Shift in IBD treatment?

This is easy enough for the OP to look into the dollars for doctors website for himself:

https://projects.propublica.org/docdollars/

Whether his doctor gets paid or not IMO I think the OP should remain on his current meds.

juststud said...
"Often times, in fact, they give up part of their day (or week) to fight insurance companies that don't want to cover an expensive treatment even if it's the best option for the patient. "

not sure how this is evidence that docs aren't getting some sort of "reward" from big pharma for prescribing certain drugs -

That's why I prefaced my comment with "I know there are those who will remain unconvinced." As others said, there are ways to research what, if any money, your doctor is paid by pharmaceutical companies. That transparency should allow patients to do their own research and decide whether or not they trust their physician, but if information isn't readily available, or leaves you with more questions than answers, talk to your doctor.

Patients should feel free to press their doctors on why they suggest particular treatments. If you have cynical feelings about your doctor's motivations, that's a major problem but easily solved by finding a doctor whose integrity you don't question. When you're in the fight of your life against a debilitating illness, I'm not sure why you'd rely on the clinical expertise of anyone you think is shady. So far it sounds like OP's doctor has been straightforward in explaining her reasoning and listening to OP's concerns, so that's good.

(It should also be known that the fees doctors collect for speaking at engagements sponsored by pharmaceutical companies are often nominal and lower than what the doctor would've earned by seeing their own patients instead. The primary reason for attending most conferences is to share information that helps them determine what drugs might work best for what patients.)

Has the rate of flare-ups gone down over the last two decades? We've got more drugs than 50 years ago, but has the rate of flare-ups actually decreased? Surgery rates have been talked about and discussed quite a bit, but not flare-up rates.

What are we meant to be proactively preventing, I don't get it either. I would get it if there was any drug which worked for life. You develop UC; you take this drug which works for life; ergo, no more UC flare-ups. I dunno, maybe the surgery folks have a point after all. Aside from pouchitis, removing the colon does at least remove UC.

Overall we're talking recommendation, so those who are happy as is can and will stay there. I believe the majority of doctors have their patients best interest in mind, with bad doctors being a minority/outlier. It's more than just a bit cynical to say our doctors are just a mouthpiece for janson biotech marketing/sales, or just looking to get extra money from onsite infusions.

I've been in the situation where there is a disconnect between symptoms and inflammation present. I was going 3-4 times a day (simmering state) mostly all right after waking up and it was manageable. Doctor would ask me how I felt, my answer fine (thinking a heck of a lot better than when I flared hard). I had a sigmoidoscopy and there was a lot of moderate inflammation. I knew it was going to be bad after the fleet (salt water) enema, ouch!

I'm feeling fine, and having significant inflammation is quite a significant disconnect. Looking back, I'm glad my treatment was aggressive as my quality of life is now significantly better (complete remission, 1 bm without urgency and I can forget about uc). I think having the diagnostic and treating it aggressively is a good thing. It makes a patient less likely to flare up sooner, and remission is the ideal quality of life.

Not everyone can achieve remission, if you cannot then you cannot. But it cannot hurt to at least try, patient willing of course.

Louiseluck said...

KS said...
I forget the exact number that they are allowed to charge/get reimbursed above the cost of the medication/procedure costs, I think it somewhere around 6%-12%.

6 to 12 percent reimbursement for an infusion that costs (how many thousands of dollars?) is a lot of money.

6-12% is a very small margin in the Business World, it needs to cover lots of expenses; why is making money a bad thing? I am well cared for at my GI's practice, they are well staffed and I never have to wait for things and this reimbursement helps to cover theses things.

I could go to a hospital to get the infusion or another infusion center and they would make the same allowed billable rate.

He has never pushed infusions on me, he actually prescribed 6-mp for me because he thought it was better for me to start with than Remicade at the time. Now he is willing to fight with my insurance company to get me Stelara because it might be better for me than the infusion of Entyvio for my situation.

iPoop said...
And actually a lot of the reasons gastroenterologist offices have infusion centers is due to insurance pressures. Having an infusion at a hospital is crazy expensive whereas the gi clinic is more affordable. Insurance is encouraging places other than hospitals for infusions.

Same thing with rheumatologists, who increasingly offer infusion centers (basically rooms with recliners and nurses) to reduce costs and because it's more convenient for patients to visit a quiet office in a familiar setting than trek to hospital centers. In the future home-based infusions will become more common to further reduce costs.