Robotics, protons and healthcare. While it may sound like something from a Star Trek marathon, I was actually reviewing some interesting healthcare news items this week that posed an intriguing question: Do we really know what we are paying for when it comes to high-tech healthcare solutions?
The first instance comes from the story on how hospitals--on their websites--appear to exaggerate the benefits of robotic surgery. Researchers at Johns Hopkins found that 41 percent of the 400 hospital websites they reviewed mentioned that they had robotic surgery.
Many times, the sites touted the advantages of robotic surgery over conventional surgery--such as less pain, shorter recovery, less scaring and less blood loss. But there is one big problem: these benefits have not been studied and verified through randomized controlled studies, the researchers said.
And, according to lead researcher Marty Makary, MD, of Johns Hopkins, no randomized, controlled studies have been completed showing patient benefit in robotic surgery. "New doesn't always mean better," he says, adding that robotic surgeries take more time, keep patients under anesthesia longer and are more costly.
This is not apparent after reviewing hospital websites that promote its use, he said. For example 33 percent of hospital websites that make robot claims say the device yields better cancer outcomes--a point, he said, is misleading to vulnerable cancer populations seeking top care.
The next story comes from Cleveland where plans for a new $30 million proton center were announced this week by University Hospitals, as part of its new cancer center. Proton therapy is hardly new--it was first proposed in the 1950s, and currently about nine centers across the country provide services to cancer patients. But it is expensive to develop.
Proton therapy has been used to provide more exact targeting of a tumor than other types of traditional radiation therapy, for example. But like the robotic surgery, one issue continues to dog the therapy: a lack of rigorous testing--through randomized, control trials--that show that this therapy works better than standard therapies (which cost far less) for various conditions.
In a technology brief from the National Cancer Institute, Kevin Camphausen, MD, chief of NCI's Radiation Oncology Branch, is quoted as saying that proton therapy has "wonderful potential" for treating some cancer. However, he cautioned that its use should not become widespread until "we can validate where it's needed, and where it has the greatest potential benefit for patients."
One of the critics of the new proton facility is Paul Levy, MD, the former chief of Beth Israel Deaconess Hospital in Boston, who was known for his blog on running a hospital. Now on his new blog, "Not Running a Hospital," he sent an open letter to Centers for Medicare and Medicaid Services head Don Berwick, MD, on Wednesday to "stop the proton beam arms race" and change the higher Medicare reimbursements for proton therapy.
Levy had argued earlier that he was not debating the use of proton beam therapy on certain types of cancer. The problem becomes when the hospitals--as purchasers--begin to use the technologies on other cancer or conditions that could be treated with less expensive equipment that is currently available.
So again we come back to the issue of whether new and improved is really new and improved when it comes to providing--and paying--for healthcare. Many time hospitals may be persuaded to follow this route to keep up with their competitors. But we need to rivisit the question: is the evidence there to support the changes? If it's not, should we as patients--and as part of the healthcare community--be paying the additional costs for it? - Janice