You would hope that decisions about treatment pathways for patients are made with outcomes in mind – albeit tempered with the realism that having a finite budget brings to the table. This is not always the case.

There are a lot of influential, wealthy vested interests at play in healthcare, and sometimes it isn’t easy to tell whether decisions are being made exclusively on the basis of what is best for the patient, or if an element of the decisions reflect what is best for those in the profession whose position and wallets lend them the most strident voices.

This is never more apparent than when considering the implementation of new, and sometimes disruptive, technology.

Take telemedicine. Subscribers can read this week how within a three week period telemedicine was legalised and then re-banned after Brazil’s Federal Medical Council received hundreds of complaints – many, we hear, from doctors concerned about losing business.

Yes, there are legitimate concerns about how telemedicine is implemented, the difficulty of long-distance diagnosis, and questions over the extent to which prescription should be allowed and whether a prior in-person appointment should be a prerequisite. But the speed with which the legitimisation of telemedicine was overturned following an outcry by members of the profession hints to us at something else at play, at least in part.

Similarly over in India, QI Spine Clinic is attempting to circumvent normal channels using data to identify when patients might benefit more from non-surgical solutions. We expect it to meet resistance from the hospitals carrying out such surgery. And to be fair, there may also be resistance from insurers struggling to judge the efficacy of non-surgical remedies.

Throughout, all the professional parties involved claim to have patient outcomes at the forefront of their decision-making but often this is not the full story. Subscribers can read more about both of these stories this week.