THE "NEW" PROSTATE CANCER INFOLINK

Craig Turner, MD, practices urology in Portland, Oregon, and for the past 6 years or so he has been carrying out laparoscopic radical prostatectomies with the help of a da Vinci robot … but he doesn’t seem to think this has made him a better prostate cancer surgeon.

In an OpEd on the Bloomberg news site, Dr. Turner writes that — in his personal opinion — we have all become seduced by the idea that “high tech” medicine is necessarily better medicine, and that this delusion has major downsides: culturally, economically, and professionally.

He believes that all physicians and patients, faced with the idea that they could use some really cool, new technology to manage a personal health care issue, should ask themselves whether they would willingly take the cash out of their own pockets to pay for the use of this technology without some very clear evidence of a real health care benefit. After all, most of us don’t ever ask that question. Why would we? Medicare or our insurance companies are going to foot the bill, and we’re “entitled.” Aren’t we? … But in the end it is still costing us all money, and it is costing us all a lot of money.

Dr. Turner goes a lot further … He basically states that, after carrying out radical prostatectomies with a da Vinci robot for the past few years, he has lost (or at least is losing) the skills he used to apply to do high quality laparoscopic radical prostatectomies “by hand” (i.e., the same operation but without the help of the da Vinci robot). He has become “reliant” (his word) on the technology to carry out some of the most detailed aspects of what has always been a complex and detailed operation, in which tiny differences in where one cuts and how one sutures can make the difference between a decent outcome and a really high quality outcome for patients. Bizarrely, however, Dr. Turner feels that use of the da Vinci robot encourages his patients to see him as some sort of high priest with super-powers.

The article is well worth a read. Dr. Turner is hardly the first clinician who treats prostate cancer to tell us that he has serious doubts over the supposed “benefits” of “high tech” medicine in general and robot-assisted laparoscopic prostatectomy (RALP) in particular.

But Dr. Turner’s article isn’t just about RALP … His arguments can be applied with equal effectiveness to proton beam radiation therapy, PET scanning, femtogram-level PSA tests, and a bunch of other technologies either available or on the drawing boards for the management of prostate cancer. Just how many of these would we really be willing to use if we had to pay the full costs ourselves?

Filed under: Management, Treatment | Tagged: care, economics, outcome, quality, RALP, technology |