TCS Daily


No Excuses Medicine

By David Charles - April 9, 2001 12:00 AM

Dr. David Charles is the Director of the Movement Disorders Clinic at Vanderbilt University Medical Center and Chairman of the National Alliance of Medical Researchers and Teaching Physicians

When the members of the insurance lobby gathered in Washington last month to single out technology for the rising cost of health care, they traveled to the nation's capital on airplanes that are much safer places to be in case of heart attack thanks to technology. Portable heart defibrillation devices, increasingly common on airplanes these days, are estimated to increase the survival rate for in-flight cardiac arrest sufferers by tenfold. They are so advanced they can be safely operated by an untrained passenger.

At a time when technology is fundamentally transforming so much of our daily lives, small miracles like the portable heart defibrillator - which voice prompts the user through its correct application and won't deliver a shock to the patient unless it detects the right symptoms of arrhythmia - are increasingly taken for granted. In the rush to blame some one or some thing for the rising cost of health care, the temptation is to view these technological wonders as expensive indulgences to be done away with rather than the building blocks of a higher quality, more patient-centered and less expensive health care system.

At their meeting, the members of the Health Insurance Association of America (HIAA) succumbed to this temptation and released a report blaming the increases in the premiums they charge patients on medical technology. But scapegoating technology for higher health care costs is like blaming computers in classrooms for higher education costs - it's misdirected, shortsighted and self-defeating. Technology may impose higher costs in the short term, but the long-term payoff is a higher quality of life for patients, a higher quality of care from doctors, and a more efficient, lower cost health care delivery system for everyone.

More than higher spending or smarter doctors, technology is the force driving improvements in patient quality of life today - improvements that often can't be captured on balance sheets and account ledgers. Thanks to medical technology, advances in angioplasty have made the procedure a less risky, less expensive alternative to open-heart surgery, reducing recovery time from 4-6 weeks to one week. Breast cancer is detectable earlier thanks to advances in mammography, lowering costs and increasing survivability. And hip and knee replacement surgery is less invasive, requiring shorter absences from family and work.

In my own practice in movement disorders at the Vanderbilt University Medical Center in Nashville, I've seen medical technology transform the lives of patients living with Parkinson's disease. A medical device now available about the size of a heart pacemaker sends electrical impulses deep into the brains of Parkinson's patients to control the tremors and painful muscle rigidity caused by the disease. It's not yet a cure - although it shows potential for slowing the relentless loss of muscle control experienced by sufferers - but it is an innovative new break-through that could allow the over 1 million Americans with Parkinson's to live fuller and more comfortable lives.

And the same technological advances that have transformed the quality of life for patients have the potential to transform the health care system itself. In an important sense, technology will do what managed care promised but failed so miserably to do: provide higher quality medical care to more people at a lower cost. Instead of robbing patients of control over their medical care as managed care did, technology empowers them with information and options. Already, information technology and the internet are changing patients' relationship with their health care providers, giving them more information about the range of doctors, drugs and therapies available. Telemedicine will soon take this one-way flow of information - from the Internet to patients - and make it an interactive experience between health care givers and consumers.

Take the day-to-day management of chronic disease, which accounts for a whopping 79 percent of our health care spending today. Combining the power of the Internet with implantable devices like the one we use to control tremors for Parkinson's patients will soon transform the management of chronic disease by transforming the doctor-patient relationship. Doctors will be able to perform virtual office visits using information captured by these devices. Patients will be able to transmit real physiological data like EKGs and blood pressure readings to their doctors over the Internet. Some devices will even allow doctors to remotely adjust their functioning in response to physical changes in the patient. The bottom line is that patients will be able to be in constant communication with their medical team - without ever having to leave the comfort of their homes.

This is the promise of technology: to transform not just the quality of life of patients, but the quality of the health care delivery system itself. So instead of searching for excuses for how to avoid investing in medical technology, we should be looking for ways to bring its promise to more Americans. Government approval of new devices by the FDA and the Health Care Financing Administration (HCFA) should be faster and more transparent. Private insurers should stop being co-conspirators in government foot-dragging.

Whether it's portable defibrillators or devices to ease the suffering of Parkinson's patients, technology is the solution, not the problem to our heath care woes. It's time to put aside excuses and let the information-technology revolution in health care begin.
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