Wednesday, July 29, 2009

You call this a photo-op, Mr. President?

Hello? Who is doing PR for President Obama? Why would you put this picture -- the President trying out a surgical robot -- on the White House web site?

Look at this post on medGadget for commentary.

So, Mr. Obama provides free nationwide marketing for this device, a machine that is totally counter to what he is trying to accomplish with health reform.

The people at Intuitive Surgical must be gloating today. You can't buy this kind of publicity.

Maybe, next he should be seen piloting an F-22 (photo credit embedded).


Jerry said...

"...a machine that is totally counter to what he is trying to accomplish with health reform."

I also saw your comment at the linked site.

Is it the gross cost of the machine that prompts your concern? Something else?

I'm not familiar with the device, and have no sense of what surgeons think about it; or if there've been any studies about efficiencies or outcomes.

Is the device intended to increase efficiencies? Improve outcomes?

I haven't checked on Intuitive's stock today, but I unrerstand that "Shares of U.S. health insurers rose broadly on Tuesday on hopes that negotiators were moving away from the public plan idea, which has drawn strong opposition from insurers who fear it would destroy the private marketplace."

Mark Graban said...

That photo reminds me of Gov Dukakis and this famous (infamous) tank photo.

Saw another blog link to your November post about buying the robot. Can you do a follow up on your perceptions after having it in place? Is it already in place?

e-Patient Dave said...

Jerry, I think the point is that the surgical robots are costly and lack any evidence of producing better outcomes. They are a classic example of new technology that hospitals feel they have to buy, whether they like it or not, because otherwise they appear to be getting behind in technology, even if they're actually being cautious about controlling spending. And when they appear to fall behind, they lose business, rank lower in air-headed reputation polls, etc.

See Paul's post about this from last November, in which he cried "Uncle!" on just this point.

Last month I heard management guru Clay Christensen speak at a BIDMC CEO Roundtable last month. This is the guy who invented the study of so-called "disruptive innovation" in which new technology undercuts old, more expensive technologies. (PCs did to minicomputers what minis did to mainframes, etc.)

He clearly stated that not all innovation is disruptive; a "sustaining" innovation is "more of the same," not cost-cutting. In fact one of his slides explicitly warned, "The pursuit of profit and differentiation in *sustaining* competition amongst similar business models generally *adds* cost."

And that's the robot situation. New tools like that, however useful or clever they may be, won't transform healthcare - especially if there are market pressures to buy them, in the absence of any demonstrated value.

Anonymous said...

Agree with you, Paul. He got manipulated on that one. One learns by hard experience.


Albert Maruggi said...

And this is where marketing trumps logic. The question is, can more visible discourse as you and e-patient Dave, among others truly counter a presidential photo op and the desires of venture capitalists.

Isn't this the way the system is supposed to work, market forces and all?

It is fitting then that the verification code to post this comment is "gredi" I'm not kidding

Anonymous said...

Sorry, Mark, but no, I choose not to. I don't publish business results about specific investments like that. The machine is in place.

Anonymous said...

The other interesting part of this is the Presidents choice of visiting the Cleveland Clinic and touting them as a "model" of halthcare reform. Unfortunately most of healthcare in this country is not structured like the Cleveland Clinic and while they are admireable and we could learn from their practices, the rest of us are stuck in the past with hospital/medical staff structures and relationships that are counter productive to effective delivery of care. If healthcare reform just insures more people and does not change the structural and financial relationships between PCP, hospital and speacialist we will not see meaningful expense control.

Anonymous said...

Forgive me, but how is this DaVinci photo counter to what the President is trying to do? Doesn't this technology give individuals -- especially women -- the option of less-invasive surgery without tearing their bodies in two? Doesn't it reduce infection rates? Doesn't it reduce time in the hospital after surgery? Isn't it more precise than a human hand? Shouldn't it be accessible to all? We know insurance companies hate innovation -- hospitals do too?

e-Patient Dave said...

Anon 1:43,

As a surgical patient myself at BIDMC two years ago, I understand your interest in less-invasive surgery. But what on earth makes you associate that with women?? I had my kidney removed laparoscopically, and according to my wife, I'm quite different from her.

And what makes you think laparoscopic surgery requires a robot? Maybe you've unwittingly fallen prey to some DaVinci marketing hype. :) My BIDMC surgeon didn't need no stinkin' robot - he did it with his bare hands.

Paul's whole point in his original post last November is no, there is NOT any evidence that robots produce better outcomes. I wonder if you had a chance to read my earlier comment on this post.

The widespread misinformation on this subject makes me increasingly aware that a LOT of the excess healthcare cost in the US is simply a result of waste: spending that is completely unnecessary, or at least waaaay out of proportion to whether it produces better care.

Riddleberger said...

The DaVinci may perform less invasive surgical procedures which may require less hospital stay time and increase in quality measures, but when the same million dollar technology is utilized in communities within <30 miles of one another to hopefully gain a competitive advantage is when our healthcare dollars are cost shifted to the consumers!

I agree with you Paul in regards to the poor decision making of the executive office of the government to post this photo during potential healthcare reform.

Jerry said...

Thanks for your perspective on this, eP Dave.

I'm going to poke through the White House blog to see if this item came up in any remarks or discussions.

Wouldn't it be great if we had a working press that would pose the kinds of questions that have been raised here, and then follow-up on them?

Yeah, rhetorical question. I guess this is where blogs come in.

If it hasn't yet been addressed, I think it's an excellent issue to press on with, until the White House provides an answer.

Any takers here? Or is it easier to just take potshots? Yeah, rhetorical question.

Also, I'd really like to hear some surgeons weigh in on the matter, since this is a surgical device.

Finally, as I noted in my more extensive response to Paul's magic wand post:

g) An ongoing assessment and re-allocation of resources, to avoid and eliminate the kind of economically-unsound duplication of services often seen in urban areas with multiple tertiary care teaching facilities whose combined capacities exceed the needs of their service areas.

I'd say this matter falls under that general category regarding reform, so I don't need my arm twisted.

Anonymous said...

"Mark Graban said... That photo reminds me of Gov Dukakis and this famous (infamous) tank photo."

The whole impact of the Gov Dukakis photo was implict in the photo. He looked ridiculous and out of place in the tank. This photo of Obama regardless of how you feel about the political ramifications of him being seem with the robot, has no such element.

It is a BIG stretch to draw a comparison between the two.

Anonymous said...

Speaking of input from surgeons, I don't think one can assume that input will be nonbiased. For instance, urologists will tell you unequivocally that the best treatment for prostate cancer is surgical; while the radiotherapists will tell you unequivocally that the best treatment is radiation. (In a patient set in which all other factors are equal, that is.) The weight of the evidence so far does not unequivocally favor either one over the other.
However, that prompts a question for Paul: I know you don't want to release business results, but can you tell us:

a) is the surgeon reimbursed more for prostate surgery using the da Vinci device rather than the same surgery without it?

b) ditto for a hospital?



Anonymous said...

I don't believe there is any difference in rates for robotically assisted versus manual laparoscopic surgery.

Anonymous said...

there is however a huge difference in payments for radiation >>>>> surgery for treatment of prostate cancer. isn't that one of the questions we are trying to answer-for equivalent outcomes, how much more $$$ do we allow people to spend to support freedom of choice, to support future innovation, to support physician belief in their chosen fields?

Anonymous said...

Anon 1130:

Since there is not yet evidence to definitively support one treatment over the other, I don't think we can start making cost judgments on that one yet. The other thing is that the side effects of both treatments are different, but not insignificant in either case. Some patients may tolerate one side effect better than another. This complicates the matter even further, not only for this particular example.
This is why "comparative effectiveness research" needs to truly emphasize "effectiveness" first, before we start making cost judgments. See the attached commentary from the American College of Physicians on this touchy subject.