The IVIG shortage

For an example of market forces at work, there are some doctors (who happen not to be reproductive endocrinologists) who aggressively advertise IVIG as the holy grail treatment for recurrent miscarriage. Their marketing tactics are so good that I spend a lot of time educating patients who bring their ads to me and demanding to get it prescribed. I explain that with IVIG, about 55-65% of patients with unexplained recurrent miscarriage will end up with a healthy baby. Then I explain that with placebo, about 50-60% of patients will end up with a healthy baby. Mind you this is based just on the PUBLISHED studies and most of these are arguably done by researchers who sort of wish that there is a statistically significant effect found. Occasionally, I fail to persuade the patients and they go off saying they’ll get it elsewhere. Almost all of them come back to me, reporting that they didn’t get it because they couldn’t afford it and they are mad that the insurance won’t pay the $14000. Of the affluent ones who decide to fork over their hard-earned money, about half of them end up successfully delivering a baby and then they become the ones going around as walking testimonials to the wonders of IVIG, angrily ranting against the doctors who failed to prescribe it to them all these years. I can only imagine if insurance was mandated to cover it. The demand would skyrocket and the immunodeficient patients who truly need the IVIG would be out of luck. I think this demonstrates two principles. Without the artificial environment created by unlimited free third-party-sponsored healthcare, people will set their own limits based on budget and priorities. True market-based medicine can be hindered by deceptive marketing and non-perfect information available to the patient. While this is true of all commercial transactions we face in life, it’s even more true with healthcare.