tag:blogger.com,1999:blog-2760353953251845523.post2302683129060903599..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Comparative Effectiveness vs. InnovationJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-2760353953251845523.post-25885434047187723382009-02-28T11:53:00.000-05:002009-02-28T11:53:00.000-05:00In response to Dr. Sucher: When you think about it...In response to Dr. Sucher: When you think about it, it is very common to hear the phrase "I like..." when surgeons are talking shop. It seems that the freedom to use and do exactly what you like is going by the wayside. It can be frustrating, I know, but I think we're all going to have to get used to it. There are a lot of really expensive things that are used in the OR mostly because the surgeon in question "likes" them, and not so much because they make any difference for the patient. Of course it goes without saying that I'm including my own specialty here. One example that comes to mind is that of Dermabond and some knock off competitor. At the hospital I was at at the time a little tube of Dermabond was a $300 charge to the patient, but there was a $100 price tag for the knock off. The knock off was definitely not as nice as the Dermabond (it was really runny until it dried, and when it dried it was really thick and grainy). While it's probably arguable, I honestly doubt that the knock off was worse for the patient. Everyone hated it, though, and continued to use the Dermabond simply because the liked it more. Is that a good reason? No. Is an extra $200 on the $60,000 bill a big deal? No. But the same thing happens every day with equipment and instruments that cost a lot more than $300.walt dandyhttps://www.blogger.com/profile/01724405932742819658noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-20109418052264404502009-02-28T09:21:00.000-05:002009-02-28T09:21:00.000-05:00Writing's on the wall Buckeye, your Laparoscopies/...Writing's on the wall Buckeye, your Laparoscopies/Laparotomies are gonna get reimbursed same as a 15 minute office visit...worse when you consider you gotta take care of them afterwards...<BR/>Eff "Plastics", Tatoo Removal's the future of Medicine...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-7587975732213208982009-02-27T18:01:00.000-05:002009-02-27T18:01:00.000-05:00Buckeye,I agree with you to a point. But I can't ...Buckeye,<BR/><BR/>I agree with you to a point. But I can't go with your shoot from the hip approach to medicine. We are in an era that allows us to be better than our forefathers, not-withstanding that the days of just being able to do something because you're a doctor just don't exist anymore.<BR/><BR/>Let's take a few of your examples. Lap chole; the introduction and expansion of lap chole happened outside the academic world because the white coats in the ivory towers couldn't get themselves to even look in the laparoscopic direction. Their failure resulted in an operation that remained with a significantly higher morbidity with respect to biliary injury than its open counterpart, leaving many patients to suffer with major complications. This may have been attenuated if given a proper review and implementation strategy. I believe that we are seeing this with NOTES. <BR/><BR/>As far as laparoscopic appendectomy is concerned. You know that I personally agree with your opinion on its superiority. However, we certainly can't see from the current literature that it is or isn't better, probably because no-one has had the ability to compare apples to apples. True and honest research to answer questions not only takes integrity, but it takes money, time and resources. This is the piece of the equation that is lacking in the discussion of Comparative Effectiveness.<BR/><BR/>We can't just cut off the ad-hoc innovation pipeline without supplying the rigorous scientific analysis pipline. <BR/><BR/>So, I agree. Innovation in medicine isn't just about the literature alone. Currently we know that it takes 15 years to implement strategies that we already KNOW are good. Cut off the ad-hoc innovation without investing in the structured approach will result in the death of medical advancement.<BR/><BR/>Finally, the one thing that does concern me about Comparative Effectiveness, is that it completely disregards what tools help you and me do our job faster and easier. For instance, I very much like to use a LigaSure device to divide the mesoappendix, and an EndoGIA to divide the appendix. Together, those devices make it my operation easier and faster. Unfortunately, it makes it more expensive, than using just a LigaSure and endoloops. I like my method. It is safe. It is effective. It works great. I can move fast. But will Comparative Effectiveness see that? The answer is NO. <BR/><BR/>So even I am concerned with the ultimate direction that I see we are heading. That is, I see that the tools will be used with a single minded implementation that simply counts the beans and doesn't care one bit about the taste.Joseph Sucher, MD FACShttps://www.blogger.com/profile/09187702675709935451noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-26204689219851192402009-02-27T16:54:00.000-05:002009-02-27T16:54:00.000-05:00Likewise EMS and resuscitation practices are seldo...Likewise EMS and resuscitation practices are seldom purely 'evidence-based' due to the inability to randomize well. ACLS admits there's no evidence that using epi in a code situation improves outcomes but notes it is 'reasonable' to continue given it is standard practice. I wonder how attempts to control costs will deal with this, and I'm not encouraged by how CMS and JCAHO jumped on, for example, blood cultures for pneumonia when they never change therapy and are probably an association with mortality rather than a causative factor.<BR/><BR/>Most recent Annals of EM has interesting articles on forward field hospitals in Iraq; sounds like a lot of innovation is coming on the battlefield.Tyrohttps://www.blogger.com/profile/06274875231456958701noreply@blogger.com