Tuesday, March 6, 2012

Marketing Surgical Robots - Set Shot, Bank Shot, Jump Shot, and Long Shot

In a time where medical bills are the leading cause of personal bankruptcy in the United States and health care spending is nearly 18% of the GDP, why are patients paying more for a technique without any proven benefits over conventional therapies? Why are hospitals marketing robotic-assisted surgery to patients without reviewing the manufacturer’s claims? Why are we allowing a single company’s bottom line to increase while insurance premiums and out-of-pocket spending for patients increase every year? We have to stop pursuing things because they are marketed to us. In medicine, there are always procedures that are feasible, but they are not always the right clinical choice; similarly, they are not always the cost-effective choice. In the case of robotic-assisted surgery, it shows neither improved clinical outcomes nor lowered costs.

Kelly Wright MD, a minimally invasive gynecologic surgery fellow in the Boston area. “The Bottom-Line,” The Health Care Blog, March 5, 2012

Unless mankind redesigns itself by changing our DNA, computer generated robots will take over our world.

Stephen William Hawkins (born 1942), British theoretical physicist. cosmologist, and amyotrophic lateral sclerosis survivor

March 6, 2012 - Doctor Kelly Wright has launched a broadside attack against surgical robots. Why, she asks, do we allow hospitals to continue to buy and to market surgical robots when they cost more than human surgeons operating without robotic assistance, when their long term outcomes are unproven, and when they are not cost- effective?

Why indeed? The reason is simple and straightforward – it’s in the human DNA. As a former college basketball player, let me share with you a few basketball analogies and insights into human behavior.

It’s a set shot.

Hospitals are in business to stay in business and to grow their businesses. So are surgeons who seek to master and to guide these surgical robots. So are patients who are always on the lookout for high tech, minimally invasive solutions to relieve their pain and suffering.
When those solutions are a “set shot” – a human guided machine that is perceived to perform surgery in a set way every time, all the time – all the better.

It’s a bank shot, maybe even a foul shot.

If you can’t score by driving directly at the goal, you may be able to by going around your opposition or banking a shot high off the backboard. Medicare has set back surgeons by systematically lowering their fees. Entrepreneurs have developed minimally invasive procedures, like endoscopic surgeries, that render open procedures – gallbladder removal and exploratory laparotomies, the surgeon’s bread and butter, inoperative. So an alternative approach , something surgeons can identify with and embrace, becomes feasible and desirable . Besides, if you’re hacked driving to the hoop, in search of an open shot, you may earn a foul shot.

It’s a jump shot.

Marketing of surgical robots have been remarkably successful. In part, this is because it’s in the human DNA to jump ahead of your competitors, your creditors, and your rectifiers.. As of June 2011, the manufacturer had installed 1,933 robotic systems. By June 2010, surgeons had performed 278,000 robotic-assisted surgical procedures, up 35% from 2009. The company projects one million assisted procedures will be performed in the United States over the next few years (Investor Report 2011). To reach this goal, the manufacturer will continue to market to smaller hospitals and surgeons, who it is assumed, will, in turn, market to communities and to patients.

It’s a long shot, but not a cheap shot.

Robotic surgical robots are not cheap. Hospitals pay $1.0 million to $2.3 million for each surgical robot. The price depends on the version of the machine. Annual service agreements run from $100,000 to $170,000 a year. For the surgical robot maker, costs of developing a surgical robot was a low percentage long shot. It was beyond the 3 point arc, considering the cost reduction climate and risk of earning FDA approval. But after reviewing the evidence, the FDA approved. The long shot is paying off for the robot maker. In 2010, company revenues exceeded $1.4 billion. Most recently there was a 38% increase in sales and a 28% growth in revenue for the 3rd quarter of 2011. Since 2006, the company reports gross profits of 66% to 73% of revenue.

The long shot is paying off hospitals, as new surgeons join their staff and new patients, expecting the latest and the best, flood into their facilities. Otherwise hospitals would not be marketing robots so vigorously. Remember: for hospitals, profits are greatest for high tech procedures.

Lack of Rationality and Justification

None of these so-called shots seem or are deemed rational by those who regard high tech procedures as something to be scrupulously and exhaustively assessed for comparative outcomes and cost effectiveness against traditional procedures at the national level before marketing.
Unfortunately, impatience runs deep in the human DNA. We humans are not big on watching, waiting, and weighing benefits against costs. Americans are always looking at the next technological horizon. They are willing to take risks in search of a better way of doing things to relieve their pain and to advance the cause of humankind and technology.

Perhaps my thoughts on human DNA and its ambitions is why I made this comment on The Health Care Blog in response to Doctor Wright’s well-reasoned blog.

“Doctor Wright: Don’t get your hopes up. Americans love technology and its promises. Hospitals want to enhance their bottom lines. Robots are made for marketing. Hospitals want to attract surgeons. Surgeons love the latest in high tech. If CTs and MRIs are any example and if surgical robots prove to be a superior technology, which they might, robotic surgery will proliferate, not matter what government says about the necessity of technology assessment and outcome research before you go to market. If robotic surgery results fail to measure up, robotic surgery will fail in the market, as they should.

Tweet: Hospitals are vigorously and successfully marketing surgical robots, even though surgical robot costs are high and outcomes are uncertain.

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