As we watch the political wrangling over healthcare reform in the United States, one key element seems to be left out: consumer demand. For better or worse, Americans expect and even demand high-cost technologically-embodied medicine. A recent article on robotic surgery in the New York Times really drove this point home.

“Results Unproven, Robotic Surgery Wins Converts” (Feb 14, 2010)  by Gina Kolata, found that patients seeking prostrate treatment increasingly preferred robotic surgery over laparoscopic procedures. (Who knew that laparoscopic surgery would be considered “traditional” and low tech?) Eight years ago robotics comprised less than 5000 prostate surgeries; last year, the number reached 73,000, or 86% of prostate surgeries. And yet the benefits remain to be clearly and definitively established.

Despite this, robotic surgery is rapidly eclipsing other prostate surgery protocols in the United States, driven by “a lot of marketing hype,” per one leading urologist. The first thing that prostate surgery patients will ask a urologist is “Do you perform robotic surgery?” If not, they move on to one who does.

This technology doesn’t come cheaply, with a price tag of $1.4 million per unit, not adding technical support and training. Such expenditures (or “investments,” rather) incentivize use, per surgeons interviewed by Kolata. And the numbers involved are significant: one in six men will face prostate cancer in America.

Little wonder that we Americans have the world’s most expensive health care without the corresponding evidence that it necessarily improves our wellness.

I refer those interested in the peculiarities of American medicine to David J. Rothman, Beginnings Count: the technological Imperative in American health care (1998), and the remarkable inquiries of the surgeon Atul Gawande, most especially, “The cost conundrum: What a Texas town can teach us about health care” in The New Yorker.

Jim Edmonson

Jim is Director of the Dittrick Museum in Cleveland, Ohio, and one of our (hopefully growing number of) guest bloggers

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