I love the sliding baby and the smoking father. The X-ray tech is unfortunately dead now since he wore no protective shield for the high tech $25,000 machine . And who wouldn’t want the pneumatic tubes for sending records?
This hospital was $2 million. The cost of building a hospital in 2009 is $2.5 million per bed. And that doesn’t include electronic medical records. Bring back the pneumatic tube.
When DrRich left his medical practice nearly a decade ago, he spent much of the next few years as a consultant to certain companies that make implantable defibrillators.
Most of his work was in research and development, and had next to nothing to do with defibrillators themselves, or any aspect of treating cardiac arrhythmias. Rather, DrRich was interested in developing physiologic sensors that could be deployed in implantable devices, and the algorithms that could use these sensors to predict and detect various developing medical conditions (so as to enable early intervention, and potentially prevent said medical conditions from becoming manifest). DrRich considered this work a) interesting, and b) representative of a business model that could potentially flourish within a healthcare system whose chief concern is reducing costs.
And whenever the captains of industry who signed his checks would ask him something about implantable defibrillators, usually seeking his opinion on a proposed subtle variation in some unbelievably complicated programming feature, DrRich’s reply was likely to be something like this: “Sir (or Madam) – I will be happy to study the question you pose to me, as I am working on your dime. But it greatly saddens me to see all this time, energy and talent wasted on adding yet more irrelevant features to a mature technology, in pursuit of a business model that is fundamentally broken.”
To which they would smile indulgently, hand DrRich the document describing the proposed changes, and schedule a meeting to discuss them.
The indulgent smile was in recognition of the fact that DrRich never made a secret of his disdain for the business model embraced by implantable defibrillator companies. The fact that these captains of industry put up with DrRich’s disapproval was a clear indicator that they considered it to be “quaint,” and apparently not worth taking seriously, and that the value DrRich provided in other arenas at least counterbalanced the annoyance of having him criticize their core business every chance he got.
DrRich’s disdain for the implantable defibrillator business model was based on two factors.
First, their business model relies on the artificially high prices the system will pay for their devices. DrRich has discussed this before. While these high prices are not directly the fault of the companies themselves (rather, they are fundamentally the fault of Medicare processes that distort and destroy natural market forces), these companies have now come to rely entirely on this artificial price structure, and have established all their business practices around this high-margin enterprise. The problem is that this high-price model absolutely precludes any reasonable penetration of this life-saving technology into the vast population of patients who might benefit from it. Also, because the price structure is not only artificial but arbitrary, a few simple changes in Medicare processes could abruptly destroy their business overnight.
Second, nobody is really interested in preventing sudden death. It’s difficult to sell any product when there’s no demand for that product, and there is no demand for sudden death prevention. In contrast, most other medical problems have a built-in constituency Read more »
The premier US cancer hospital and research center in Houston released a statement today distancing themselves from a Dallas company claiming an endorsement of their water product by The University of Texas M.D. Anderson Cancer Center:
Recently, you may have heard or read about a company that sells Evolv, a “nutraceutical beverage,” which is being promoted in part based upon testing done at The University of Texas M. D. Anderson Cancer Center, but also is being mistakenly viewed as endorsed by M. D. Anderson. M. D. Anderson conducted limited chemical analysis of the product to evaluate its anti-inflammatory activity for a fee at the request of the manufacturer. No efficacy or toxicity data were generated at M. D. Anderson nor was the product tested on humans. Moreover, M. D. Anderson does not have any involvement with the company, the product is not produced by M. D. Anderson, and M. D. Anderson does not endorse the product or recommend its use.
Evolv’s nutraceutical beverage with Archaea Active is tested by M.D. Anderson Cancer Center in Houston, Texas.
The statement as listed is not exactly wrong; it’s just not complete. Nothing there about what the product was tested for, but the implication is that it gained some healing power by passing through the hallowed halls of M.D. Anderson. I also have no clue as to whether it was tested for archaea (formerly archaebacteria) or if it has the capacity to amplify DNA.
Of course, my blogging about this is going to give the company publicity (a very, very small amount). Evolv is not just water but it is sold by a multi-level marketing company. I already knew to put one hand on my wallet when I dialed up their website. The header has the quote from Mary Kay Ash, “Nothing happens until somebody sells something,” which rotates with others from her and Zig Ziglar who, no doubt, did not authorize their association with the company.
Note added 10 September 2009: This comment from EvolvHealth’s Chief Marketing Officer, Mr Jonathan Gilliam, brought to my attention that I had the incorrect website for the company (as corrected above). The actual website should be http://evolvhealth.com. Currently, their product page lists the M.D. Anderson claim as follows:
Our active ingredient has been tested by the MD Anderson Cancer Center of the University of Texas. Evolv will be released in Fall 2009
*This blog post was originally published at Terra Sigillata*
I’m sure I don’t see as many patients with common skin warts as my family practice or dermatology colleagues, but these patients still make it to my office. Sometimes it’s the primary complaint, sometimes it’s an afterthought. In reviewing the topic, it occurred to me that most patients don’t need to see any of us for this problem. They mostly need to accept the fact that the treatment takes TIME. So if you will persist, then you will often be successful without the expense of seeing a doctor. (photo credit)
Common warts (Verruca vulgaris) are caused by the human papillomavirus (HPV). Warts on the hands or feet do not carry the same clinical consequences of HPV infection in the genital area. It is estimated about 10% of children and adolescents have warts at any given time. As many as 22% of children will contract warts during childhood.
Common warts can occur anywhere on the body, but 70% occur on the hand. Often they will disappear on their own within a year. Even with treatment, warts can take up to a year to go away.
Before heading to the doctor, there are treatments you can try at home: salicylic acid or duct tape.
When using the 17% salicylic acid gel (one brand name: Compound W), it must be applied every day until the wart is gone. Only apply to the wart, not the skin around the wart. This treatment is enhanced by covering the wart with an occlusive water-proof band-aid or duct tape after applying the acid. It can also be enhanced by gently filing the wart with an emery board daily to remove the dead cells prior to applying the salicylic acid. Treatment can take weeks to months. Don’t give up early.
Duct Tape can take weeks or months to be effective. Apply the duct tape to the wart and keep it in place for six days. After removing the tape, soak the wart, and pare it down with a filing (emery) board. Repeat the above until the wart disappears. Once again, don’t give up early.
The two treatments (salicylic acid and duct tape) can be combined. Apply the salicylic acid liquid to the wart before bedtime. After letting it air dry for a minute or so, then apply the duct tape over the wart, completely covering the area. Remove the duct tape the following morning. Each time you remove the tape, you will be debriding some of the wart tissue. Repeat the application each night, until there is no remaining wart tissue. As with using only one treatment, don’t give up early.
If the above don’t work or you just don’t want to take the time, then you may wish to see your physician for removal. He can use cryotherapy to destroy the wart. This method may involve repeated treatment over several weeks. You can do the following to “get the wart ready for removal” and make the cryotherapy more effective:
Every night for 2 weeks, clean the wart with soap and water and put 17% salicylic acid gel (one brand name: Compound W) on it.
After putting on the gel, cover the wart with a piece of 40% salicylic acid pad (one brand name: Mediplast). Cut the pad so that it is a little bit bigger than the wart. The pad has a sticky backing that will help it stay on the wart.
Leave the pad on the wart for 24 hours. If the area becomes very sore or red, stop using the gel and pad and call your doctor’s office.
After you take the pad off, clean the area with soap and water, put more gel on the wart and put on another pad. If you are very active during the day and the pad moves off the wart, you can leave the area uncovered during the day and only wear the pad at night.
If none of the above work, then your wart may need to be removed surgically. Remember the above all take time, so give them time to work. Even if the wart disappears with any of the above treatments, it may recur later.
Sources
Treatment of Warts; Medscape Article, May 27, 2005: W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD
I got something in my e-mail this morning. It’s a press release aimed at helping with prostate cancer awareness month, and is supported by Lance Armstrong’s foundation.
SURVEY SHOWS AT-RISK MEN LACKING IN PROSTATE CANCER KNOWLEDGE
SUNNYVALE, CALIF.,– September 9, 2009 – Prostate cancer remains one of the most commonly diagnosed cancers in the United States. In fact, one in six men will develop prostate cancer. It is also the second-leading cause of cancer death in the United States. But a recent survey suggests that many men at risk for the cancer still aren’t aware of all available treatment options. The survey, conducted late last year, reveals that nearly 50% of men aged 40 and older are not aware of the most common approach to surgery for prostate cancer — robotic-assisted surgery to remove the prostate. “I had to do my own research and then self-admit myself to the [hospital],” says surgery patient Tim Propheter. “…. Most people are just told … ‘Sorry, you have to have surgery, and we’ll set you up for such and such day,’ and they don’t know any better until they run into someone like me,” he says. This lack of information persists despite the fact that prostate cancer treatment has changed dramatically in the last decade. For example, surgery — which remains the gold standard treatment for localized prostate cancer — has become much less invasive. According to the American Urologic Association, the major benefit of prostatectomy, or prostate removal, is a potential “cancer cure” in patients with localized or early stage cancer.
Guess who the press release was from? Guess who sponsored the survey? The following was at the bottom of the email:
About the survey
Data was collected from 1000 self-selected adult healthcare information seekers through an online panel available through Ztelligence.com, using an survey questionnaire. Fifty-four percent of those were male and 46 percent were female. The results reflect only the opinions of the healthcare seekers who chose to participate.
About Intuitive Surgical, Inc.
The survey was conducted by Intuitive Surgical, Inc. (NASDAQ: ISRG), the manufacturer of the da Vinci Surgical System, the world’s only commercially available system designed to allow physicians to provide a minimally invasive option for complex surgeries. Intuitive Surgical, headquartered in Sunnyvale, California, is the global technology leader in robotic-assisted, minimally invasive surgery (MIS). Intuitive Surgical develops, manufactures and markets robotic technologies designed to improve clinical outcomes and help patients return more quickly to active and productive lives. The company’s mission is to extend the benefits of minimally invasive surgery to the broadest possible base of patients. Intuitive Surgical — Taking surgery beyond the limits of the human hand.™
Imagine that. A survey done by company that sells the da Vinci robotic surgical equipment shows that men have tragically no knowledge of the da Vinci robotic prostate surgery!
So let’s see what the evidence shows:
Prostate cancer occurs in 186,000 men each year and kills nearly 29,000.
In a well-known autopsy survey, over 1/3 of men over 80 were found to have cancer present in their prostate without evidence of significant disease. It is not clear how many of these men will progress to overt cancer, but it is very clear that this is the vast minority.
PSA Testing (the blood test for prostate cancer screening) is by far the largest source of surgical candidates. It is a controversial test, having a high rate of false positives and an unproven record of significant benefit.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a small absolute survival benefit with PSA screening after nine years of follow-up; however, 48 additional patients would need aggressive treatment to prevent one prostate cancer death. Although the report did not address quality of life outcomes, considerable data show the potential harms from aggressive treatments. Further sustaining the uncertainty surrounding screening, a report from the large United States trial, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, published concurrently with the European trial, found no benefit for annual PSA and digital rectal examination (DRE) screening after seven to ten years of follow-up. The crux of this screening dilemma was aptly stated by the urologist Willet Whitmore, who asked “is cure possible in those for whom it is necessary, and is cure necessary in those for whom it is possible?”
The most important line in this is at the end of the first sentence, stating that 48 patients would need aggressive treatment (including prostatectomy) to prevent one prostate cancer death. So how much does “aggressive treatment to prevent cancer death” cost?
For patients in the treatment-received analysis, the average costs were significantly different; $14,048 (95% confidence interval [CI], $13,765 to $14,330) for radiation therapy and $17,226 (95% CI, $16,891 to $17,560) for radical prostatectomy (P < .001). The average costs for patients in the intent-to-treat analysis were also significantly less for radiation therapy patients ($14,048; 95% CI, $13,765 to $14,330) than for those who underwent radical prostatectomy ($17,516; 95% CI, $17,195 to $17,837; P < .001).
note: it was very hard to find numbers here. This is actually from Medicare claims from 1992 and 1993, so it is a huge underestimate from today’s numbers.
Which means that based on the 1992 numbers, you would spend $672,000 to save one life using radiation therapy and $1,084,000 if you used surgery. This does not take into account the consequences of surgery for the men who underwent the surgery.
What about robotic surgery? In a comparison of the cost of open prostatectomy to robot-assisted surgery, the cost is even higher.
Cost was the one area in which the older open surgery was the clear winner: Open radical prostatectomy costs $487 less a case than non-robotic laparoscopy and $1,726 less than robot-assisted prostatectomy.
According to the review, “Shorter operative time and decreased hospital stays associated with the robotic procedure did not make up for the cost of the additional equipment expenditure.” Estimated costs of the robotic system to a provider run about $1.2 million a year, with maintenance costs of $120,000 a year and one-time costs of $1,500 a case.
To summarize:
Prostate cancer screening is controversial, as it fails to differentiate between the minority of men who would die from the disease from the majority who would simply die with it.
PSA Testing as greatly increased the number of men diagnosed with early stage cancers.
Prostate cancer surgery or radiation therapy is recommended for men who have early stage cancers.
Aggressive prostate cancer treatment has to be done 48 times to save one life.
The most expensive treatment for prostate cancer is prostatectomy, or removal of the prostate.
The robotic form of the surgery is a higher-cost procedure by a significant amount.
So, an expensive form of surgery that may not be appropriate is done on a group of men identified on a very unreliable test yielding a very small number of lives saved and a lot of men who then have to deal with the physical consequences of the surgery. Why in the world is this being promoted at all?
Money. Here’s the homepage of one of our local hospitals. They have aggressively marketed da Vinci surgery on television, billboards, and the radio.
Why do you think they would pay as much money as they do for this device? It’s good business? Not so fast. Dr. Paul Levy stated back in 2007 about this very procedure:
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?
No, hospitals are employing this just to keep pace. The real winner in this is Intuitive Surgical, Inc., who has been a darling of Wall Street, beating estimates in earnings with a Q2 net profit of $62.4 Million.
Why is the cost of healthcare going up while physician reimbursement goes down and hospitals go out of business?
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