I have never considered the dollar cost of medical technology to make sense. It seems that any product or service that includes "medical" in the description commands a ridiculous price premium. This largely unjustified profiteering costs communities in untold ways.
There is the problem of opportunity cost. With vast sums of money going to pay for anything medical there is that much less money available to pay for other things. You can easily think of what they are yourself, but don’t forget all those things that will help to ensure better health in the first place so we can help to eliminate the causes of disease, rather than continue to waste money on treatment (especially when that treatment is overpriced, doesn’t work very well and frequently itself causes many additional problems).
For example, improving the nutritional quality of foods and better protecting our food chains. Improving the quality of water including removing the alarming number of largely unreported contaminants. Dealing with air quality by implementation of better policy and new technology. Clearly, even in so-called advanced economies, there are better ways to spend dollars to achieve personal and population health.
As a passionate advocate for Primary Health Care (PHC) I strongly support the principles that ensure we utilize the strictest minimum of technology consistent with achieving health goals. Indeed, I have elsewhere said:
Unfortunately there is a perceived association between use of high-technology and high levels of knowledge, skill and power (and of course, the status, prestige and hopefully income that go with these). This can mean that people who want to practice PHC still want to maintain the association and therefore promote the view that PHC is as much about high-technology as any other approach to health care.
The fact is that the use of any technology in PHC must pass three tests.
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The technology must be appropriate, that is, no more than is needed and no less than is needed and it must actually perform the function for which it is employed at a satisfactory level. -
The technology must be acceptable, that is, its users and consumers must have a choice in whether or not it will be used and they must approve its use.
- It must also be affordable. If the country or community cannot afford it then it simply cannot be considered. PHC promotes living healthfully within one’s means and recognises that when affordability is breached then overall everything else suffers, making the use counterproductive.
Note here that PHC is not anti-technology, it merely requires that the above tests be applied before technological solutions are implemented. Frankly, a great deal of waste and harm could have been avoided if these tests were required for the use of technology generally in health care.
So it is particularly disturbing to see the regular reports of suffering, resulting from the harm and even unnecessary deaths, caused by the overuse and abuse of medical technologies. Just today the FDA MedWatch program has reported another example. Consider the following report.
MedWatch – The FDA Safety Information and Adverse Event Reporting Program
Mallinckrodt, Palatin Technologies and FDA notified healthcare professionals of postmarketing reports of serious and life-threatening cardiopulmonary events following the administration of NeutroSpec [Technetium (99m Tc) fanolesomab],a radiodiagnostic agent consisting of a murine IgM monoclonal antibody formulated to be labeled with technetium,indicated for scintigraphic imaging of patients with equivocal signs and symptoms of appendicitis who are five years of age or older.
Onset of these events generally occurred within minutes of injection and included two deaths attributed to cardiopulmonary failure within 30 minutes of injection. Additional cases of serious cardiopulmonary events including cardiac arrest, hypoxia, dyspnea and hypotension required resuscitation with fluids, vasopressors, and oxygen.
Any patient who receives NeutroSpec should be closely monitored for at least one hour following product administration. Resuscitation equipment and appropriately trained personnel must be readily available during this time.
Patients with underlying cardiopulmonary conditions may be at higher risk for serious complication. NeutroSpec administration to these patients should only follow careful consideration of the known and potential risks and benefits, including the possibly higher risks.
So what is this saying? It says that doctors are seriously injuring and even killing people by using advanced radiologic imaging technologies. To do what exactly, just why are these techniques being used? Astonishingly, it is to make diagnosing appendicitis easier in cases where they have difficulty confirming that is the real problem!
What is going on here? Are they all mad? Diagnosing appendicitis has never presented much of a challenge as far as I’m concerned; it’s really quite straight forward. Could it be that doctors are now so poorly trained? Or could it be just another way of justifying exhorbitant medical bills? Do they use the technology simply because they can? Is it more prestigious?
I’m certain that the reasons are many and complex. I’m just as certain that they are unacceptable. I have no sympathy for the doctor who has to tell parents that their child who was thought to possibly have appendicitis is now in intensive care, or dead, because the doctor decided to use an advanced, expensive, dangerous and totally unnecessary technology to clarify the diagnosis. My sympathies are entirely with the parents.
The real costs of medical technologies are therefore many. There are opportunity costs to consider, measurable in financial, lifestyle and health outcome terms. Importantly, there are costs in terms of increased suffering and death that result directly from the use and abuse of medical technologies. In my view, the use of medical technologies simply must not be left so largely in the inadequately policed hands of the medical profession.
