December 31st, 2011 by ChristopherChangMD in Opinion, Research
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I came across this article the other day regarding use of the daVinci robot to perform base of tongue surgery for obstructive sleep apnea.
For those who don’t know, the daVinci robot system made by Intuitive Surgical is a robotic system whereby the surgeon directs the arms of the robot to perform surgery in difficult-to-access areas of the body.
My feeling is that using a robot to perform sleep apnea surgery is way overkill akin to using a $50,000 sniper rifle to kill an ant on the wall.
Everything the daVinci robot can do can also be done without the robot with equivalent patient outcomes. In fact, Read more »
*This blog post was originally published at Fauquier ENT Blog*
August 8th, 2011 by GarySchwitzer in Opinion, Research
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The surgeon who blogs as Skeptical Scalpel writes that he (she?) is unable to contain him(her)self any longer and then lunges into a review of evidence (or lack thereof) for robotic surgery.
You may disagree with Skeptical Scalpel’s decision to be anonymous, but he/she explains:
“I’ve been a surgeon for almost 40 years and a surgical department chairman for over 23 of those years. During much of that time, conforming to the norms, rules and regulations of government agencies, accrediting bodies, hospitals, societies, and social convention was necessary for survival. I was always somewhat outspoken but in a controlled way most of the time. I now have a purely clinical surgery practice with no meetings, site visits or administrative hassles. I am free to speak my mind about medicine or anything else.”
On robotics, Skeptical Scalpel writes: Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
March 24th, 2011 by GarySchwitzer in Opinion
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Maggie Mahar’s Health Beat blog tipped me off about a Bloomberg opinion piece by an Oregon urologist that begins by stating:
“The decision to opt for medical care that relies on the most costly technology is often based on blind faith that newer, elaborate and expensive must be better.”
Later, he focuses specifically on robotic surgery devices:
“They are costly and require significant re-training for surgeons. Yet consumers hungrily seek out surgeons versed in their use. If a surgeon recommends an older, less expensive technology, many patients will shop for a surgeon willing to use the newest and costliest devices, even if the added benefits are unproven and the risks may be greater.
Hospitals do nothing to discourage this and engage in the kind of tawdry marketing more familiar on late-night infomercials by using patient testimonials. “I cannot believe how quickly I recovered,” a vigorous-looking patient is quoted as saying.
As a surgeon I have to ask: Where is the data? Was the recovery any quicker than in a procedure done without a robot? Would another surgical approach have served the patient as well? And cost a lot less?
…
We are all keepers of the health-care system treasury. In making treatment choices, physicians and patients alike would do well to ask: “If I were paying for this out of my own pocket would I choose this treatment, or am I just being wowed by the cool factor at someone else’s expense?”
In the first decade of practice I was enthralled with the amazing new technology. Moving into my second decade I hope to temper some of that enthusiasm with a bit of good old-fashioned fiscal responsibility.”
It should be noted that the urologist/author discloses in the editorial that he is is founder of a medical device company with its own surgical system.
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
August 30th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News
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More than one-fifth of hospitals are government-owned, but states and counties are out of cash to keep them open. So, charitable hospitals are being sold to for-profit groups or facing closures. Rising costs and more uninsured patients run smack into falling Medicare and Medicaid reimbursement. When bonds come due, there’s little chance of states and counties paying them back. And the facilities are often standalones, and they can’t fall back on corporate backing. This year, 53 hospitals have been sold in 25 arrangements. While the deals often stipulate that care for the poor continues, no one is certain exactly how or even whether such services will continue.
That said, other charitable hospitals are making big profits. What are they doing differently? First, they’re competing for patients, so they’re increasing room sizes, offering amenities and even investing in high-end procedures such as robotic surgery. They continue to offer community care, but they’re acting more like for-profit institutions to cover their charitable missions. But this conflicts with an old-fashioned view of what charitable care is supposed to be.
Stepping into the breach is the Centers for Medicare and Medicaid Services, which is offering one solution, by increasing reimbursement for inpatient services in rural areas. The agency is expanding a pilot program by increasing reimbursement for inpatient services. Facilities are eligible if they offer care to rural areas in the 20 states with the lowest population densities, have fewer than 51 beds, provide emergency-care services and are not a critical-access hospital. (Wall Street Journal, Washington Post, Modern Healthcare)
*This blog post was originally published at ACP Internist*
August 21st, 2010 by AndrewSchorr in Better Health Network, News, Research, True Stories
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There’s news that Hollywood star Michael Douglas, 65, is undergoing treatment for throat cancer. Reporters say his doctors say he is expected to make a full recovery. But, believe me — when someone is diagnosed with any kind of head and neck cancer, as this is, it’s not an easy go.
My first encounter with it was with my friend Bob Moore, a former sales rep for a major pharmaceutical company. He was a positive, yet realistic guy. The disease and the toxic treatment a few years ago eventually took its toll and he passed on.
My dear friend Mike Piller, famous as writer and co-executive producer of the Star Trek television series, had a similar diagnosis. He did his research and traveled to the best centers. Surgery and radiation took away part of his jaw and his ability to taste and swallow. Of course his speech was affected. He was a trooper, but he never recovered.
In both cases the doctors did what they could to cut out or zap the cancerous tissue tucked away around a lot of critical structures. Read more »
*This blog post was originally published at Andrew's Blog*
