Wednesday, February 17, 2010

Hospitals and Doctors, Clinical innovations - Hospital Marketing and Robotic Surgery

A Case of the Obvious: People Responding to What They Usually Respond and Doing What They Usually Do

The battle is lost, marketing is driving the case here.

Jeffrey Cadeiddu MD, “Unproven, Robotic Surgery Wins Converts,” New York Times, February 11, 2010

If you only have a hammer, you tend to see every problem as a nail.

Abraham Maslow

Sometimes I am incredulous when people overlook the obvious.

It is obvious to me,

• hospitals will inevitably market technologies what draws people to their institutions, attracts specialists , and buttresses their bottom line.

• Specialists will gravitate towards those technologies that appeal to the public.

• The American people and American doctors cannot resist new technologies.

• People in general will do what they usually do to better their lot in life.

Health reformers may overlook the obvious as they seek to reduce costs and improve quality. They argue that data on outcomes will always prevail in a rational world. This sounds scientific, but it ignores the psychological nature of humankind.

I was present at a 1976 talk by Howard Hiatt, MD, who was then head of the School of Public Health at Harvard. He said the U.S. ought to form a national technological assessment center to curtail the marketing and premature use of CT scans.

This is a recurrent thought. It has resurfaced in the form of Comparative Effectiveness Research (CER). CER will supposedly separate the good technologies, i.e, the cost effective technologies, from the bad.

CER results will be embedded in protocols, checklists, and decision trees, and from these, doctors and patients and payers will learn what works and doesn’t work. Current reformers and Hiatt ignore the obvious – to doctors CT imaging and robotic surgery were and are potentially superior technologies, and physicians were and are going to use them, no matter what government officials thought and think.

This is true of robotic surgery for prostate cancer, as it was for CT scans. Urologists and other surgeons are going to use robots to perform surgery even in the face of higher costs and even if robotic surgery may not outperforms manual surgery.

There is something irresistible about machines replacing man – the consistency, the relative bloodlessness, the high tech appeal, the quicker recovery times, the doctor as a kind of remote pilot guiding the attack on a cancer enemy.

People will not wait for objective prospective appraisal. In time, we will know if robots surgery is superior to human surgery, but human nature being what it is, hospitals, doctors, and patients are unlikely to wait for results.

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