“First of All, Get a Second Opinion” is the title of
Holly Finn’s most recent column in last Saturday’s Wall Street Journal. She cites
the same article I have already discussed about doctors being overly deferential
toward each other and goes on to say that we are more cautious about
buying blue jeans or flat-screen TV’s than about opting for medical
procedures. The main part of the article
is a discussion of the second-opinion industry, which has grown up in recent
years and whose services are increasingly covered by medical insurance. Advances in medical technology mean that a
patient’s data can be shared instantly with experts around the country with a
response available in a couple of days. The
piece concludes with some sobering statistics.
“In an estimated 60% of cases, an alternate treatment is recommended –
often one that’s more conservative and cheaper.” At one second-opinion firm, 6 out of 10 cases
reviewed had been misdiagnosed or mistreated.
At one breast clinic, second opinions led to the cancellation of 73% of
1053 surgeries in favor of less-invasive options. This article really hit a nerve with several
doctors who commented on the article and took offense at both its content and its
tone.
Coincidentally, the night before, I had watched an episode
of the PBS program “Need to Know” that dealt with medical devices. The show, reported by Medical Correspondent
Dr. Emily Senay began with an interview with Linda Gross, a former nurse, who
had had a mesh device surgically implanted to correct pelvic organ
prolapse. The procedure and its
consequences have been a disaster for Gross and her family and resulted in a
lawsuit against the manufacturer. Dr. Senay later spoke with Dr. Gregory Curfman, Senior Executive
Editor of The New England Journal of
Medicine, who said that more testing needs to be done to ensure the safety
and effectiveness of such devices. The
response from a representative of the organization of medical device manufacturers
was that the approval procedure should actually be faster in order to promote innovation.
Jeff Greenfield, host of the program, then interviewed
Dr. Josh Rising, who is Project Director of the Medical Devices Initiative at
the Pew Charitable Trusts. Dr. Rising, a
diabetic himself, has an implanted insulin pump to regulate his blood
sugar. He said that there have been
problems not only with mesh devices but also with implantable defibrillators,
and metal-on-metal hip replacements. He
said that in Australia there is a registry of hip and knee replacement devices that has made it possible to track the outcomes for patients who had had the
devices implanted. Based on information
from the registry, doctors in Australia stopped using metal-on-metal hip
replacements years before they did in the US.
If a similar program were instituted here, according to Dr. Rising, both
safety and innovation would benefit. On
the safety side, devices that caused problems could be taken off the market;
for device manufacturers, there would be a source of information on how the
current devices are doing so that they could plan for the next generation of
products.
