Future health trends - if the drugs don’t work, just ask mum

Wednesday, July 01, 2009 | Posted by: Grant Thornton
Categories: Healthcare | Tags: government, healthcare, google, medicine

Each year, hospital errors kill five times as many Americans as AIDS. Scared? There’s more. According to the Institute of Medicine, hospital errors kill more people than car accidents or breast cancer. So, pop quiz. Do you think society in general is more or less trusting of medical institutions?

Here’s a clue – the market for over-the-counter (OTC) medicines has grown 10-fold in forty years, from $2bn to $15bn. Do-It-Yourself medicine has never been so popular.

In 2006, 136m Americans used the internet to consult medical information; an increase of 16% on the previous year. United Kingdom statistics on this subject are not as comprehensive, but the general trend towards increased self medication and self-diagnosis is established. Future healthcare markets are being shaped to sell products and services to a knowledgeable, curious and cost-conscious consumer.

Doctors are no longer taken at their word, and some, as has been my experience, are quick to Google a query while the patient is still sitting in the surgery. Of course, you have to know what you’re looking for when you get to Google, so maybe med school was useful after all. Most patients probably have a good idea what’s wrong with them, most of the time, but instead of chicken soup and rest, one in three of us will reach for some form of complimentary alternative medicine (CAMs). Evidence supporting CAMs is scant, and should, in a rational world, encourage a resurgence in chicken soup consumption.

Women make most household health decisions; they are more sceptical of medical advice, and more ready to challenge professional medical opinions. Whether we are right or wrong in our self-diagnosis, patients are altering the patient-doctor relationship; moving closer to a system of partnership, where the paternalistic GP is being undermined by an advancing matriarchy.

The tipping point of health landscape change comes closer every year. Global populations are getting older, meaning health demands increase, and tax revenues will struggle to cover ailing health systems. Encouraging self-medication is not a solution to the problem, but better health education will go some way towards improved health rationing.

Education is a long-term strategy to manage health spending, and an arena in which public-private partnerships are often viable and productive; it is also a sphere in which women exercise increasing power and greater autonomy. There is a strong argument for results-driven health initiatives focused on women as the channel for change, and to support family healthcare with a long-term view of cost-reduction. Meanwhile, drug manufacturers are advancing the limits of direct-to-consumer advertising, fully aware of patient pester power.

Advertising restrictions in the UK remain relatively tight compared with the US, but the switching of medicines from ‘POM’ (prescription-only) status, to ‘P’ (pharmacy-only), or to OTC, is becoming easier. Part of this change is assisted by an increased use of pharmacies as minor ailments surgeries. Up-take of pharmacy consultation services in the UK has not been a resounding success, partly because patients observe pharmacists as dispensers of goods rather than services. Ironically, pharmacists spend about four times more hours studying medicine interactions than doctors; so, who is more likely to make a medication error?

The cost of drugs can be managed effectively by efficient markets, but the drug budget continues to soar annually. Our health policy is slanted towards a dispensing culture, rather than an early intervention culture.

No health minister has had the foresight and political capital to walk away from a dispensing culture; and yet, intervention with lifestyle changes such as nicotine replacement, and increased early detection programmes, can potentially save billions per year for the health budget. Part of the problem is the lack of incentives for patients and consumers to change.

Freakonomics authors Stephen Dubner and Steven Levitt describe how society responds to incentives. They give the example of nursery care in Israel: parents were arriving late to collect their kids, no penalty was enforced. When a small penalty was introduced, the rate of late arrivals increased. Why? Well, parents reckoned that the $5 fine was worth paying for the extra half hour shopping, or chatting in a cafe. The solution was a more substantive penalty. With healthcare we can expect future governments to reward the healthy and punish the negligent – for their own good of course.

Future Health Trends

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