Would a billboard sway your surgery?

We all know that a rush to embrace new technology is part of the reason why health care costs continue to increase.  We also know that new technology is not always better than the ‘tried and true.’

This week’s JAMA  has an article reviewing complications from prostate surgery, the newfangled often ‘robotic’ minimally invasive surgery, as well as the terrifyingly-  named “radical” prostatectomy.   I mean, who would want to have radical surgery if there was a less-invasive alternative.  Further, I pass a billboard on the Mass Pike every day on my way to work proclaiming the benefits of robotic prostate surgery.  Minimally invasive robotic surgery was under 1% of prostatectomies in 2001, and over 40% in 2006.   Harvard Link

It turns out that the minimally invasive surgery is better (in some ways)– patients spend less time in the hospital, get fewer transfusions, and have fewer postoperative pneumonias.  However, the rate of incontinence and erectile dysfunction (ED) is statistically significantly higher.  This is not a perfect study – the authors used medical claims to ascertain incontinence and erectile dysfunction. In fact, actual rates of complications are dramatically higher if an investigator asks patients directly, rather than relying on physicians to code ED or incontinence for billing purposes.

So – the billboard on the Mass Pike is not the source of truth about advances in surgical therapy.

On another note about medical marketing, NPR had a good piece on direct-to-patient advertising by the pharmaceutical industry.   Most of us have forgotten Seldane, a withdrawn non-sedating antihistamine that skyrocketed from sales of under $40 million to sales of over $800 million - and this was before the manufacturer could even use the name of the prescription medication on TV!

It’s been a good day of reminders that direct-to-patient advertising generally indicates high margin – as opposed to high value.