Monday, April 9, 2012

Bring On The Death Panels 2


I was asked to perform a diagnostic procedure on a demented 93 year old this week. The procedure requires passing a long black tube into the patent's throat and using the the ultrasound it generates to produce produce pictures the heart with exquisite clarity. 

It's not terribly dangerous and the patients are asleep during the test  but it's still an invasive procedure with a potential for harm, and it retails for about $3500.

I was asked to study this man because he has a disease called critical aortic stenosis, which over time is uniformly fatal. The big blob in the middle of the picture below with the narrow dotted slit in the middle is one such typically narrowed valve.

Until recently the only treatment for this problem was to replace the valve surgically but now 2 companies have designed valves that can be implanted without surgery , "transcutaneously"

Given that aortic stenosis is mostly a disease of the elderly, and the number of older folks across the industrialized world is increasing exponentially, the number of eligible patients, and the profits they may bring (at about 50K per valve) is hard to overstate. As the technology advances these valves have great potential to relieve suffering and extend life. But I already had performed a viability study in our patient that demonstrated that he would not benefit from valve replacement of any kind. Never mind that he could not remember either my name or his own.

But the the hospital is desperate to push the technology so we can "get a leg up" on our competitors, and his cardiologist wants it done. What will happen next is anybody's guess

This is what makes me crazy about the 17%-of-the-economy that I live in


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