Ever so briefly…
In the Annals of Internal Medicine I came upon an article:
Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation
by
- Aaron L. Nelson,
- Joshua T. Cohen,
- Dan Greenberg,
- and David M. Kent
The title was a little off-putting, but the message was sound. In medicine it very rarely happens that we invent technology that is less expensive and almost as good. In all sorts of other fields we do that. India invented the Nano, a small, very cheap, very fuel efficient car. Apple created the iPod shuffle. I don’t know who invented the amazingly warm, rock bottom cheap microfiber soft fluffy fabric that my bathrobe is made of, but my hat is off to them. In medicine we keep innovating, and we make these things that are a tiny bit better than the thing before them, and are much more expensive. If cost were of no consequence this would not be an issue. But when we talk about more expensive, the millions of dollars that get spent on these new technologies quickly adds up.
In this article the authors look at some of the rare medical technologies that are less expensive than the pre-existing technologies with which they compete, and come up first with the cardiac angioplasty, or PTCA. In this procedure a blocked artery around the heart is dilated open with a balloon rather than being bypassed surgically. It is much cheaper to do it that way, but not quite as effective. But the researchers fail to point out that this procedure also allowed all sorts of people who wouldn’t have been able to tolerate heart surgery to live free of heart pain or heart attacks for years. So the technologies that are cheaper are, in a way, also sometimes better.
I merely point this out as yet another path toward responsible, successful, human centered medical care.
The cost of angioplasties and stenting is cheaper for each individual event, about 1/2 to 2/3 the cost of a CABG. However, its effects do not last nearly as long. People are needing to go back much more often for follow up procedures. Patients do go back to work faster. I know patients who have had 7 procedures over the course of 5 to 10 years before getting a CABG.
We really dont need to invent new, almost as good stuff. We already have them, the old stuff. So much of what is new, especially in devices shows marginal improvements. Same with drugs. If we just gave people the option of having the slightly older therapy, we could save a lot. Was health care that much worse in 2006?
Steve
I agree, sort of. But I also think that innovation in the right spirit can include things that are a little less perfect and a lot more accessible.
To the general point, our culture promotes a blanket assertion: More is always better. Outside of medicine, this drives the consumption culture that translates the more-better from the individual level (I’ve got a new(er, better) toy!) to the corporate level, being increased profits and higher compensation for executives and stockholders.
We need a new culture, which I dub the culture of enough. We have moved beyond the planned obsolescence model into the forced consumption model, case in point: A coworker who has a well-functioning, six-year-old PC that cannot process very well because the software she is forced to use is designed assuming that the PC it runs on has a CPU twice (or more) as fast and has double (or more) memory available to it. I’m not referring to high-end graphics or anything close to it. I’m referring to email apps, internet connectivity and simple document apps like Word and Excel.