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Neurologists in clinical practice endure multiple demands on their time. Excellent and safe clinical care is their foremost priority; however, several ancillary calls also require their attention. Increasingly complex regulations, nonuniform insurer systems, and marketing claims all erode into precious time necessary for clinical scholarship. Generators of these nonclinical demands answer to mandates different from ours. Payers value risk-sharing schemes based on cost-effectiveness.1 Similar priorities influence industry and payer decisions about pricing and coverage for new drugs or technologies. Industry, while keen on promoting innovation, cannot decouple its mission entirely from profit. Clinical competency is our ascendant mission and it should be distant from other mandates. Historically, in the United States, a combination of politics, plenty, and people's will have isolated all stakeholders, not just clinicians, from cost concerns. Nevertheless, we can ill afford to be ignorant of the basics of health economics. High cost of targeted therapies, enlarging beneficiary pools, and competing technologies are affecting health policy priorities, and secondarily, clinical decisions also. Now, we in the United States should start to face unpleasant truths about resource restraints.2
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Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the author is available with the full text of this article at Neurology.org/cp.
- © 2013 American Academy of Neurology
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