Physicians are cautioned that the two obstacles to reforming post-marketing clinical trials are the FDA's reluctance to revisit past approvals and its inability to enforce pharmaceutical companies' commitment to conduct Phase IV trials.
Physicians can work with their patients to explore less expensive alternatives for delivering health care if physicians welcome the topic of cost during the clinical encounter.
A physicians urges practitioners to use cost-effective alternatives to dispensing samples to patients who cannot afford to pay for their prescriptions.
Appropriate use of the pay-for-performance system may improve quality of care by counteracting physician incentives to overtreat in fee-for-service situations or undertreat in capitation plans.
To be a useful tool for assessing quality of physician care, pay-for-performance must be designed to include process measures and to not penalize physicians for treating patients with difficult-to-manage conditions.