Dark Future 'What if'

[Sushirolls]

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Absolutely. I mean there's a pretty significant portion of people that will go spend thousands of dollars on things that can be overtly harmful (ex. chelation therapy). As long as you have a good fancy sales pitch and some credentials behind your name (even without), it can be pretty easy to convince people to undergo all sorts of therapies/procedures/imaging/etc. People really like the idea of "doing" something procedural or "visualizing" a problem specifically, and really who can blame them? It brings a level of perceived certainty to very uncertain/nebulous conditions.

In my own practice, I have to often catch myself and remind myself not to just sit on top of my educated high horse and stare down my nose disdainfully at these ideas when patients bring them up. Empathizing with patients about the difficulty of the problems they're dealing with and validating the desire to have some certainty while also gently noting my concern that from my perspective they'll be spending a lot of money on something that I'm not sure has any significant value in terms of planning or treatment is approach I usually end up taking.

But for some their high deductible or co-pay is almost like a poison pill... the idea of paying a natropath for their snake oil is palatable, but their Physician expenses are a painful chore. The volume of people I see shelling out money to NDs just makes me wonder why I'm even taking insurance in the first place at times.

 

[Splenda88]

I'm not sure this is true in a world where Gwenyth Paltrow's GOOP website is considered a legitimate health cite by large swaths of the publi. Especially with her $75 genital-scented candle selling out in hours...

We are doomed if this is true.

 

[dl2dp2]

Most educated but non-neuroscience/psychiatry trained people are going to have a tough time figuring out that he is a quack. It's not like he's peddling colloidal silver.

This is not the point. I'm not talking about middle-class educated people. I'm talking about WEALTHY people who are at least top 10%ile, if not top 5%ile. The Amen clinic pitch is really not very good for that group.

I'm not sure this is true in a world where Gwenyth Paltrow's GOOP website is considered a legitimate health cite by large swaths of the publi. Especially with her $75 genital-scented candle selling out in hours...

Much of the public has $300 in savings. Their thought is irrelevant in capturing value. Gwenyth is smart, but she's not running anything that I would consider technologically innovative, and she knows it. You are not thinking about this the right way. For example, much of healthcare dollars are spent not by consumers but by payers. If you are a provider, you need to demonstrate value to the payers.

These are very elementary concepts in healthcare economics. The bottom line is that the conceptual basis of much of the discussion here is sort of unsound.

 

[nowaysanjose]

Regardless of employment projections I just can't see child psych ever being saturated. It seems like ADHD and ASD are everywhere and only increasing, and child psychiatrists are nowhere to be found.

 

[clausewitz2]

This is not the point. I'm not talking about middle-class educated people. I'm talking about WEALTHY people who are at least top 10%ile, if not top 5%ile. The Amen clinic pitch is really not very good for that group.

I have to agree. Amen is too obviously trying to sell something to appeal to the kind of folks I think @sluox is talking about. I think of the folks from very old money that I've known in the past (like, literal Barons) and I really struggle to see them having the slightest interest in Amen. He gives off very strong motivational speaker vibes and this is poison class-wise to this set. I think it's less about money and more class; striving is for the nouveau riche.

 

[Stagg737]

This is not the point. I'm not talking about middle-class educated people. I'm talking about WEALTHY people who are at least top 10%ile, if not top 5%ile. The Amen clinic pitch is really not very good for that group.



Much of the public has $300 in savings. Their thought is irrelevant in capturing value. Gwenyth is smart, but she's not running anything that I would consider technologically innovative, and she knows it. You are not thinking about this the right way. For example, much of healthcare dollars are spent not by consumers but by payers. If you are a provider, you need to demonstrate value to the payers.

These are very elementary concepts in healthcare economics. The bottom line is that the conceptual basis of much of the discussion here is sort of unsound.

My point was that even the wealthy and "educated" are willing to pay out their a$$es for pseudoscientific treatments. Especially if it's trendy.

 

[JKinSC]

Woowoo is declasse and most rich people don't want any of it.

It’s a volume game; there are a lot more gullible than rich people.

Especially with her $75 genital-scented candle selling out in hours...

Wait, what? That’s it, I’m out.

 

[Attending1985]

Western medicine isn’t very good at treating chronic illness. Psychiatry’s statistics are awful and only seem to be getting worse. Why wouldn’t people seek alternatives? If they believe it’s effective it probably will be.

 

[J ROD]

Retire myself out and collect stud fees like a champion race horse.

 

[dl2dp2]

It’s a volume game; there are a lot more gullible than rich people.

Volume game is not smart marketing. Haven't you learned enough about last 20 years? It's about targeted marketing to people who can actually afford and demand your services that drive higher margin. With much of the capital captured by a small band of the population, this is literally the story of every. single. successful. company/industry. in the last 20 years. including psychiatry.

Volume marketing is really the domain of public finance and public governance (i.e. "X for all"). Businesses that derive profits from volume marketing (i.e. conventional retail, energy, etc.), in general, are in secular decline.

 

[dl2dp2]

My point was that even the wealthy and "educated" are willing to pay out their a$$es for pseudoscientific treatments. Especially if it's trendy.

Are they though? Have you done marketing studies on the wealthy and educated? Do they REALLY pay for pseudoscientific treatments even if they are trendy? You are making these statements without any confirmational data.

All I see is that rich people are the first ones getting the COVID vaccine. The first ones getting expensive biologics, including the ones that actually work, such as immunotherapies. The first ones getting ketamine, TMS, etc. As I said, in psychiatry science-based treatment may be a bit more woowoo, but still they are backed by billion-dollar clinical trials.

Even psychotherapies. Who's getting the twice-weekly DBT/TSF therapist that charges $500 an hour?
Who's getting woowoo therapists online who's charge $30 an hour? Woowoo marketing is super downmarket.

Who do you think is paying for the billion-dollar clinical trials? Not the peons. Who are the stakeholders here?

 

[Stagg737]

Are they though? Have you done marketing studies on the wealthy and educated? Do they REALLY pay for pseudoscientific treatments even if they are trendy? You are making these statements without any confirmational data.

I could ask the same of you. I'll ask it slightly differently. What demographic do you think is paying for weekly/monthly treatments costing hundreds of dollars per session/treatment or thousands of dollars total? Do you think the middle to lower economic classes are dropping significant portions of their income into those "treatments" or is it the people who have money at their disposal?

Anyway, I haven't done the studies, but the CDC has. Here's some data from the CDC's annual wellness survey from 2012. 69% of expenditures on alternative healthcare come from households making over $50k/year and 36% comes from those making over $100k/yr. CDC has plenty more data, but here's a link for previous data: https://www.cdc.gov/nchs/data/nhsr/nhsr095.pdf

All I see is that rich people are the first ones getting the COVID vaccine. The first ones getting expensive biologics, including the ones that actually work, such as immunotherapies. The first ones getting ketamine, TMS, etc. As I said, in psychiatry science-based treatment may be a bit more woo-woo, but still they are backed by billion-dollar clinical trials.

Even psychotherapies. Who's getting the twice weekly DBT/TSF therapist that charges $500 an hour?
Who's getting woowoo therapists online who's charge $30 an hour? Woowoo marketing is super downmarket.

Of course the wealthy are the ones getting expensive treatments, they're the ones who can afford it. I'm not arguing that the rich aren't the ones supporting science or that it's not expensive. My point was in regards to the prevalence of support for pseudoscience by the general public and that there are very significant payers backing this. "Natural" medicine and many other components of pseudoscientific treatments are a multi-billion dollar industry. We can argue that "science" is more expensive, but science encompasses almost everything. It's such a generalized sweeping statement that it's essentially meaningless.

I think we're probably also looking at the valuation of these things differently. What's more "expensive", paying $500/hr for DBT which has strong evidence behind it and has an end date, or paying $300/mo for vitamin supplements with no data backing them up because Gwen said they help? If we're talking pure dollar-for-dollar, then "science" (specifically medicine or even more specific if you want) is obviously more expensive. If we're taking outcomes into account as well I think it's a different story.

 

[Stagg737]

We are doomed if this is true.

It's unfortunately very true from my experiences.

Wait, what? That’s it, I’m out.

If that's scary look up her jade vagina eggs that are rechargeable with solar energy to balance your hormones (100% serious, she actually sells these). Weird times...

 

[PsyDr]

There are many social trends that I disagree with. I also recognize that I am not extraordinary enough to change the course of those trends. With that knowledge, I am able to identify areas in those trends in which I can make money.

 

[Candidate2017]

Who do you think is paying for the billion-dollar clinical trials? Not the peons. Who are the stakeholders here?

No. I can tell you that's not how pharma works or capital markets in general. Rich people don't fund pharma research. It's regular working people. Teachers, firemen, truck drivers, nurses, and everyday working people. Via their union dues, pension funds, 401k's, college saving plans, savings, mortgages, life insurance. Every 2-4 weeks, they get a chunk of money taken from their paychecks for which they have no idea what happens to it, other than it somehow magically grows.

And what's with the wealthy fetish? I can also unequivocally say I've worked in the past with, and for, more 7 and 8 figure earners than you. They aren't going to be buying Gwyneth Paltrow vagina candles, but their wives, kids, and mistresses will use their money to pay for a ton of nonsense. Then again, you'd probably consider these people "nouveau riche" as they work for a living.

 

[calvnandhobbs68]

No. I can tell you that's not how pharma works or capital markets in general. Rich people don't fund pharma research. It's regular working people. Teachers, firemen, truck drivers, nurses, and everyday working people. Via their union dues, pension funds, 401k's, college saving plans, savings, mortgages, life insurance. Every 2-4 weeks, they get a chunk of money taken from their paychecks for which they have no idea what happens to it, other than it somehow magically grows.

And what's with the wealthy fetish? I can also unequivocally say I've worked in the past with, and for, more 7 and 8 figure earners than you. They aren't going to be buying Gwyneth Paltrow vagina candles, but their wives, kids, and mistresses will use their money to pay for a ton of nonsense. Then again, you'd probably consider these people "nouveau riche" as they work for a living.

Lol what’s with this d*ck measuring contest about who interacts with the most rich people?

 

[dl2dp2]

No. I can tell you that's not how pharma works or capital markets in general. Rich people don't fund pharma research.

Rich people (i.e. in your sense, "financiers" broadly defined) don't fund it (actually, they do, it's called 'skin in the game', but then we'll have to talk about percentages), but they make decisions to deploy capital from institutional investors to provide financing for biopharma. CalPERS of the world are certainly not funding companies driven by woowoo. I'm not sure what you are trying to say here.

On occasion, a hedge fund or two interact with companies that are strongly driven by woowoo, like the whole Pershing Square Herbalife saga. But this is sort of the contra-lesson that proves the rule. Woowoo has no #valueadd. If you want to sell a personal brand, sell a personal brand. The most successful personal brand (i.e. the Kardashians and etc) deliberately don't use any woowoo marketing--they categorically avoid anything that's not 100% "authentic". They let their customers know that they buy stuff BECAUSE of the personal appeal ONLY.

Lol what’s with this d*ck measuring contest about who interacts with the most rich people?

People have these intrinsic emotional reactions to ideas about value capture. If you want to dick measure contest you need to first define who is a "rich person". A lot of these emotional reactions have to do with confusion in the conceptual foundation. e.g. a "rich person" who is a financier who makes money through carry by his biopharma hedge fund is not the same as a "rich person" who is your conventional upper-middle-class who has 300k banked in IRA but struggling to pay for kid's college, classically still seeking high-quality psychiatric services because the quality delta could mean employed or unemployed, and yet quite "rich" as the median savings number is you know what.

The idea that woowoo marketing would appeal, en masse, the capital base that supports the current payer-servicer model in mental health is complete nonsense. Nonsense. You'd have to think that everyone who runs any kind of sizable mental health service is an idiot. But feel free to not believe me and continue in that direction and see if your practice will thrive or if you'd get picked to be an admin.

 

[hamstergang]

This whole discussion is getting ridiculous and off topic. The initial post that started this train was what seemed like a joke about setting up a woowoo practice. That clearly can make money regardless of whether it's the richest of people or not who pay for it. The Amen Clinic makes a lot of money -- does it really matter what their clientele's median income is?

 

[Sushirolls]

When and where did woowoo come about? Please tell me y'all just made that up. Or have I just gotten older that I missed this 'woowoo' memo? Or is this geographical like some might say 'foo foo' in other regions?

 

[TexasPhysician]

I believe the question has been answered sufficiently and now off topic.