screening tests, the Bird machine, HUAM, and sickness
Preventive medicine and screening tests have been a bane for years. Bladder tumor markers (CA 27.29, CA 19-9, etc.) are routine in many circles without, I think, really having shown their worth. Bone density studies are everywhere done more frequently than routine. There's even professional consensus that every expecting couple get genetic workups so they can prepare for what might be wrong with their unborn. How much of all of this is the result of aggressive product marketing, and how much is based on a scientifically demonstrated health benefit?
I was a Medicare home health case manager for three years a decade ago. The heyday of home health. It didn't take me long to understand that it probably cost Medicare more to keep a sick person at home than institutionalized. A very expensive program to take care of some of the nation's chronic and elderly, disproportionate to that which our society can afford. Even though outcomes effected on some individuals are epic, I suggest many payors are concluding that many such programs directed toward prevention do not cost less overall in the short, or the long run. Especially in cases when things like virtual colonoscopy are promoted as essential for prevention.
If preventing malady often fails society's cost-benefit ratio, diagnosing and treating the sick are close behind. The treatment of the those with a diagnosis of exclusion is part of the enigma. These used to be easy to pick out until we opened up disease categorizations to accept more of the possible candidates. I am convinced that two-thirds of the nations population has AASM defined, clinically significant obstructive sleep apnea deserving of a home machine or one or more out-patient ENT procedures. Don’t we all know someone who has chronic fatigue, polycystic ovary, Raynaud's, polymyositis, and maybe a few more, all at the same time? As a clinician, I am ashamed I have to approach diagnoses of Lupus, bleeding disorders, and even such as myasthenia gravis with skepticism as to the person's true extent of dissability. It is disheartening to know there are those few clinicians and patients who use some of these diagnoses to game the system for money.
Again, we must not forget we live in a capitalistic society. I am a respiratory therapist by training. When we look at the history of my chosen profession we see we used to be orderlies, and sometimes "oxygen techs." One of the single greatest influences in our evolution to a legitimate licensed health profession was the invention and marketing genius of Dr. Forrest Bird. He invented the fluid valve ventilator and marketed it in the highly successful Bird Mark VII ventilator. This device wasn't necessarily intended to breathe for the apneic, but was used to rehabilitate compromised pulmonary function. Studies showed that postoperative patients, who used the "Bird Machine" as we called it, were much less likely to develop atelectasis, pneumonia or other pulmonary complications. In the 1970's and early 1980's every hospital had dozens of these devices used as part of standing orders for nearly every surgical and pulmonary patient. These technical treatments became the property of us newly recognized respiratory techs/Respiratory Therapists. One wonders how much society could have saved on machines, therapists, and resultant nosocomial infections and other complications had we understood that simple breathing exercises, self-practiced by the patient, were even more effective in achieving the desired outcomes. The use of the Bird Mark VII has fallen into antiquity. Lucky for me, respiratory therapists are still useful.
This is one example. There are other similar stories including BMT's for breast cancer and HUAM for high-risk pregnancy, and I've lost count of the examples in the pharmacy industry. All may have been based on noble ideals and good science. But we cannot ignore the monetary influences that made them widely accepted despite a lack of good clinical evidence. The difficult trick is knowing when something truly is "latest and greatest" or merely a marketing hyped fad. Healthcare is an industry, and any industry's biggest influence is money. I suspect in the case for virtual colonoscopy, anything but a definitive "no" by the scientific community is a "must do" to the marketing spinmasters
I was a Medicare home health case manager for three years a decade ago. The heyday of home health. It didn't take me long to understand that it probably cost Medicare more to keep a sick person at home than institutionalized. A very expensive program to take care of some of the nation's chronic and elderly, disproportionate to that which our society can afford. Even though outcomes effected on some individuals are epic, I suggest many payors are concluding that many such programs directed toward prevention do not cost less overall in the short, or the long run. Especially in cases when things like virtual colonoscopy are promoted as essential for prevention.
If preventing malady often fails society's cost-benefit ratio, diagnosing and treating the sick are close behind. The treatment of the those with a diagnosis of exclusion is part of the enigma. These used to be easy to pick out until we opened up disease categorizations to accept more of the possible candidates. I am convinced that two-thirds of the nations population has AASM defined, clinically significant obstructive sleep apnea deserving of a home machine or one or more out-patient ENT procedures. Don’t we all know someone who has chronic fatigue, polycystic ovary, Raynaud's, polymyositis, and maybe a few more, all at the same time? As a clinician, I am ashamed I have to approach diagnoses of Lupus, bleeding disorders, and even such as myasthenia gravis with skepticism as to the person's true extent of dissability. It is disheartening to know there are those few clinicians and patients who use some of these diagnoses to game the system for money.
Again, we must not forget we live in a capitalistic society. I am a respiratory therapist by training. When we look at the history of my chosen profession we see we used to be orderlies, and sometimes "oxygen techs." One of the single greatest influences in our evolution to a legitimate licensed health profession was the invention and marketing genius of Dr. Forrest Bird. He invented the fluid valve ventilator and marketed it in the highly successful Bird Mark VII ventilator. This device wasn't necessarily intended to breathe for the apneic, but was used to rehabilitate compromised pulmonary function. Studies showed that postoperative patients, who used the "Bird Machine" as we called it, were much less likely to develop atelectasis, pneumonia or other pulmonary complications. In the 1970's and early 1980's every hospital had dozens of these devices used as part of standing orders for nearly every surgical and pulmonary patient. These technical treatments became the property of us newly recognized respiratory techs/Respiratory Therapists. One wonders how much society could have saved on machines, therapists, and resultant nosocomial infections and other complications had we understood that simple breathing exercises, self-practiced by the patient, were even more effective in achieving the desired outcomes. The use of the Bird Mark VII has fallen into antiquity. Lucky for me, respiratory therapists are still useful.
This is one example. There are other similar stories including BMT's for breast cancer and HUAM for high-risk pregnancy, and I've lost count of the examples in the pharmacy industry. All may have been based on noble ideals and good science. But we cannot ignore the monetary influences that made them widely accepted despite a lack of good clinical evidence. The difficult trick is knowing when something truly is "latest and greatest" or merely a marketing hyped fad. Healthcare is an industry, and any industry's biggest influence is money. I suspect in the case for virtual colonoscopy, anything but a definitive "no" by the scientific community is a "must do" to the marketing spinmasters
posted by nawledge at
7:10 PM
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