Well we're done so old and shows over the years talking about you know loss of Louisiana's coastal and and the horrible repercussions. Is it turns out there may be a little bit of its overall and is that. It's possible. Then all of the innovations have been unemployed since -- -- It's possible bid everything we've learned and or learning about land me in different ways to handle it. Or products that can be exported. And we can make money off of it and greed. Over GNU be talking to be yeah. -- New Orleans community dieters says that three people coming up and skewed view or involved. Tracking this and figuring out just how important it is to some of the good news when it comes -- coastal front. 11 o'clock. We're gonna talk about something that doesn't seem to affect but it just like. The mid west in California. Under a tremendous round. Getting rid of that food supply news and -- it's encouraging certain states in certain cities. To think about putting pipes were so abuse straw. In Two Rivers like the misery of Bob laws. In order to get them from water that they go through we need to cores would affect -- So will be talking to a senior Richard fell one. More resources lord too lenient for some of these 11 o'clock. This -- typical. And and basically says. In people with actual medical groups. Oh or recommending. That doctors are weighing the cost of treatment. On its. Just on that and doesn't seem like a big thing when you read about it. If nothing else it is. Brings about and talk decisions I think. Where doctor Lloyd -- with this press frozen -- -- and medical society and practicing pediatrician. Doctor welcome back to ensure Pritchard to. What do you make a business. Well -- they did a couple of issues that under the surface mean one is there are certain treatments that are expensive. And in some articles. Recently published about that that they kind of come on the heels of this. Government decision to release the list the names of doctors how much money they get from the government. And and that's where the real issues I think that when the government is and the bills -- put pressure on doctors to keep that. The bill flow and I think that some states. I think the decision about one's health care should be made by the patient -- advice from the position but not being made that the person actually pain in the you know. -- but by the government to buy these medical groups whoever initiates it. Of the web will the doctor wants who were not that he's he's good changes can be put that position. It out but that that's not any different than it ever began means. Positions at this -- patients to who're. In critical situations and you debt. All the time. But that's part of the skill of being in position has been able to talk with with patients about. That. Game and it's inevitability and it's gonna happen. And everyone has to make decisions like that it's gonna happen to each -- -- -- that -- each of our families. And I AM I just hate to have this money issues come up the surface. Because. Is it should be an individual decision as far as. The cost of care. Are -- golfers broke boom come by. Comments questions to sids or one he -- when he told -- its execs and redundancy -- celebrity. A lot of people who look at this sunscreen death panels. Others will look at it and say. Yours is no different than the insurance companies that have actuary who moves that held and off how much money they have to ensure people. And when that money is not available -- won't help. So let's come -- -- more details. This bring in the thing mind you that. Changes that we we always -- ours is remembered for a true wonders and -- told Wednesday. 2601. -- The article billboard called my attention can be -- totals costs of treatment may influence doctors. And we didn't do first -- open talks about implement actual medical groups around the nation. -- recommending that doctors stored -- the cost. And I double -- bureau prove it jaguar opinion poll we -- -- -- different topic -- you agree or disagree with this. This way of Madison. A being practice. 86%. 85%. Viewed totally discrete. The better understand this we grew via experts we've talked forward bureaus with this past present museum medical society. And practicing pediatrician. Doctor did did I understand you save the even though this this who's come into the surface now because some recent development. This pretty much is the way it's always. It's always been that way. I mean not situation has the situation. There antibiotics. For here infection that are expensive and there are antibiotics in infections that are inexpensive. I think as a general strategy -- all the strides though most of them the inexpensive antibiotics firms. And we say the expensive but those rare cases. Because one of my duties as a position to the goods due later resources. Would stop put everybody on the most expensive drug every time. Then out really wasted resources that could have been used by rather's. I think that that's that's nothing new. Yeah I mean would look at the -- was in -- they would start their migration. You know there was a member of the tribe that was six -- they couldn't make the migration it would simply left the you know that the group didn't use resources to carry this that someone who let it. Haven't I chances survival they simply accepted in society. That you know. Inevitable that somebody's gonna get sick -- get old and not going to be able to make the trip so it's an ethical issues that -- been around. The trick is being good position being able to balance. The needs of individual patient with the stewardship requirement for the society as a. Oh I think a lot of Republicans would called caller called that a death travel. But perhaps that's always been the case in episode earlier insurance companies. With the actual world saying things that. That that's what -- figure out does the cost to me that's an actuary who will do. And mandates that you Ukraine team is based on their assumptions about how much it's going to cost that's the whole concept of insurance. You know -- figure out what is that the risk. And you try to figure out an estimate cost. And and use share the resources. Eagle that -- back you know 150 years at least I have followed the I'm benevolent and protective organizations. -- social related pleasure clubs. I mean in a day when it wasn't a lot of safety net out there. People banded together to make their own safety. That you belong to -- a social aid and pleasure club are benevolent protective association. And -- one of the members of the group was ill or it needs the rest of the group would come together to help amount. But the group as a -- had to make a decision on how they were gonna use the resources of the group. You know I think we've done in modern life is that institutionalized. That -- insurance companies going out with with the government oversight. But it's a decision at all does that add that to face forever and other soldiers on the battlefield. That someone has long did you gonna risk the lives of the an entire platoon. Just to save a colleague debt debt as a limited chances -- violent night in fact which he's at risk the -- of the source of ethical issues. Society estimates it's not the positions. Who make decisions positions through are only going to is to go along with its the mores of the society in which -- work. Where -- look at this is slated to give all the colleges they're developing a scorecard. True value where drugs based on their cost and value. And a couple of example reported -- to drugs for Matt macular degeneration can keep people from -- in laws and one -- fifty dollars a -- the overblown close to 2000. -- doctors use the fifty dollar when Medicare's cities hundreds of millions of dollars. And and end the the the most expensive drug. I mean I'm told the cheapest shrug of this bill -- -- slights and hubris. Is that the way it's always been here. It's always been that way I mean as a patient there are lots of drugs that there that might help you but there might be a favorite. Remember a year ago that was that weight reduction drug redux. In Allen and I'll decide that refining out that. They were patient -- at heart troubles because as it. Let's east -- -- the balances. The risk of the obesity issues. Vs the risk that the drug is going to be some. Some damage in and you got to put a monetary value and that's what. Lawyers do in in product liability is solid you know. This is a monetary value of the risk I mean it's. The way society operates and and that is that the news. Out -- -- like that can be useful. Because his position and that's it with anybody I'm gonna go with. The least expensive antibiotic that is gonna treat the -- the situation. You know I get frustrated sometimes when agents did not show up in the emergency room someplace cents. The opposition puts you know prescribes became an earache but that's the most expensive -- antibiotic that's out there. When there are a lot of other alternatives they're just some people who who think that way of stopping -- more expensive -- -- speed data. By developing a scorecard you're actually taking a scientific approach. To rank and rate the Madison's. And that is probably helpful. It's meant to be -- guidelines not a cookbook it's too this is how you should practice habits. You're -- example. There's a new and highly effective drug for health providers -- called so -- -- there and yeah it's it's 84000. Dollars per course of treatment at the dollar that is pretty serious stuff. Somebody gets a job. And and you're looking good in 84000 dollar recruitment of new drug that maybe we're better than the others. What what what happens this. Well that's where one has to make a societal choice he'd do everything possible. Or he indeed is the best possible. But that should be an individual decision and that's lie where acting that. Where you know we've got multiple plays in the game you've got insurance companies -- that government. Agencies. And it really shouldn't be that way GB -- choices in individual. And then accept. And the -- this concept of health savings account becomes important because in you've got to help they -- out. The government's contribution to the account -- -- it's so it's not there decision on what drug each each -- If he she's so less expensive drug which network quite as well which but you get to to keep the profits. That your individual choice. Should be Ali -- individual choice. And all of these outside agencies future is our government agencies. Simply should be. Someone who contributes to apply and or an -- pool of resources using can tap into. And then you make the decision on how much is your own money wanna put into it. The travel is guidelines say what's best for the drug but they -- probably studies. What is best for society at the ethical decision. And that's where -- -- that the breakdown as you know we'd all like to do everything for everybody. But that's not realistic. -- I don't have pretty scientific proof but I got eight years behind this Mike talking to people. About health care Obama appears everything else and they would cement. The majority of people hearing about the eskimos are hearing about you know we gotta make good choices do. Who we create with certain drugs and who don't. Bad that there there have been screaming death panel number one but number two. Does that affect their trust in their doctors or they look at the doctors and thinking. Okay on the old girl or I'm younger but I am very sick. And my chances of getting the Altima treatment here or laughs. It it it should be respected trusted that if the doctor is truthful at all stages on the way. And if the people -- honest conversations with a patient throughout. The patient knows that -- talent on the truth all along the way. And and they contrast -- because you've always been truthfully be try to keep these cost numbers secret. Then I can understand where patient would -- But at the ear eye doctor for example comes up to you and says parity drugs like cost fifty dollars one cost 2000 Dallas. We've got to make a choice that have a conversation about it. And he had that conversation with the patients. I think they can -- -- an anti EPA decision that the patient is it's. To go with a more expensive -- then as a position that's what I'm gonna do with the understanding that you as a patient has the responsibility. 22. And out come up with the funding for the decisions he made. Doctor you're it's a new busy being a pediatrician and I appreciate the time very much could talk. Come right back will continue this conversation in part of this -- -- -- you were. Pretty much talk in depth for adults to music 0187. Are welcome back -- with a good about. Stumble a more ordered Coleman -- -- gold. This subject. Got a number of others. This worthy of thing tonight. The initial stories that are bred to have the headline of cost of treatment may influence doctors. And it goes into a little burden details about influential medical groups were on the country. Or going to and Orton now recommending. That doctors worry that clause. When they think about what treatment did you view. And we're bug doctor -- UP. So Macy witness. To talk about a -- -- doctor appreciated the talk. Good morning. What do you. Is is this different than the way things have dinner or we as patients move actually. Josh not aware that this. And this is this significant. Different that development. Story is that it's several. Or medical organizations. The American College of Cardiology. And the American society for clinical oncology. And I have. Decided. That they will try to sit guidelines. War as physicians. In those specialties in cardiology and in oncology. For how to choose missions base. Not simply. Whether they work -- -- -- on a combination of how effective they are and how much they cost. You're professor of medicine and ethics university in Chicago. What's the at this it's a business. But it's got its complicated. You know I think that. Certainly. It's clear to almost everybody's at the costs I mean this man and has gotten him out of control. -- and that we're not doing it very bridge. Trying to rein in those costs. It's been it's considered there's three things you can say about America and and medicine. One is that everybody wants everything. The second is that nobody wants to pay for anything. And the third is that no one little. Say -- to anybody. Com and that's not -- stable set of propositions as part of the chaos that debt that we're in -- and and so. Win. These organizations are doing it I think in many ways. They are stepping into the breach because as we as a society has failed to hand. Of this kind of conversation. On the national level. When. I'm looking forward right with the media. American College of Cardiology American Heart Association. Have the votes are going to be used that they're gonna begin to use calls data to raped the value treatments. And I just wonder when it comes to the end of life treatment. Actors they're going to be. Report card. Ratings car deal. Don't know that that now that now what's being. Acts. Recommended it's not that physicians are going to be. Ready did. But grand -- I mean these -- treatment itself. You know guidelines get the guidelines guidelines will say that this. You know -- for instance. This drug. And and new drug costs. On new let's say 500000 dollars. A year per patient. And he would average extends the life of the patient to to exit. One month. And their currency. Should that -- be used to or drug. We go and be effective but not quite as effective cost fifty cents be used to those circumstances most patients' mean that's the kind of. Things they're trying to. Recommend with which these guidelines. The problem from an ethical point of view with dealing is that fair. It's just the cardiologists. Who -- -- is this is the kind of discussion needs to take place. At a national level with everybody. I'm just leading bank in the country -- patient's physician. The government is it's business leaders insurers we all have a -- in -- and I think that the cardiologists and others stepping up and saying no one else is having the conversation and and so they're stepping into the breach. -- mr. carper stricter or more come back. -- let's talk about patient perception. And I would suggest the or somebody that has bred this Oreo or loosen the should oh. This may come as a surprise that in some way is this this is always and so. But potentially. More so wrong with the use new development. Like talking about the perception. Of patients. And whether or not they should see this as some form of death now. Common right of the vogue were wrote Lincoln about here's and a bit of DO Perugia bar -- at Wimbledon. Yeah it's good to deal or it tells you need to deal with the rising medical cause some medical groups. Now say doctors should -- costs when they're assessing a patient's care do you agree with -- to screen 83%. Of you disagree. -- -- and it's in real surprise we have doctor Daniel the use from the agency. Who's a professor of medicine and ethics at the University of Chicago. Doctor -- -- stood to patients' perception of this but does this have the the look of debt that. Well I don't think kids that -- panel I think that -- and. Get -- extreme interpretation. Of of what it's. What's being attempted by these medical organizations. But I think in some ways. What -- poll reflects and what I think is always important is that patients need to trust them. That if position is going to do his or her best for the patient in the sitting -- the doctor patient relationship. Within the constraints that society outputs -- around the -- within the boundaries -- no rational medicine. We can save a lot of money and we don't do the job of this by practicing rational medicine. -- again when a patient asks for them and antibiotics and they've got a virus in the cold and they don't need them. We shouldn't be prescribing. Antibiotics to patients. Says I wanna act cat -- for my headache content muscle tension headache how we shouldn't give them like cats came under those circumstances. And that's part of what distinguishes this physicians from them morally from machine salesman if issues. Look ugly issues salesman. If you like them it's gonna seventy but the position. Shouldn't and the -- and the patient needs to trust. And that is positioned to acting in his or her. I'm the best interest so if someone if this position is gonna take costs into account the bad side. They should do that first and foremost. By practicing rational medicine not wasting resources. When they're not going to help a patient. If beyond that we need to take costs into account it shouldn't be done arbitrarily by the -- -- physician that should be done. By eight public pitches Torre a process. In which the same rules apply to everybody so that. Patients can have trust. This is something that society has decided to do collectively. Doctor Who would come and help cure there is nothing simple this there. No he never did an excellent medicine doctor thank you so much grief talk -- look pretty should go over in my -- agreed to. Allocate -- -- being if you Bynum or don't forget. America Howell and all the way nationwide and just complimented stay with those. It was interceding we're. Talking about a number of -- shows coming out. Talking about cost of treatment that costs of treating you -- me implement your doctor. A number of implement -- medical groups. Are recommending that doctors worried because that QB couple examples. It's the American college show book cardiology. They're gonna begin to use cost data to rate the value of treatments. Society of other colleges developing a scorecard. True value where drugs based on their calls -- and -- -- example. The cardiology society. A plan to read about you treatments based on what they call. Calls for equality. Adjusted light year or -- QA LOY. A method used in Britain and by many health economist. The societies do big cardiology society -- say the treatment costing less than 50000 dollars a Collie. Will be rated as high -- But those costing more than 100 in -- and a -- Would be loan value. The two interest and we talked to -- Two doctors when the pediatricians. Said this really isn't that different than some of where it's always been may be different people -- and agencies that we're used to doing it. But basically go where we've always been in do we have doctor. Doctoral buddhists and and the -- you -- Chicago -- -- this was gonna push the ethics. Who's gonna. Push on some off. Schwartz's -- -- -- Give an example at least seek to have in this story. Maktoob merger ration -- being that -- producer is -- that thing could lead to blindness. And right though there their -- drugs. That respected and treating this disease. One cost fifty dollars but don't lose 50. -- and cost 2000 dollars. And Medicare could save hundreds of millions of dollars a year. If ever one to use the cheaper drugs which is call Allison. And -- the -- -- -- and loosened its. But the Food and Drug Administration has not approved -- cheaper would use in the and using it rather as the alternative. Loose inclusive experts are born. Might carry an additional slight sleep the Britons. Should the the cheaper one didn't called the risk. Higher prize from when doubles. So what do doctors treating that Susie Q do the most expensive drug or group lesson -- You go to a doctor and you've got hepatitis C things produce serious disease can certainly lead to serious side effects. There's a new drug and everything about it show was so far the testing that is highly effective and it's called so Baltic. Well. It could lead to a -- minutes increase in spending. Because so many patients toward use it at eight. 4000. Dollars full course of treatment.