In Medicine, Falling for Fake Innovation

From the New York Times online, commentary from Ezekiel J. Emanuel.

The sleek, four-armed “da Vinci” robot has been called a breakthrough technology for procedures like prostate surgery. “Imagine,” the manufacturer says, “having the benefits of a definitive treatment but with the potential for significantly less pain, a shorter hospital stay, faster return to normal daily activities.”

That’s just the kind of impressive-sounding innovation that critics of the health care reform act say will be stifled by the new law, with its emphasis on cost control and the comparative effectiveness of new pills and devices. “Instead of encouraging innovation,” wrote Senator Ron Johnson, Republican of Wisconsin, in The Wall Street Journal, “it stifles creativity.”

The critics are right — if they’re talking about innovations like the da Vinci robot, which costs more than a million dollars and yet has never been shown by a randomized trial to improve the outcomes of prostate surgery. Indeed, a 2009 study showed that while patients had shorter hospital stays and fewer surgical complications like blood loss when they underwent this kind of robotic surgery, they later “experienced more … incontinence and erectile dysfunction.” Similar problems are occurring with robotic surgery for other cancers.

In other words, this is a pseudo-innovation — a technology that increases costs without improving patients’ health.

To read the complete article, click here.

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