Wednesday, February 20, 2013

Americans and Their Medical Machines Revisited
Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity. If the face of our machines sag, we lift its faces up. If our pipes clog, we roto rooter them out or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to remove something in the machine’s interior, we take it out through a laparoscope. If the fuel or metabolic mix is wrong, we alter the mix or correct the metabolic defect with drugs If anything else goes wrong, we diagnose it and rearrange it electronically
R. Reece, MD, “Americans and Their Medical Machines,” Medinnovation blog, May 9, 2010

February 20, 2013 – When will critics of medical high tech ever learn?  Critics complain high tech machines should not be marketed or used until randomized control led studies prove their worth – until proven outcomes can justify their costs.
Yet American hospitals, physicians, and patients rush to try high tech  machines before study results are in.  This has been the case for CT and MI scans and PET imaging, for laporoscopic procedures, and now robotic surgeries.
The case in point for this blog post is the fast-growing, exploding use of da Vinci Surgical systems, where the surgeon site sits behind a console and operates four robotic arems that manipulate miniaturized tools inserted into the patient though tiny incisions. A study in the Journal of the American Medical Association doubts the value of robotic surgery.
Yet the number of  de Vinci robot surgeries is exploding – by a factor of 10 or more in the last 5 years.   Today 85% of prostates are removed  robotially.  And robotic surgeries have spread to surgery on the heart, lung, pancreas, abdomen, and gynecological region.

The average total cost for a robotic hysterectomy is $8,868,  compared to $6,679 for the laporoscopic procedure, and $6,651 for open surgery.  Patients may ask, why quibble about price when someone else in paying the bill?
Advocates maintain  robotic procedures require smaller incisions, and produce less scarring,  less pain,  fewer complications , shorter hospitals stays, and much faster recoveries.
So why not robotic?  Why not indeed?   Last year 1370 U.S. hospitals purchased at least one robotic system, and   robots performed 1.5 million procedures worldwide.  Besides, hospitals like robots  to show they are on the cutting edge.  Robots are great hospital marketing tools.  Surgeons like them. Their use attracts more patients and show they are masters of technology.  Patients swear by them because of  smaller incisions,  less pain, and faster recoveries.
What’s not to like? In the minds of hospitals,  surgeons, and patients, these very human factors outweigh lack of randomized controlled studies.  This may be unfortunate and non-scientific, but it is reality.
Should we surprised? I think not.  One of my most visited blog posts is “Americans and Their Medical Machines,” written over 2 years ago. And John Naisbitt, Author of the 1982 classic,  Megatrends. wrote:
“High tech/high touch is a formula I use to describe the way we have responded to technology.  What happens is that when a new te4chnology is introduced into society there must be a counterbalancing response, that is, high touch – or the technology is rejected .  The more high tech, the more high touch.”
The da Vinci surgical system is high tech, the faster recovery with less pain is high touch.
Tweet:  da Vinci  surgical robots for performing surgeries is catching on fast, though they cost more and are unproven to produced better outcomes

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