I wrote a brief piece for the newly renamed Digital Healthcare and Productivity on ePrescribing. Don’t get too carried away by the headline in the piece—I did know about Surescripts before this week! But while the dog-food has now been put into a can with an easy release top (eRx apps connected to pharmacies), it’s still not clear how fast the dogs are going to eat it.

Those of you in the tech world might want to come back here to comment.

In the late 1990s several companies promised to
bring handheld ePrescribing to America’s physicians. ePrescribing was
supposed to improve efficiency for doctors, particularly by reducing
calls from pharmacies to their offices. But most savings from
ePrescribing go to pharmacies, whose employees spend less time entering
data, and to health plans because ePrescribing helps increases generic
substitution. In addition, many early systems ended up generating a fax
from office to pharmacy becausethere was no easy way to transmit those
prescriptions electronically. Continue …

I have been struggling with the new attention on online virtual worlds like Second Life, World of Warcraft, etc, etc. I think that there’s something here that’s more than games. But I can’t quite tell what yet. And if it’s just games, well I don’t want to get sucked into this, as I waste enough time on the Internet already.

Here’s an article by a tech veteran suggesting that this is The Next Big Thing. The question is, what moves to virtual worlds? If it’s just games, then it’s self limiting as only some people have that much time on their hands and they’re not the ones with the money. There are obviously options for moving community online to virtual worlds, but community per se doesn’t have that much economic value. However in some aspects of health care, like patient groups, there is real value from community.

The web though is most important for moving commerce and information online. It’s not clear to me how you put that into a virtual world, other than advertising to those who are playing games or otherwise spending time there which is the TV/newspaper model. Any ideas?

(Note: Slight edits made to clarify)

Here’s the article from the NY Times confirming that drug-eluting stents are being used less since the recent findings of increased risk over bare-metal stents.

But now stent sales are falling and some doctors are rethinking their faith in the devices, driven by emerging evidence that the newest and most common type — drug-coated stents — can sometimes cause potentially fatal blood clots months or even years after they are implanted.

SNIP

There is no question that stents have saved countless lives in the short term by preventing impending heart attacks or opening arteries while an attack is being treated. But neither type of stent, no matter how much better it may make a patient feel, has been shown in rigorous clinical trials to improve long-term survival compared with other forms of treatment.

SNIP

Drug-coated stents cost an average of about $2,200 each in the United States, nearly three times the price of bare-metal ones. Despite the higher price, they quickly captured more than 85 percent of the United States market after their introduction in this country two years ago. Overseas, where national health insurers have been more reluctant to pay the higher prices, drug-coated stents have caught on more slowly.

SNIP

But other doctors’ uncertainty is starting to show in the declining sales of stents. Just this week, Boston Scientific said that its third-quarter stent sales, $572 million, were 4.8 percent lower than a year earlier.  Johnson & Johnson, whose Cypher is the only other drug-coated stent currently sold in this country, said this week that its worldwide stent sales of $627 million in the quarter included a 6 percent decline from a year earlier in the United States. Its sales in Europe were down 3 percent.

And showing what’s going to replace these drug-eluting stents—more CABGs? more drugs? diet and exercise? Dean Ornish’s program (still waiting for Medicare reimbursement 15 years after it’s been more or less proven to work? Unlikely.

Several competitors are still anxious to enter the domestic market, including medical giants like Medtronic and Abbott Laboratories and smaller players like Conor Medsystems whose products are already on the market overseas. Some have claimed that results to date suggest their products have little or none of the clotting risks. Because none of them plan to apply for F.D.A. approval before next year, it is unclear whether or how the agency’s new scrutiny of stent safety will affect their prospects. New stents will not address the issue of whether too many patients get stents instead of first trying therapy with drugs, including statins, that might improve their condition.