Death to the robot II
Today is a great day. My starbucks gave me free coffee, it didn’t snow, and two articles came out in major metropolitan newspapers about the fallacy of the robot.
The first was on the front page of the Boston Globe. Globe staff writer Liz Kowalczyk reported on a Massachusetts health advisory sent to hospitals regarding rising safety concerns about robotic surgery. Aggressively marketed, these devices have NOT in fact shown to produce better outcomes and there is increasing evidence that significant harm can result. Here’s a great quote by the director of perioperative services at MGH, with credit to Liz:
“The marketing is not based on any data. This tool was brought to us [by the manufacturer] solely as a marketing device. The medical community didn’t do what it should have done – say ‘Wait a minute, hold on'”.
The second article is in the New York Times science section. Roni Caryn Rabin authored an article entitles “Salesmen in the Surgical Suite”. This one is even more revealing. It talks about how industry reps are in the operating rooms and have access to the operating schedules of surgeons and try to convince them to convert a laparoscopic procedure (with a camera but with manually operated instruments) to a robotic one. I know for a fact from my own practice that often the only person in the OR advising the surgeon about how to do the surgery is that same industry representative. The training program for new users is one day of hands-on training and a 10 question online quiz. Mmmhmm. An online quiz. I asked an industry representative to comment on the cost-effectiveness and outcome data for the robot and was told “I am not allowed to comment on these issues. I can only tell you how to work the robot.”
Here’s something else: the FDA allowed the sale of the DaVinci robotic system made by Intuitive Surgical WITHOUT requiring trials of safety and efficacy typically required of new treatments. This is because Intuitive managed to convince the FDA that the robot was similar to other devices on the market. What devices would those be?
A Februrary article in the Journal of the American Medical Association detailed a study of more than 264,000 hysterectomies (removal of the uterus) using the conventional laparoscopic technique vs the robotic method. No difference in complication rates, which sounds ok until you read that the robot costs at least 1/3 more per case. Why are we paying 1/3 more if there’s no difference?
To all my readers: stay away from doctors, but if you have to go to one, please don’t blindly go with the guy with the newest technology.