- Fractional use of vials/pills to decrease per-patient cost, because the main driver of high cost of drugs is not manufacturing (i.e. a ten times more efficient manufacturing process would not result in 10 times, or even 2 times lower prices). If you don’t believe me just look at what Sanofi did with alemtuzumab.
- Using real-world data instead of randomized controlled trials, because while retrospective, non-randomized, uncontrolled studies Now rebranded as “real-world data”. are good for generating hypotheses and maybe, maybe, detecting enormous effect sizes Think: smoking causing cancer, but not: who-knows-what new material causing lymphoma. we have learned through much trial and error that RCTs are critical for evaluating whether a medical intervention works or not. Back when personal computers were too big and expensive for mass use, the answer wasn’t to invent a story of why calculators were better — it was to make PCs so cheap and small that not having one in your pocket was a matter of personal choice, not cost. Same for RCTs.
- The Choosing Wisely initiative, which was all the rage back when I was a resident and still seems to have legs. Not to mention that the program unintentionally promoted a dangerous frame of mind in which some doctors thought extensive testing was never indicated, thus missing some rare but life-theratening diagnoses. Money spent on producing more content for doctors to read, listen, and watch — thus taking up their time — and encouraging patients to talk to their doctors at length about questionable data behind many of the procedures — thus, again, taking up their time — may have been better spent designing and running pragmatic RCTs that would answer these questions and save both the doctors' and patients' time by reducing ambiguity. Oh well.
- Yet another health care delivery reform — this may be just my healthcare policy naiveté, but these all had the whiff of rearranging deck chairs on the Titanic. See also: the Homer Simpson car Mandating the desired outcome instead of thinking about the right incentives is bound to increase cost through second-order effects.