Avoid Vena Cava Filters

Shannon Brownlee warns us:

We tend to reward innovation in medicine for innovation's sake. Here's an example: there are, oh, on the order of at least 10 different companies all making a device called a vena cava filter. Each one claims superiority on the basis of some innovation in design. But do vena cava filters actually improve outcomes? Surgeons have been using these things for decades, yet they've never actually put them to the real test of efficacy. The French finally did, and it looks like for most patients the devices don't add value, they just add risk and cost. Now, we probably want to do another study just to be sure, but what's the value of innovation in vena cava filters if you aren't going to find out if they actually help patients.
GD Star Rating
loading...
Tagged as:
Trackback URL:
  • http://profile.typekey.com/cronodas/ Doug S.

    This is not too surprising – surgical interventions are difficult to test properly (is it ethical to literally cut open a control group in order to do literally nothing to them?) and I’ve heard about other surgical interventions that, when compared to placebo surgery, showed no benefit.

    So, yeah.

  • http://retiredurologist.com retired urologist

    In the article to which you link, the co-author, Virginia Postrel, states: “One thing I’ve wondered is why doctors aren’t paid more like lawyers, by the hour rather than the procedure.” I, for one, would have enjoyed being compensated as are contingency attorneys. The patient pays nothing for the care (or in the case of a surgeon, the procedure) unless he receives benefit. Then he pays 40% of the value of the benefit he received. For instance, when a patient presented with an illness that is fatal without proper surgery, I would perform the necessary surgery. If he died anyway, his estate would owe nothing. If he died because of my negligence, his estate could sue for malpractice. But if he was cured and achieved a normal life expectancy, he would owe 40% of his income for the remainder of his life. If it were a non-fatal malady, such as erectile dysfunction, and he resumed a happy sexual life as a result of surgery, he would owe the dollar equivalent of 40% of the happiness he achieved (and perhaps some contribution for that of his partner[-s]). Patients could sue for pain and suffering (as they do presently), and doctors could sue for happiness and well-being, which currently is not allowed. Bravo, Ms. Postrel!

    Perhaps Robin Hanson could devise a system of prediction markets to provide the monetary input instead of insurance or patient assets. By some method beyond my simple imagination, bets would be made on the outcome of each doctor-patient interaction, and winnings distributed appropriately. Bad doctors and bad treatments would disappear quickly.

  • http://diogenes42.blogspot.com nz

    Vena Cava filters are not first line treatment — they are more like 2nd to 3rd line treatment. They are used in patients who are usually pretty sick and have failed a couple different therapies. I don’t know the details of the french study — but from my limmitted experience this would be a hard study to conduct with generalizable conclusions.

    But to the larger point — this is not a good example of waste in medical innovation. The number of patients is small, they are generally sick, and we don’t have a good remaining therapy for them. In contrast, there are a lot of examples, for common diseases, where patients aren’t that sick, and we have many alternative therapies — where we waste a lot of money on new high tech treatment.

    Retired urologist — I think the logistics of a paying for benefit to a particular patient are waaaaaaaaay to difficult to implement in reality. Pay for hour is a much simpler idea. Of course its funny how economists forget they came up with fee-for-service model we now employ — which obviously has been gamed into wasting a shit load of money.