Comments for Health News Review http://www.healthnewsreview.org Wed, 22 Feb 2012 17:55:53 +0000 hourly 1 http://wordpress.org/?v=3.3.1 Comment on An “exercise pill”? Take two and call us in the morning by Phil Costello http://www.healthnewsreview.org/2012/02/an-exercise-pill-take-two-and-call-us-in-the-morning/#comment-15867 Phil Costello Wed, 22 Feb 2012 17:55:53 +0000 http://www.healthnewsreview.org/?p=10893#comment-15867 Thanks Carol - a well informed populace will lead to healthier, happier people. Too many folks seek the quick-fix magic pill (or exercise option or supplement, etc) - prudent and purposeful effort works best. Thanks Carol – a well informed populace will lead to healthier, happier people. Too many folks seek the quick-fix magic pill (or exercise option or supplement, etc) – prudent and purposeful effort works best.

]]> Comment on Questions about scare tactics in health advocacy/awareness campaigns by Marilyn Mann http://www.healthnewsreview.org/2012/02/questions-about-scare-tactics-in-health-advocacyawareness-campaigns/#comment-15863 Marilyn Mann Wed, 22 Feb 2012 16:04:32 +0000 http://www.healthnewsreview.org/?p=11094#comment-15863 Thanks for the mention, Gary. The folks at CardioExchange were kind enough to post my post also. Thanks for the mention, Gary. The folks at CardioExchange were kind enough to post my post also.

]]> Comment on Questions about scare tactics in health advocacy/awareness campaigns by Liz Scherer http://www.healthnewsreview.org/2012/02/questions-about-scare-tactics-in-health-advocacyawareness-campaigns/#comment-15862 Liz Scherer Wed, 22 Feb 2012 15:38:29 +0000 http://www.healthnewsreview.org/?p=11094#comment-15862 Thanks for the heads up on this. I am not shocked by these tactics nor am I surprised. We have become a society that is numb to meaningful exchange so marketers resort to ads that challenge and insult. I don't support this approach but apathy often calls for extremism. By the same token, I do believe that shock tactics need to be backed by dissemination of useful education and as Laura aptly notes, "where's the data?" Still, responsibility starts with each and every one of us, particularly when it comes to health. Sometimes the finger pointing can be as counterproductive as the things that are being pointed to/at. Just a thought. Thanks for the heads up on this. I am not shocked by these tactics nor am I surprised. We have become a society that is numb to meaningful exchange so marketers resort to ads that challenge and insult. I don’t support this approach but apathy often calls for extremism. By the same token, I do believe that shock tactics need to be backed by dissemination of useful education and as Laura aptly notes, “where’s the data?” Still, responsibility starts with each and every one of us, particularly when it comes to health. Sometimes the finger pointing can be as counterproductive as the things that are being pointed to/at. Just a thought.

]]> Comment on Questions about scare tactics in health advocacy/awareness campaigns by Ken Leebow http://www.healthnewsreview.org/2012/02/questions-about-scare-tactics-in-health-advocacyawareness-campaigns/#comment-15861 Ken Leebow Wed, 22 Feb 2012 15:34:44 +0000 http://www.healthnewsreview.org/?p=11094#comment-15861 Actually, the data is that fear or death is not a very good motivator for change. Here's a good read ... (Change or Die) ... http://www.fastcompany.com/magazine/94/open_change-or-die.html As a sidebar, we do not have an "obesity epidemic". You can go from a food epidemic straight to disease ... no need to address obesity. That's a diversion. Unfortunately, we love diversions. Ken Leebow http://www.SatietyandTaste.com Actually, the data is that fear or death is not a very good motivator for change.

Here’s a good read … (Change or Die) … http://www.fastcompany.com/magazine/94/open_change-or-die.html

As a sidebar, we do not have an “obesity epidemic”. You can go from a food epidemic straight to disease … no need to address obesity. That’s a diversion. Unfortunately, we love diversions.

Ken Leebow
http://www.SatietyandTaste.com

]]> Comment on How hospitals recoup the cost of buying robotic surgery systems by njhm http://www.healthnewsreview.org/2012/02/how-hospitals-recoup-the-cost-of-buying-robotic-surgery-systems/#comment-15857 njhm Wed, 22 Feb 2012 13:38:31 +0000 http://www.healthnewsreview.org/?p=10788#comment-15857 Dr. Luthringshausen, Thanks for the interesting discussion. But, a couple notes. The argument that the Davinci doesn't increase costs is a common held fallacy. Although I agree that physicians or hospitals aren’t directly reimbursed more for robotic cases, proliferation of the robot indirectly increases cost/reimbursement inflation for these procedures. When hospitals increase charges for a robotic case, Medicare uses these charges to determine future Medicare weightings/rates. So the higher charges cause future Medicare rates to be higher. Since commercial insurers base their reimbursement rates off Medicare rates, these rates go up as well. Since ’04, Medicare prostate rates have grown +18% above Medicare inflation and hysterectomy rates +15% above inflation. So the robot is causing huge reimbursement inflation in these areas in order to allow hospitals to cover the cost of the robot. And this ignores the over-utilization that the robot is causing – see http://www.nejm.org/doi/full/10.1056/NEJMp1006602 I also think you’ll find two articles published in this month’s Journal of Clinical Oncology from your peers at MGH and Columbia interesting (see below). Like Skeptical Scalpel, I continue to struggle to find the data that shows that the robot actually improves outcomes for patients. But, I’d be very happy to be proven wrong. http://jco.ascopubs.org/content/early/2012/01/30/JCO.2011.36.7508.abstract http://jco.ascopubs.org/content/30/5/513.abstract http://www.hopkinsmedicine.org/news/media/releases/hospitals_misleading_patients_about_benefits_of_robotic_surgery_study_suggests I also think an article from the Chicago Tribune last week sums it up pretty nicely (http://ht.ly/96K22). This explains a lot of what is wrong with our current healthcare system. “For example, a 50 percent increase in the number of surgeries to remove men's prostate glands in the United States from 2005 to 2008 was driven by the adoption of robotic-assisted laparoscopic prostatectomy, according to a study presented at the American Urological Association meeting last May. Prostatectomies performed by the $1.5 million robot, manufactured by Intuitive Surgical, accounted for 80 percent of such surgeries in 2008, up from 15 percent four years earlier. The increase in prostatectomies came at a time when the incidence of prostate cancer decreased. "When hospitals buy robots they also use them as a marketing tool in direct-to-consumer marketing. That started with the drug companies and it worked well. It's very effective," said Dr. Hugh Lavery, a urologist at Mount Sinai Medical Center in New York who authored the study. "Surgeons are paid more to do prostatectomy than to occasionally biopsy someone. There's pressure from the (hospital) administration. They'll say, 'We just bought this thing, why aren't you using it?' It's kind of like if you buy your kid an Xbox and he doesn't use it," said Lavery.” Dr. Luthringshausen,

Thanks for the interesting discussion. But, a couple notes.

The argument that the Davinci doesn’t increase costs is a common held fallacy. Although I agree that physicians or hospitals aren’t directly reimbursed more for robotic cases, proliferation of the robot indirectly increases cost/reimbursement inflation for these procedures. When hospitals increase charges for a robotic case, Medicare uses these charges to determine future Medicare weightings/rates. So the higher charges cause future Medicare rates to be higher. Since commercial insurers base their reimbursement rates off Medicare rates, these rates go up as well. Since ’04, Medicare prostate rates have grown +18% above Medicare inflation and hysterectomy rates +15% above inflation. So the robot is causing huge reimbursement inflation in these areas in order to allow hospitals to cover the cost of the robot. And this ignores the over-utilization that the robot is causing – see http://www.nejm.org/doi/full/10.1056/NEJMp1006602

I also think you’ll find two articles published in this month’s Journal of Clinical Oncology from your peers at MGH and Columbia interesting (see below). Like Skeptical Scalpel, I continue to struggle to find the data that shows that the robot actually improves outcomes for patients. But, I’d be very happy to be proven wrong.
http://jco.ascopubs.org/content/early/2012/01/30/JCO.2011.36.7508.abstract
http://jco.ascopubs.org/content/30/5/513.abstract
http://www.hopkinsmedicine.org/news/media/releases/hospitals_misleading_patients_about_benefits_of_robotic_surgery_study_suggests

I also think an article from the Chicago Tribune last week sums it up pretty nicely (http://ht.ly/96K22). This explains a lot of what is wrong with our current healthcare system.

“For example, a 50 percent increase in the number of surgeries to remove men’s prostate glands in the United States from 2005 to 2008 was driven by the adoption of robotic-assisted laparoscopic prostatectomy, according to a study presented at the American Urological Association meeting last May.

Prostatectomies performed by the $1.5 million robot, manufactured by Intuitive Surgical, accounted for 80 percent of such surgeries in 2008, up from 15 percent four years earlier. The increase in prostatectomies came at a time when the incidence of prostate cancer decreased.

“When hospitals buy robots they also use them as a marketing tool in direct-to-consumer marketing. That started with the drug companies and it worked well. It’s very effective,” said Dr. Hugh Lavery, a urologist at Mount Sinai Medical Center in New York who authored the study.

“Surgeons are paid more to do prostatectomy than to occasionally biopsy someone. There’s pressure from the (hospital) administration. They’ll say, ‘We just bought this thing, why aren’t you using it?’ It’s kind of like if you buy your kid an Xbox and he doesn’t use it,” said Lavery.”

]]> Comment on How hospitals recoup the cost of buying robotic surgery systems by Skeptical Scalpel http://www.healthnewsreview.org/2012/02/how-hospitals-recoup-the-cost-of-buying-robotic-surgery-systems/#comment-15820 Skeptical Scalpel Wed, 22 Feb 2012 00:51:00 +0000 http://www.healthnewsreview.org/?p=10788#comment-15820 Dr. Luthringshausen is listed as the Medical Director of the Gynecologic Robotic Surgery Institute at Northwest Community Hospital in Arlington, IL. Obviously she is an advocate of robotic surgery. I would point out that I was merely reporting what the author/presenter (a fellow in advanced minimally invasive gynecologic surgery) of the study of robotic hysterectomy said in the article in Surgical News. I did not do any analysis, shallow or otherwise. Dr. Luthringshausen, please provide us with a link to the study that shows a complication rate of 3% for robotic hysterectomy. And why compare it to open hysterectomy? Wouldn’t a comparison to standard laparoscopic hysterectomy be more appropriate? A meta-analysis of 22 non-randomized studies (there are no randomized studies) of hysterectomy in the British Journal of Surgery in 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20949554) found the following: “The available evidence shows that robotic surgery offers limited advantages with respect to short-term outcomes. However, the clinical outcomes should be interpreted with caution owing to the methodological quality of the studies.” And another review article from Obstetrics and Gynecology International in 2011 (http://www.ncbi.nlm.nih.gov/pubmed/22190948) by a group from the Cleveland Clinic said: “Despite the rapid and widespread adoption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches." Dr. Luthringshausen is listed as the Medical Director of the Gynecologic Robotic Surgery Institute at Northwest Community Hospital in Arlington, IL. Obviously she is an advocate of robotic surgery.

I would point out that I was merely reporting what the author/presenter (a fellow in advanced minimally invasive gynecologic surgery) of the study of robotic hysterectomy said in the article in Surgical News. I did not do any analysis, shallow or otherwise.

Dr. Luthringshausen, please provide us with a link to the study that shows a complication rate of 3% for robotic hysterectomy. And why compare it to open hysterectomy? Wouldn’t a comparison to standard laparoscopic hysterectomy be more appropriate? A meta-analysis of 22 non-randomized studies (there are no randomized studies) of hysterectomy in the British Journal of Surgery in 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20949554) found the following:

“The available evidence shows that robotic surgery offers limited advantages with respect to short-term outcomes. However, the clinical outcomes should be interpreted with caution owing to the methodological quality of the studies.”

And another review article from Obstetrics and Gynecology International in 2011 (http://www.ncbi.nlm.nih.gov/pubmed/22190948) by a group from the Cleveland Clinic said:

“Despite the rapid and widespread adoption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches.”

]]> Comment on Breast Cancer & Social Media tweetchat by The Accidental Amazon http://www.healthnewsreview.org/2012/02/breast-cancer-social-media-tweetchat/#comment-15727 The Accidental Amazon Tue, 21 Feb 2012 15:39:40 +0000 http://www.healthnewsreview.org/?p=11075#comment-15727 We were glad to have you, Gary. Thank you. Just missed meeting you at NBCC last year. Jody & I were roommates there at the hotel. HNR provides an invaluable service, especially for us bloggers trying to wade through everything to figure out what is meaningful and what is not. Much appreciated. We were glad to have you, Gary. Thank you. Just missed meeting you at NBCC last year. Jody & I were roommates there at the hotel. HNR provides an invaluable service, especially for us bloggers trying to wade through everything to figure out what is meaningful and what is not. Much appreciated.

]]> Comment on How hospitals recoup the cost of buying robotic surgery systems by Michelle Luthringshausen, MD http://www.healthnewsreview.org/2012/02/how-hospitals-recoup-the-cost-of-buying-robotic-surgery-systems/#comment-15718 Michelle Luthringshausen, MD Tue, 21 Feb 2012 14:54:29 +0000 http://www.healthnewsreview.org/?p=10788#comment-15718 As a surgeon, I am fascinated by this shallow analysis of cost and complete disregard for what is best for the patient. An open hysterectomy has a complication rate of 11%, highest in obese patients. A robotic hysterectomy done by an experienced surgeon in an obese patient has a complication rate of 3%. Complications are expensive for hospitals, health systems and especially patients. According to the American College of Surgeons NSQIP data, one complication's DIRECT costs are around $12,000. My second comment is that "charges" are only relevant in the uninsured patient, which will rarely be recouped anyway. The "cost" is what the insurance company and patients actually pay or reimburse, which is a contracted price based on the procedure done, NOT the way it was done, in an insured patient. In most cases, the hospital and surgeon get paid the same fee whether the robot was used or not. As a surgeon, I am fascinated by this shallow analysis of cost and complete disregard for what is best for the patient. An open hysterectomy has a complication rate of 11%, highest in obese patients. A robotic hysterectomy done by an experienced surgeon in an obese patient has a complication rate of 3%. Complications are expensive for hospitals, health systems and especially patients. According to the American College of Surgeons NSQIP data, one complication’s DIRECT costs are around $12,000.
My second comment is that “charges” are only relevant in the uninsured patient, which will rarely be recouped anyway. The “cost” is what the insurance company and patients actually pay or reimburse, which is a contracted price based on the procedure done, NOT the way it was done, in an insured patient. In most cases, the hospital and surgeon get paid the same fee whether the robot was used or not.

]]> Comment on Komen supporter Colbert parodies “Lawsuits for the Cure” by Nan Parrish http://www.healthnewsreview.org/2011/01/komen-supporter-colbert-parodies-lawsuits-for-the-cure/#comment-15634 Nan Parrish Tue, 21 Feb 2012 00:41:44 +0000 http://www.healthnewsreview.org/2011/01/komen-supporter-colbert-parodies-lawsuits-for-the-cure/#comment-15634 Agree with previous post. Now I know why SGK is not spending money for prevention research. And we survivorss thought they cared about breast cancer research!!!!!!!!!!!!!! Agree with previous post. Now I know why SGK is not spending money for prevention research. And we survivorss thought they cared about breast cancer research!!!!!!!!!!!!!!

]]> Comment on Former Pfizer exec: Maybe it’s time for pharma to drop TV ads by mego http://www.healthnewsreview.org/2012/02/former-pfizer-exec-maybe-its-time-for-pharma-to-drop-tv-ads/#comment-15633 mego Tue, 21 Feb 2012 00:32:33 +0000 http://www.healthnewsreview.org/?p=10978#comment-15633 If Big Pharma stops their drug ads it will only be because all the money in the world can't spin the benefits of these drugs against those endless, amazing, litany of negative side effects (always my favorite part of any of ad). I'm guessing they are just realizing they can push these drugs more easily the less we know about them. If Big Pharma stops their drug ads it will only be because all the money in the world can’t spin the benefits of these drugs against those endless, amazing, litany of negative side effects (always my favorite part of any of ad). I’m guessing they are just realizing they can push these drugs more easily the less we know about them.

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