But I want it … Now !!!

I will be at two conferences today, including the Israeli TedMed. I feel very honored to be participating in these conferences and I hope to report about many interesting updates. A couple of nights ago, Apple had its eagerly anticipated presentation of the iPhone 6 as well as the new Apple Watch. Interestingly, many of Apple’s competitors were anxiously awaiting this evening, for they knew that Apple’s foray into the smartwatch arena, would dramatically increase the public’s interest in this area of technology. So, as a rising tide raises all ships, other smartwatch companies are hoping to benefit from Apple’s version of the digital wrist.

Such are things today in the world of technology. There is a desperate fight to find the greatest and the newest in all areas of technology and then to excite the public beyond a reasonable level of interest. The hope, from the seller’s side, is that people will over buy these technologies beyond their real need. In some ways, this is a good part of how even newer technologies are financed. Companies like Microsoft and Apple have a tremendous amount of cash that is not necessarily active from a business point of view. With every successful round of sales, there cache of cash grows and drives them to invest in new ideas and new companies. It’s nice to know that a lot of these investments and quite a number of these companies are related to Israel. It is the best kept secret that everybody knows about, that Israel is at the forefront of technology breakthroughs that present themselves in everything from fighter jets to home computers and even likely to Apple’s new watch.

What happens when technology doesn’t advance fast enough? From time to time, which is too often, you hear of a tragic story of someone who is fighting a deadly disease and who has exhausted every available treatment. However, there is talk and early research about a new medication that shows promise, albeit at a very early stage in its development and research. For the one with the terminal disease, any chance greater than zero is still a chance. What do you say to this person who really has no other option? Do you really that it is too soon to allow them to try an experimental treatment and/or medication?

Even if the risk of this new medication is death, the terminal patient will most likely be willing to take the risk. What if the medication succeeds? What if news gets out that there have been two or three successes that have not been part of a rigid research protocol? What can happen is that there is literally a frenzy whereby a large number of people demand access to the medication or treatment on the principle of compassionate use. Does a drug company have a responsibility to fully test a treatment and/or medication before allowing the public access to it, especially if it means people will die in the interim? This question has been debated by physicians and ethicists in great number. And it should be to no one’s surprise that there is no clear answer and that every case must be considered individually.

This is by no means a trivial issue. If it becomes standard practice that a medication becomes available to the general public before being fully tested, the marketplace could literally be flooded with medications that end up being useless. More so, the audience for these medications will likely grow and the conditions of the patients will likely become less desperate. In other words, if there is a risk of death from one of these medications and/or treatments, it will be a far more serious outcome than expected without the treatment for many of the patients begging for the compassionate access.

Perhaps this truly sounds trivial, but now the question is who pays for this treatment? Should such treatments be covered by insurance? How much should be charged for these early treatments? In general, early on in the medication’s life, its cost is far far greater than it is, once a generic option becomes available. Should people be charged very little as they are effectively another part of the research study, or should they be charged a great deal due to the exceptional conditions and the need to fund proper research? To be honest, another reason to charge a significant amount would be to deter people from using this option, unless they literally have no other choice.

Needless to say, not only will this situation not easily be settled, but it will most likely grow in frequency as more and more medications come to market due to better technologies for developing pharmaceuticals. At some point, some rules will have to be enforced, that some patients will consider draconian. But without rules, you could easily see the development of an open and chaotic market, in which patients will definitely suffer. This somewhat paternalistic approach is necessary to protect the public. And unfortunately, sometimes the hardest choices are those that are made in order to protect the largest number of people.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
Related Topics
Related Posts