Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises

By Richard A. Deyo; Donald L. Patrick | Go to book overview

PREFACE: DISILLUSIONED INSIDERS

This book isn't intended to be an anti-technology rant, although some people may read it that way. We're great fans of many medical innovations, and we are definitely not Luddites, opposed to technological change. We don't long for the bad old days before antibiotics, anesthesia, cataract surgery, joint replacements, or Prozac. Indeed, we're happy consumers of medical products, old and new.

Both of us are hopelessly nearsighted, and without spectacles would have been seriously disabled since about the second grade. Rick likes his soft contact lenses and Donald his photosensitive glasses. Maybe some day both Rick and Donald will even have a Lasik procedure, but for now we're chicken. Rick also likes his antihistamines for allergies and his inhaled cortisone drugs that prevent both runny nose and wheezing. His eightytwo-year-old mother has benefited tremendously from cataract surgery in both eyes and from hip replacements on both sides.

Donald maintains his cholesterol at a normal level with a remarkable statin drug, and he has a family member with chronic illness who benefits hourly from assistive technology and drugs. He's waiting for advances in affordable wheelchair technology that will permit going up stairs and wheeling on the beach. We're not reflexively opposed to new technology, and we would be hypocritical if we were.

On the other hand, we've witnessed disturbing practices that seem designed to maximize someone's income, regardless of whether there was benefit or harm to patients. Those practices include aggressive marketing of new products with high costs but only modest (or no) advantages over older alternatives. They include performing operations with the rationale that "it may not be necessary, but if I don't do it, somebody else will." They include writing guidelines to ensure that one medical specialty doesn't lose patients or income to another with a competing approach. They include

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