the difference between translation and transcription, and (s)he sure as hell couldn't tell you how Asian flushing and esophageal cancer are related. Ask your family physician what a SNP chip is the next time you see them.

MDs and DOs are absolutely not needed to order and interpret genetic tests. A friend of mine is in the Genetic Counseling MS program here at UW-Madison and that seems the appropriate training for this type of work.

The bottom line is that we still know so little about how highly polygenic disease phenotypes even arise (see the issue of missing heritability), that there's very little a whole genome can tell you that a good family history can't.

Good points. Whoever would be drafted to oversee such operations certainly should have the proper training in the field.

 

[CycloWizard]

/facepalm

Someone needs to Identify Fraud. Only those aware of Proper Procedure and Practices can do this. What part of this do you not understand?

Yes, this has worked out very well in the past when we put bankers in charge of reporting banking fraud, accountants for accounting fraud, and so on down the line. What could possibly go wrong?

 

[Hacp]

What do doctors know about microbiology? Much less than a PHD microbiologist I assume.

 

[Hayabusa Rider]

What are you talking about?

Why does the patient have a headache? Do we need a Dr. to prescribe Tylenol?

Why does the patient have a cut? Do we need a Dr. to prescribe bandaids?

Why does the patient have a runny nose? Do we need a Dr. to prescribe tissues?

I'm talking about things I know about because I deal with this every day. How about you?

 

[sandorski]

Yes, this has worked out very well in the past when we put bankers in charge of reporting banking fraud, accountants for accounting fraud, and so on down the line. What could possibly go wrong?

Obviously Self Regulation doesn't work. However, only people trained in certain fields can identify what's occurring in those fields.

 

[CycloWizard]

Obviously Self Regulation doesn't work. However, only people trained in certain fields can identify what's occurring in those fields.

So rather than having a handful of dedicated regulators who are experts in this field, we will impose a huge price increase on all such services, take physicians out of the healthcare delivery pool, and put them in an area where they do not necessarily have any expertise but will vouch for the validity of their employer's services? Again, what could possibly go wrong?

 

[sandorski]

So rather than having a handful of dedicated regulators who are experts in this field, we will impose a huge price increase on all such services, take physicians out of the healthcare delivery pool, and put them in an area where they do not necessarily have any expertise but will vouch for the validity of their employer's services? Again, what could possibly go wrong?

/facepalm

 

[3chordcharlie]

/facepalm

He's mostly right though... The skin rash is a good example of escalating costs with no real benefit.

So $6 worth of cream costs somebody (whether it's the patient, the insurer, or the taxpayer) a minimum of $100. The same problem applies to things like ear infections.

Yes, these could be signs of something different, and more serious, and in those cases it's going to take a doctor to correctly diagnose. Yet the fact is they aren't going to diagnose anything exotic at the first visit. Allow people to diagnose themselves for some of these things, buy $10 worth of medicine, and then see the doctor in a few days if the medicine doesn't work. It doesn't mean you can't go to the doctor with an ear infection, it just means you don't have to.

For this testing, any action, treatment, etc is going to go through a doctor anyway; so make sure the raw data is turned over to the (qualified!) physician, and you're good. Most medical professionals will want to re-do the test anyway if something serious shows up.

Now you can get your initial screening done at a good price, and there's no reason it should affect the quality of service you end up getting.

 

[CycloWizard]

He's mostly right though... The skin rash is a good example of escalating costs with no real benefit.

So $6 worth of cream costs somebody (whether it's the patient, the insurer, or the taxpayer) a minimum of $100. The same problem applies to things like ear infections.

Yes, these could be signs of something different, and more serious, and in those cases it's going to take a doctor to correctly diagnose. Yet the fact is they aren't going to diagnose anything exotic at the first visit. Allow people to diagnose themselves for some of these things, buy $10 worth of medicine, and then see the doctor in a few days if the medicine doesn't work. It doesn't mean you can't go to the doctor with an ear infection, it just means you don't have to.

For this testing, any action, treatment, etc is going to go through a doctor anyway; so make sure the raw data is turned over to the (qualified!) physician, and you're good. Most medical professionals will want to re-do the test anyway if something serious shows up.

Now you can get your initial screening done at a good price, and there's no reason it should affect the quality of service you end up getting.

Thanks. The cheapest and best diagnostic method is often just to try the most common (and, not coincidentally, cheapest) treatment. If that doesn't work, up the ante. Any pharmacist can tell you the same thing a physician would about what to put on a rash, take for a headache, or any other super-common problem, thereby saving the patient a trip to the office. This in turn frees up primary care physicians so that wait times will be shorter for other patients. This in turn means that patients will go to primary care docs first before going to see a specialist for every little thing. It's a small change with a huge impact for both quality of care and cost control, but it means those in power have to give up some of that power.

 

[JD50]

I'm talking about things I know about because I deal with this every day. How about you?

I have 3 kids, so I'm pretty familiar with headaches, cuts, runny noses, and rashes.

Your rationale that a rash could be more serious than just a rash so you need to see a doctor is no different than thinking that a cut, runny nose, or a headache could be more serious.

 

[JD50]

Thanks. The cheapest and best diagnostic method is often just to try the most common (and, not coincidentally, cheapest) treatment. If that doesn't work, up the ante. Any pharmacist can tell you the same thing a physician would about what to put on a rash, take for a headache, or any other super-common problem, thereby saving the patient a trip to the office. This in turn frees up primary care physicians so that wait times will be shorter for other patients. This in turn means that patients will go to primary care docs first before going to see a specialist for every little thing. It's a small change with a huge impact for both quality of care and cost control, but it means those in power have to give up some of that power.

:thumbsup:

 

[sandorski]

He's mostly right though... The skin rash is a good example of escalating costs with no real benefit.

So $6 worth of cream costs somebody (whether it's the patient, the insurer, or the taxpayer) a minimum of $100. The same problem applies to things like ear infections.

Yes, these could be signs of something different, and more serious, and in those cases it's going to take a doctor to correctly diagnose. Yet the fact is they aren't going to diagnose anything exotic at the first visit. Allow people to diagnose themselves for some of these things, buy $10 worth of medicine, and then see the doctor in a few days if the medicine doesn't work. It doesn't mean you can't go to the doctor with an ear infection, it just means you don't have to.

For this testing, any action, treatment, etc is going to go through a doctor anyway; so make sure the raw data is turned over to the (qualified!) physician, and you're good. Most medical professionals will want to re-do the test anyway if something serious shows up.

Now you can get your initial screening done at a good price, and there's no reason it should affect the quality of service you end up getting.

Nah, he's just introducing a canard.

 

[3chordcharlie]

Nah, he's just introducing a canard.

I don't so much see the 'removing doctors from the system' bit; this would only mean an incremental increase in workload.

I'm right there with him on the completely unneeded price increase though.

 

[sandorski]

I don't so much see the 'removing doctors from the system' bit; this would only mean an incremental increase in workload.

I'm right there with him on the completely unneeded price increase though.

He's wrong on that, just part of his canard.

 

[Hayabusa Rider]

I have 3 kids, so I'm pretty familiar with headaches, cuts, runny noses, and rashes.

Your rationale that a rash could be more serious than just a rash so you need to see a doctor is no different than thinking that a cut, runny nose, or a headache could be more serious.

Nope. That's not what was going on. Try again.

 

[CycloWizard]

He's wrong on that, just part of his canard.

So your argument is that no one has ever gone to the doctor to get a rash checked out, then given a topical steroid to treat it? Really? You're an even bigger idiot than I realized.

 

[3chordcharlie]

He's wrong on that, just part of his canard.

How is he wrong about that?

You're forcing a highly trained, and expensive professional to be part of the price of every test that is run.

It's going to increase the price, likely by a fair bit.

 

[sandorski]

How is he wrong about that?

You're forcing a highly trained, and expensive professional to be part of the price of every test that is run.

It's going to increase the price, likely by a fair bit.

If it's going to be done correctly, it needs to be done by someone Trained to do it correctly.

 

[CycloWizard]

If it's going to be done correctly, it needs to be done by someone Trained to do it correctly.

Why? If I want to pay a burger flipper to rebuild my car's transmission, whose problem will it be when my car won't start? Are you going to regulate like this on all fronts, or just pick and choose?

 

[Hayabusa Rider]

He's mostly right though... The skin rash is a good example of escalating costs with no real benefit.

There are low potency steroid preparations which have been on the market a long time. The next step up can cause problems if used incorrectly or applied to children. Then there's the problem of masking symptoms rather than going to the doc. Example- Summer before last a guy came to me with a tube of hydrocortisone and asked me if that would be good for his "rash". He showed me the inner part of his thigh. He was going to apply a steroid cream to a full blown staph infection. You've heard of flesh eating bacteria? Know what would have happened if he had applied a medium strength steroid cream to it? Fortunately he asked and got to the ER right away. He came back a couple months later and told me he was in the hospital for the better part of a week fighting a resistant strain. They told him that if he had waited another day there was a chance he wouldn't have made it. He's an extreme case but steroids mask problems. He could have applied something to make it look better earlier. You can guess where that would lead.

The same problem applies to things like ear infections.

You just made every pediatrician cringe who read that. An ear infection IS a more serious thing. You have a parent who has a child who complains about an earache. So he goes and picks up a bottle of antibiotic ear drops and treats it. Unfortunately you don't know what's going on in the ear, and the organisms that live there live in balance. Things feel better, but little Johnny seems to be having a problem hearing. Congrats, you've treated his ear wax with something that caused an imbalance of bacteria and the various yeasts and you've made your child deaf in that ear. Don't laugh, people who have had access to medications not normally available to the public, but didn't have the training have done this very thing.

You've provided a very good reason to limit access to medication.

As far as if physicians need to read the tests, the answer is no because there are others who are experts in this, but the concern is real. What standards are used when reading these? Who does it? Is there a trained expert evaluating, or some crap program spewing out answer on subtle results? Who the heck knows? There ought to be something in place to ensure quality results.

 

[3chordcharlie]

Why? If I want to pay a burger flipper to rebuild my car's transmission, whose problem will it be when my car won't start? Are you going to regulate like this on all fronts, or just pick and choose?

I would regulate the ability to hang out a shingle saying 'transmission repairs' without qualification.

That's no what this is about though - this is about representing that only a doctor is qualified to do anything remotely medical, which is one of the reasons doctoring has become a restricted cartel.

 

[3chordcharlie]

There are low potency steroid preparations which have been on the market a long time. The next step up can cause problems if used incorrectly or applied to children. Then there's the problem of masking symptoms rather than going to the doc. Example- Summer before last a guy came to me with a tube of hydrocortisone and asked me if that would be good for his "rash". He showed me the inner part of his thigh. He was going to apply a steroid cream to a full blown staph infection. You've heard of flesh eating bacteria? Know what would have happened if he had applied a medium strength steroid cream to it? Fortunately he asked and got to the ER right away. He came back a couple months later and told me he was in the hospital for the better part of a week fighting a resistant strain. They told him that if he had waited another day there was a chance he wouldn't have made it. He's an extreme case but steroids mask problems. He could have applied something to make it look better earlier. You can guess where that would lead.

You just made every pediatrician cringe who read that. An ear infection IS a more serious thing. You have a parent who has a child who complains about an earache. So he goes and picks up a bottle of antibiotic ear drops and treats it. Unfortunately you don't know what's going on in the ear, and the organisms that live there live in balance. Things feel better, but little Johnny seems to be having a problem hearing. Congrats, you've treated his ear wax with something that caused an imbalance of bacteria and the various yeasts and you've made your child deaf in that ear. Don't laugh, people who have had access to medications not normally available to the public, but didn't have the training have done this very thing.

You've provided a very good reason to limit access to medication.

As far as if physicians need to read the tests, the answer is no because there are others who are experts in this, but the concern is real. What standards are used when reading these? Who does it? Is there a trained expert evaluating, or some crap program spewing out answer on subtle results? Who the heck knows? There ought to be something in place to ensure quality results.

Lot's of people don't go to the doctor, who should. Some of them die.

Should we regulate weekly visits?

Don't get me wrong, I'd be happy enough if with a triage layer of nurses who were allowed to prescribe for a least some problems if it would reduce the insane cost of medical care.

Edit - Think of it this way: You are almost certainly 'not an expert' on both brains and hearts, but can probably tell who needs a neurologist and who needs a cardiologist. The most important skill is to recognize the limits of your own ignorance. A nurse can see the difference between athlete's foot and gangrene, and force the patient up the ladder if it's serious. Working this way could mean one doctor backing up three or four nurses, and cutting the cost of visits in half for the patient.

 

[nonlnear]

Existing Laws don't have expertise in the subject of Genetics. That's why Medical Professionals being involved makes perfect sense.

Neither do most doctors. While human genetics is in a sense a subfield of medicine, requiring a doctor to order and interpret genetic testing makes about as much sense as requiring retail jewelers to order and interpret x-ray crystalography tests on gemstones.

 

[CycloWizard]

I would regulate the ability to hang out a shingle saying 'transmission repairs' without qualification.

That's no what this is about though - this is about representing that only a doctor is qualified to do anything remotely medical, which is one of the reasons doctoring has become a restricted cartel.

But in the same breath, you're arguing for licensing automobile repairs. I had no experience performing auto repairs, but successfully repaired and/or replaced virtually every system in my first car. If it was a regulated industry, that would have been illegal and replacing my engine would have cost me more than the $104 ($50+$54 shipping) I paid for a used engine on eBay - I couldn't have paid $1500 for someone else to do the same job because I only had about $150 to my name at the time.

 

[sandorski]

But in the same breath, you're arguing for licensing automobile repairs. I had no experience performing auto repairs, but successfully repaired and/or replaced virtually every system in my first car. If it was a regulated industry, that would have been illegal and replacing my engine would have cost me more than the $104 ($50+$54 shipping) I paid for a used engine on eBay - I couldn't have paid $1500 for someone else to do the same job because I only had about $150 to my name at the time.

No. Where do you come up with these hair brained ideas? :\