Is more testing really the way to save American healthcare?

doctor showing thumb upWhat was the Daily Beast thinking when it gave a big wet kiss to the piece headlined “How to Save American Healthcare” by British journalist Charlotte Lytton, a contributor who asserts that even more technology is the path to cheaper healthcare?

Lytton writes:

“A new wave of tests and technologies is slowly bringing about the kind of developments the country’s health industry has been calling out for. Labs on microchips, home-administered HIV kits, hypertension tracking smartphone apps; these innovations are proof that the medical landscape is capable of change, and that the 30 million uninsured Americans, and tens of millions of citizens with inadequate coverage could face a different, better, future. Welcome to the age of bite-sized megabucks-saving medicine.”

Megabucks-saving medicine, really? The piece sounds like it could have been written by Big Pharma or AdvaMed, the device makers’ trade group. Perhaps it’s company-sponsored content in the guise of a legitimate news story. The column is labeled “Breakthroughs” and she refers to the “lab on a chip” as a “breakthrough device.” That’s PR jargon and is usually a tip-off some company is trying to sell something. The word should be banished from all healthcare reporting.

At the very least the column demonstrates little grounding in the complexities of the country’s chronic price escalation. New medical technology—the good, the bad, the harmful, the effective—unleashed over the last several years is the real culprit for much of the continual price rise. In the last few weeks I’ve interviewed Medicare’s former chief actuary Richard Foster to understand the program’s financing and why opponents claim it costs too much. Foster told me mostly the reason circles back to technology. “Even when technology gets more expensive, it gets used more often and you end up with greater cost growth,” he says. Lytton doesn’t say how the millions of uninsured and underinsured are going to navigate this costly terrain. Nor does she explore how home testing kits and smartphone apps that track every blip of your blood pressure can compete in the saving-money department against the likes of $144 million facilities hospitals have built to administer proton beam therapy. It’s the cost of the big ticket stuff without any controls on how much sellers can charge that helps make ours the costliest system in the world. Lytton talks about “shrinking down the costs and expanding the benefits of health tests,” but as HealthNewsReview.org has pointed out many times, there’s little benefit to be had from a number widely promoted tests. Some examples of our coverage:

Much of Lytton’s piece is given over to comments from two makers of this new megabuck-saving technology. Martin Yarmush, a professor of biomedical engineering at Rutgers, talks extensively about meeting “a specific need that could not be addressed with current technology,” adding “any diagnostic procedure that can provide the same answers at a lower cost will have an impact.” Yes, but sometimes that impact is simply to generate greater use, which contributes mightily to the national healthcare tab. Let’s remember that more testing of questionable value will inevitably lead to more false-positive results, which in turn leads to additional tests and treatments that are costly but don’t help anyone.

In her discussion of home testing for HIV, Lytton doesn’t actually talk much about its cost-saving potential. Ron Ticho, a VP of communications for OraSure, a company that made the first home HIV kit, says the trend toward more self-administered care is due to many factors including healthcare costs. That’s it for how the kit is supposed to save those megabucks.

Except for the closing graph where an ER resident offers a few caveats and calls the device a “fantastic idea” with “great potential if the limitations are understood,” there’s no balance, no opposing view, no scientific evidence offered in the piece. It’s just opinion and the usual hype that comes with a news release. The Daily Beast should know better.


Trudy Lieberman is a veteran health care journalist and regular blogger for HealthNewsReview.org. She often writes about health care cost and safety issues. She tweets as @Trudy_Lieberman.


 

Publisher’s note:  on a related theme, see the Analysis piece in The BMJ this week, “Why cancer screening has never been shown to “save lives”—and what we can do about it.” It concludes with this:

We call for higher standards of evidence, not to satisfy an esoteric standard, but to enable rational, shared decision making between doctors and patients. As Otis Brawley, chief scientific and medical officer of the American Cancer Society, often states: “We must be honest about what we know, what we don’t know, and what we simply believe.”

Comments (1)

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Brian Wood

January 9, 2016 at 8:32 am

Look at technology adoption and benefits in general and you will find that many things used widely today were expensive and low fidility initially, and are now ubiquitous and cheap. Lab on a chip technologies will no only reduce costs and improve results here in the “first world”, but at least as importantly, it will make reasonable health care available to billions in the developing world who have little or no access to modern medical testing at anything near affordable rates. If you can prick your finger, or spit on a sensor, and have precise medical information available almost instantly in an electronic format that can be shared with remote health care providers who can consult with you via voice and/or video, things will change significantly!