SHIFT: How medical technology can help cure U.S. health care

Health-care spending has doubled since the mid '80s. Trying to figure out why, lots of people are pointing fingers toward high-tech gadgetry, and the expensive drugs that advanced medical technology has created. That's understandable when a day in intensive care can cost $10,000. Spending on medical tech has risen to well over $200 billion per year and is responsible for 20% of those rising costs.

But wait a second. Sure, technology is inflating costs, but it's also saving lives, isn't it? The problem with medical tech isn't the cost, but that it's used at the wrong times and on the wrong patients. For example, how do you decide if a $100,000 drug should be administered to a terminally ill patient? That's where tech can help us out of this jam, using networked information to figure out where to aim these big guns.


Tech Successes

The medical tech landscape is heavily populated by success stories. Spiffy gadgets such as the MRI machine and PET scan can diagnose diseases that used to require invasive surgery. Cardiac defibrillators, now implanted in half of heart attack survivors, reduce the risk of death from a heart attack by 30%. The 3D HDTV da Vinci robot, even though it costs $1.5 million, allows near-microscopic accuracy in cardiac bypass and prostate surgery that was never possible before.

The technology is remarkable, and can save lives. The problem is, doctors use this technology on anyone who even remotely might be able to benefit from it. Sure, an implanted cardiac defibrillator might save a heart attack patient, but putting it in a terminally ill 95-year-old man is a waste of effort and $100,000.

Titanium knee replacements help people who would've had to remain disabled in the past. But is that a good idea to replace the knee of someone who is bedridden with terminal cancer? And that $1.5 million da Vinci robot can do amazing things, but many surgeries can be performed just as well without it, and, incidentally, without spending the $2,000 for parts that must be replaced after each operation.


Is It Worth It?

The problem is, there's no way for doctors to accurately assess just how successful particular treatments will be. And there's no reason to, because driving the decisions to use expensive tech is profit, not efficacy. Doctors (and especially their bosses who own the hospital) are eager to use each million-dollar machine they can get their hands on. Let's face it — when you get a new hammer, everything starts looking like a nail.

Doctors and hospitals need a way to accurately assess how effective treatments are, rather than how profitable. Our health care system needs widespread information technology to determine which treatments are most effective, or even necessary.

This goes way beyond electronic billing software. The system needs electronic health records, properly filled out, that network clinical data. That data can then be used to rate performance of specific treatments. With detailed analysis that only powerful computers armed with reams of data can do, combined with networked software deployed in every medical facility, doctors will be able to properly evaluate how effective each treatment has been in similar cases across the country.


Somebody Has to Say No

With all this expensive tech floating around, and a whole lot more on the way, someone is going to have to get courageous and make tough decisions about how and when it will be used, and on whom. Yes, it's rationing, but we already have rationing today. It's especially problematic now, because making the choices are corporate bureaucrats at insurance companies, who are motivated by profit, not by saving lives by using technology effectively.

If there must be hard choices made, those choices must be based on the probability of a positive outcome. That could be done effectively if there were enough data to sift through. This techno-triage is not going to be easy to implement in our society today, where it's taboo to put a price on someone's life, or a price on the technology that might be able to save it. Making matters even more difficult are hospitals and doctors who don't want facts to dictate which procedures to implement, because those medical profiteers can rake in more money by ordering more tests, procedures and surgeries.

Let's face it — health care will be rationed one way or another, and should be. When the U.S. political-medical-industrial complex finally gets honest about that, let's hope real information is used to make those decisions, rather than greed. Let's use technology based on how effective these tools are in certain situations to decide how to wield them. After all, technology doesn't raise health care costs — people do.