Irrational fears, availability heuristic --> cognitive bias

It really seems like a lot of people are scared of certain technological advances because they simply don't understand them. The fact is that most new technologies are superbly complex and to understand how they work would require a lot of (mostly esoteric) knowledge. Thus, since people don't really know how things work, they rely on: 1. what "experts" (on their favorite biased news network) say, 2. what the results of these new technologies are. So whenever a technology comes along and produces positive results, people are happy about it and like the new technology. However, when something goes wrong and one person exposed to the new technology suffers some crazy adverse reaction, public sentiment shifts to fear. Of course I'm generalizing, but this is how I see things a lot of times. Everything in health care should be considered in terms of a cost-to-benefit ratio. Costs include both financial costs and health risks involved. People tacitly accept the cost and risk of getting in their car and driving because they see the convenience of driving places as a big enough benefit to outweigh the costs (both actual and potential). It is very helpful that people are very familiar with driving and do it all the time, so they have a good understanding of the risks involved. If they hear of a horrible car accident, it doesn't bother them that much because they can remember driving every day for the past year without any incident. However, if they hear of a mishap in some new screening technology they have no familiarity with, they will automatically think of that mishap if they ever have to go to get the screening. People are bad at estimating the frequency of certain events partly because they rely on what they can easily bring to mind. This isn't always a bad thing because it lets people rely on their own experiences to affect their future behaviors, but since people get a lot of their information from the media, their perception of reality can be skewed.

That said, not all new technologies work as they should and there should be constant testing of new treatments to test their safety and effectiveness.

(sorry I posted so late.. completely forgot about the blog this week.. will do better next time)

The topic of treatment side effects is a grey area. FDA only studies drugs and therapies for a few years. If the drug is approved, it can then be administered to millions of people. The long term side effects (i.e. 30 or 40 years) are extremely unknown to the physician, and the patient. However, there are both pros and cons to treatments. A benefit is that the immediate condition can be treated with the drug, but the unknown is that maybe the treatment will cause some other condition down the line. It is a fine line of immediate reward versus long term consequences that the medical field plays and it is one that is almost impossible to be correct every time on.

CT scans

I used to work for R&D and we were trying to develop an assay that would specifically detect cancer cells. It costs a lot of money and energy to qualify a test let alone a machine. That is why I'm not amazed at how expensive CT scanners are. If a person really needs the procedure done and if it will help in early determination, than I am all for it. However, if a doctor just prescribes CT scans to make money and pay off the machine then that is unethical. I agree with everyone, it all boils down to how people perceived their risks and benefits. Everyday someone is trying to make a machine that would give off less radiation.

I think new technology is improving long term health. For instance, the company that I am working at is trying to use this new machine that can count cancer cells in blood. If the machine can detect how many cancer cells are in a person or left in a person, doctors will know how to treat the patient.

There should always be alternatives. The patient should be told the about the benefits and risks before deciding on a treatment plan.

I will fee safe receiving these treatments because most are evidence based and have been tested to reduce minimal side effects.

All opportunities come with risk, and I think that advanced medical technology is no exception. While dangers exist with both CT scans and radiation therapy, there is no question that these procedures are means of detection and treatment for disease, and have advanced long-term health outcomes for patients. However, use of these procedures begs a new question: how can we quickly and efficiently respond to the problems brought about by new technology?

The answer to this question isn't readily available, which makes this such a complicated issue. Ultimately, there remains the problem of insufficient regulation, which seems to occur too often. A financially overburdened and potentially understaffed medical system may not be equipped to have teams of therapists and physicists monitoring every procedure, which heightens associated risks. Stringent regulation of existing protocols is essential in such situations. In the article mentioned in the prompt, it was noted that a patient at Stony Brook University Medical Center "received 10 times as much radiation as prescribed in one spot, and one-tenth of her prescribed dose in another." While the therapist was "reprimanded," the article also mentions that there simply aren't enough consequences for such mistakes, namely fines and license revocations. However, this introduces another issue: how much falls on the shoulders of the therapist, physicist, or physician? What types of consequences are suitable? Should an otherwise exemplary therapist have his/her license revoked due to an error that may be instrument malfunction? Where does the responsibility of medical equipment manufacturers come into play?

Alternatives should always exist, and patients should be made aware of such alternatives. Any procedure, big or small, is associated with risks - even simple blood draws. With complicated procedures such as CT scans and radiation therapy, the risks multiply. Stricter regulations, on both equipment and personnel, as well as more frequent quality-control measures may help to reduce these risks, but may not eliminate the problem.

I think that advanced technologies in medicine are helping to improve long-term health outcomes. It’s not a huge surprise that there is a possible danger of radiation exposure involved with medical technology such as the CT scan (we’ve known about X-ray radiation for years). But when considering the various uses of the procedure (a common one being to discover tumors in the body) further steps can be taken to treat the condition, which could have the outcome of an improved state of health. On the other hand, there are certainly cases where these same procedures produce no result and there is no beneficial long-term health outcome. If you ask a family dealing with the possibility of a tumor or cancer, and tell them that a CT scan would help provide a more precise diagnosis, but it would involve some unsafe radiation exposure, most likely they would go ahead with it anyway. It is a bit like when I used to hold my breath before eating my vegetables: it may taste bad, but it’s good for you.

I agree with Dmitry that this is definitely a question of opportunity cost. While technological advancements can definitely improve the quality of medical examinations and, consequently, one's lifespan, the cumulative exposure effects of radiation can negatively impact health. However, if a CT scan is recommended following a physician's detection of some health abnormality, then one would presumably prefer to risk the minor radiation exposure rather than not detecting a potentially severe problem.

This topic also made me think of all the other technological improvements that may be posing a risk to our health such as cell phones, laptops, and other electronics that we are constantly surrounded by. Several articles have proposed links between cell phone use and adverse outcomes like infertility and brain cancer. Yet I somehow doubt that most readers of these articles decided that they should throw away their cell phones. Similarly, I also doubt that the majority of the population would veto the research of new and improved health technologies on the basis of their potential side effects. In the case of CT scans, perhaps the solution is to investigate ways of minimizing radiation exposure while still upholding a high quality scanning capability. The major downfall of course would be funding. How to minimize health care costs while still advancing care is a difficult matter to consider especially within the U.S. framework of a weakened economy, exorbitant health prices, and massive debt.

Quality Assurance

My brother in law works in the field of radiation oncology, so I talked to him to understand things from his point of view. Basically quality assurance techniques are advancing at a slower rate than treatment technologies. For example, one company's new software allows for delivery of higher doses of radiation in less time, but that company does not offer compatible software to verify that the actual dose matches the expected dose. There is compatible software from another company, but it is extremely expensive. So, what many hospitals and doctors do is resort to older, less accurate quality assurance techniques. A hospital may advertise that they use 'Software X', but that doesn't mean they use "Software X Quality Assurance.' It is very complicated, but this partly explains why some people receive doses higher (and more dangerous) than prescribed.



Also, the radiation dangers reported in the NY Times happened years ago. The machines that failed have these moving leaves that act as shields to prevent the radiation from entering unwanted areas of the body. Often, the people who administered the radiation assumed the machines were working as intended since it was all computer programmed. Because they relied on technology and didn't bother to double check (quality assurance), they failed to see that the leaves were NOT working properly. The excess radiation led to massive damage and death.



http://www.nytimes.com/2010/01/24/health/24radiation.html?pagewanted=2



The solution, the advertisement said, was a linear accelerator with 120 computer-controlled metal leaves, called a multileaf collimator, which could more precisely shape and modulate the radiation beam. (View an interactive graphic demonstrating how multileaf collimators work, and how problems at St. Vincent's caused a fatal overdose.) This treatment is called Intensity Modulated Radiation Therapy, or I.M.R.T. The unit St. Vincent’s had was made by Varian Medical Systems, a leading supplier of radiation equipment.



Check out the interactive graphic!

After reading the prompt, I decided to go on google to research the cost of purchasing a CT scanner. Turns out the average price of a CT scanner in the U.S. is about $1 million. I also stumbled on an article that talked about a cardiologist in San Francisco who was considering buying such equipment. Although the doctor could use the scanner to get an unparalleled view of pateints' arteries, he knew he'd have to pay for the expensive gadget by potentially ordering unnecessary CT scans. Each scan, which costs $500-$1500, would generate revenue , but it's ionizing radiation could compromise the health of individuals.

With regards to whether a patient will use potentially unsafe technology, I think it all boils down to an individual's perception of risk. If there is a percieved benefit associated with a certain behavior, we tend to minimize the risk associated with that behavior. For instance, if a patient is diagnosed with atherosclerosis and is advised to go get a CT scan to verify progression of the disease in his heart, he would probably risk the adverse effects of radiation for the potential benefits of controlling the atherosclerosis, such as improvement in quality of life.

It depends

Regarding the questions posed for this week, it really depends on what technological advancement you're talking about -- and that's the problem. While new technology has indeed saved lives, some innovations may have simply introduced new costs without additional efficacy. (This doesn't even touch on the fact that certain technologies can reach the mainstream market before longitudinal studies can uncover hidden long-term effects).

All of this makes me wonder whether the US needs some sort of different research/testing paradigm for new medical advances; right now, it seems as though once something is proven to be merely as effective as its predecessor (and doesn't produce any immediate ill effects), it's adopted for mainstream use and coverage no matter the cost. Someone mentioned something in an earlier class period about how certain countries have centralized entities that research the outcomes of new medical treatments and technologies before they are put into widespread use, evaluating the effectiveness and the efficiency of adopting the innovation. Perhaps this is something the US needs to think about adopting, whether forming a new agency to do this or changing the FDA to look for more than just minimal safety and efficacy. However, this may not be very feasible without other changes to the way health care is provided in the US, so who knows.

Reports of Cat Scans (CT) being unsafe are not new. In the early 1990’s, UK scientists have reported that CT scans have the potential of causing more harm than good. So why did America choose to ignore this world finding? I believe it is directly due to our paying system, more specifically ICD-9 and CPT codes. In order for physicians and hospitals to bill for services rendered, a list of “procedures” must be done in order to receive full payment. For instance, a patient arrives in the Emergency Dept with the chief complaint of Abdominal Pain (AP). In order to bill for an AP diagnosis, a CT scan is ordered (they have to follow the list of procedures). Unnecessary CT scans are ordered everyday just to follow these procedures. Please bear in mind; US physicians are trained today to follow these guidelines and some are refusing to follow this practice because they are aware of such radiation dangers. Inclusively, these guidelines were created by non-physicians and worse yet have little to no medical background. The question that is presented today, Is health technology improving our health outcomes? I have to say yes! In recent publication, there are more and more findings that suggest that holistic and alternative medicine and treatment that are NOT of radiation born is improving our long-term health. Alternative procedures do exist however most are not covered in insurance coverage because they are viewed as Evidence-Based medicine and not scientific findings. I, for one, am an advocate for alternative medicines. If health reform is to ever change we should begin by re-evaluating our paying system and revise our medical coding guidelines and exclude such danger procedures such as CT scans.

Before answering the questions about Technology and Health Care, we must first consider quality and effectiveness of care. Health care professionals must decide what treatments are actually beneficial to patients and if enhancing these technologies will be cost effective. It is important to consider whether or not developing certain technologies would just be excessive and add expenses to the health care deficit or would these technologies save millions of lives and increase the number of healthy and fruitful years of people.