The decision to opt for medical care that relies on the most costly technology is often based on blind faith that newer, elaborate and expensive must be better.
The sentiment is understandable. We look to the miracles of medical technology to solve all sorts of problems, from weight loss to wrinkle removal. We place even greater faith in this technology when engaged in life’s inevitable losing battle against disease and death.
So exalted is medical technology that it has become our de facto God during times of personal health crisis. Considerations about costs fly out the window. Risks are downplayed or ignored.
Hospitals and physicians are perhaps even more susceptible than the lay public to the allure of new medical technology. Competitive market pressures and our enduring hope that somehow the latest, greatest and best will help us beat the odds combine to create an environment that, at its worst, can foster irrational and ill-considered decisions.
We seem to be promoting newer technology even in the absence of data. Exciting cutting-edge treatments are marketed with the singular effect of peddling hope to patients when they are at their most vulnerable. Rival hospitals and physicians afraid of losing revenue respond by escalating the medical arms race, buying more and more expensive new technology.
Once purchased, the pressure to use this new equipment becomes overwhelming. A procedure accomplished perfectly well ― maybe even better ― with older technology is shoved aside.
One health care administrator told me the basement of the hospital is full of million-dollar machines collecting dust ― not because they didn’t work or because they were ineffective, but because they have been displaced by newer technology.
All of this spending, which in part explains why the U.S. has the world’s most costly health care system, takes place while the country ranks 46th in infant mortality and 36th in longevity ― tied with Cuba, according to the United Nations.
To be sure, technological advances have on the whole brought undeniable benefits to health care. The list is long, from the invention of antibiotics to the development of anesthesia.
What is different with the new wave of technological marvels is that many are heavily driven by marketing, require that physicians master arduous new skills and often lack clear benefits compared with established and less-costly technology.
Now 10 years into surgical practice, I have learned some hard lessons related to new equipment and techniques. For one, patients often are put at greater risk as we physicians scale the learning curve.
But put aside for a moment that costs increase when the doctor isn’t familiar with the technology. More things can go wrong.
The most telling case in point is that of robotics used for surgery. They are costly and require significant re-training for surgeons. Yet consumers hungrily seek out surgeons versed in their use. If a surgeon recommends an older, less expensive technology, many patients will shop for a surgeon willing to use the newest and costliest devices, even if the added benefits are unproven and the risks may be greater.
Hospitals do nothing to discourage this and engage in the kind of tawdry marketing more familiar on late-night infomercials by using patient testimonials. “I cannot believe how quickly I recovered,” a vigorous-looking patient is quoted as saying.
As a surgeon I have to ask: Where is the data? Was the recovery any quicker than in a procedure done without a robot? Would another surgical approach have served the patient as well? And cost a lot less?
I have been using a robot known as da Vinci, made by Intuitive Surgical Inc., since 2004. The system was developed with funding from the U.S. Army with the main goal of allowing the surgeon to operate through telepresence at a safe distance from a wounded soldier on the battle field.
In a hospital setting, the surgeon sits in the corner of the room at a master console looking into a 3-D virtual view of the surgical field. Hand movements of the surgeon are translated to the robotic arms at the bedside a few feet away. This disconnect of surgeon from patient comes with a $2 million price tag (for the robot) and costs $2,000 to $3,000 each time the device is used.
I try to tell my patients there is no conclusive data aside from reduced blood loss to show the da Vinci is significantly better than open surgery. Furthermore the reduced blood loss is most likely secondary to the machine’s laparoscopic approach, in which one or several tubes are inserted into the body, letting the surgeon see and operate, rather than the benefits of the robot itself.
For example, in using the da Vinci for removal of the prostate in cancer patients, there is no consensus in the data that it provides any improvement in post-operative potency or urine control compared with standard laparoscopy or even larger incision surgery. There has even been some data to suggest cancer control can be compromised with robotic surgery.
But when I tell prospective patients and their families that I plan to use a robot, more often than not they grow wide-eyed and awe-struck.
Lost in the discussion is that I have actually become dependent on the da Vinci. My skills with standard laparoscopy have suffered to the point that I am now reliant on the robot to assist me in performing some of the finer movements of the surgery. Rather than being viewed as incompetent, though, I am seen as the priest who, imbued with the power of robot, will deliver the patient from the shadow of death.
When done correctly, innovation should make things more cost-effective and safer while ensuring better results. There are always ramp-up costs and physician-learning curves to consider, and therefore we must use only the most appropriate innovative technology and use it wisely.
We are all keepers of the health-care system treasury. In making treatment choices, physicians and patients alike would do well to ask: “If I were paying for this out of my own pocket would I choose this treatment, or am I just being wowed by the cool factor at someone else’s expense?”
In the first decade of practice I was enthralled with the amazing new technology. Moving into my second decade I hope to temper some of that enthusiasm with a bit of good old-fashioned fiscal responsibility.
By Craig D. Turner
Craig D. Turner practices urology in Portland, Oregon, and is founder of medical device company ETHOS Surgical. The opinions expressed are his own. ― Ed.