Visiting my in-laws in southern Florida, I came across a magazine story from the Westside Regional Medical Center with a story entitled "Dr. Robot is IN", extolling the virtues of their new $1.5 million da Vinci Robot Surgical System. It is also featured on their website.
The da Vinci system combines computer and robotic technologies and takes surgical treatment to the next level. Here's how it works.
As a surgeon prepares to perform a procedure using da Vinci, he or she sits at a console in the operating room that is often several feet away from the patient....
Because da Vinci magnifies images and its robotic arms follow the slightest movement of the surgeon's hands and feet (sometimes used to refocus the camera or adjust a robotic arm), da Vinci enhances dexterity, precision, and control during surgical procedures. da Vince can also scale down hand movements when the tiniest cuts are needed and eliminates hand tremors, which further enhances the technology;s precision.
A doctor at Westside says, "It offers excellent outcomes and a quick recovery, as well as many other advantages for today's on-the-go citizens -- all in the comfort of their community."
da Vinci is being set forth as the state-of-the-art approach to urological surgery, particularly prostatectomy (removal of the prostate.)
In a posting below, I set forth the current knowledge about the relative benefits of laparoscopic versus open prostate surgery. Suffice it to say that there is not a clear winner. Just so, too, in the case of regular laparoscopic surgery versus robot-assisted laparoscopic surgery.
So, in the absence of clinical evidence that the robot is better, what is going on here? Here's the answer, as set forth so clearly by Nancy Schlichting, President and CEO of the Henry Ford Health system in Detroit:
We've seen double-digit increases in the number of prostate cases performed since we introduced the da Vinci Surgical System.
And by the manufacturer:
The following are three examples of hospitals that have captured market share with the da Vinci Surgical System. These organizations have established a leadership position within their communities and have achieved a significant return on investment.
In short, what we have here is a new technology, with no proven advantage in terms of clinical results, that is rapidly moving forward in hospitals because urologists and their hospital administrators have become convinced that their market position depends on owning this robot. It apparently has worked as a marketing plan.
Since its first da Vinci System shipment, Intuitive Surgical has expanded its installed base to more than 300 academic and community hospital sites, while sustaining growth in excess of 25% annually.
Boston has not been immune from this land rush. Boston Medical Center recently bought this machine. The verdict from their surgeon: "Dr. Richard Babayan, chairman of urology at Boston Medical Center, said he's found no difference in continence rates in the 30 robotic cases he's done, compared with traditional surgery."
Notwithstanding the lack of evidence of enhanced clinical efficacy, I have been advised the following by one of our leading doctors:
Due to market forces beyond any of our control, the unfortunate reality is that without a DaVinci robot, BIDMC prostatectomy volume would likely plummet by 2010 and BIDMC would consequently quickly become a non-entity in regional prostate cancer care. This would have dire consequences for BIDMC clinical urology, radiology, radiation oncology, medical oncology, as well as for research in translational oncology. It is unlikely that [we can] fully gauge the breadth and depth of collateral damage that absence of a daVinci robot would bring to our medical center.
Why do I feel like the American Congress several years after President Bush promised them that Iraq had weapons of mass destruction?
Here you have it folks -- the problem facing every hospital, and especially every academic medical center. Do I spend over $1 million on a machine that has no proven incremental value for patients, so that our doctors can become adept at using it and stay up-to-date with the "state of the art", so that I can then spend more money marketing it, and so that I can protect profitable market share against similar moves by my competitors?
I welcome advice from those of you out there who care about the cost and quality of health care, but also from those of you in other business sectors who make choices like this all the time.