We are regaled in the lay press about new medical breakthroughs a novel cholesterol-lowering drug mimics the effects of a genetic mutation and improves lipid profiles when conventional treatment is ineffective; new cancer therapies are tailored medications designed to specifically attack tumor cells without the nonspecific toxicity of conventional chemotherapy; hepatitis C can be cured by short-term oral agents, not prolonged courses of parenteral infusions; mitral valves can be repaired percutaneously without the potential risks of extracorporeal circulation. The potential of new medical technology for diagnosis and cure seems boundless, except for three major issues: cost, cost, and more cost. Amping up the application of these technologies from successful clinical trials to the general patient population may be financially unsustainable and certainly generates ugly moral hazards. For instance, we can wipe out hepatitis in the imprisoned and addicted populations, but may not then have enough resources for immunization and cancer screening. Moreover, these technologies may only be available at specialized, tertiary referral medical centers, not within community hospitals and clinics.
With this background, I read with interest the front page of a recent Sunday New York Times headline that death rates from heart attacks have plunged 38% over the past decade. No new technology, no pioneering discovery, no payment incentives, just a hospital's focus on known protocols to clear a blockage in a patient’s coronary artery as quickly as possible to restore nutrient blood flow and thus limit the amount of heart muscle damage. Simple things like transmitting EKG readings from the ambulance to the ER and subsequently using this data to identify the probability of evolving infarction and summoning treatment teams with a single call that mandates rapid response has done the trick. Reproducible, beneficial results were achieved in all hospitals serving the gamut of demographics. Not only was mortality diminished, but serious complications of heart failure and malignant rhythm disturbances were also decreased. Lives were saved and costs were contained, not by some new drug or agent, but by doing what we already know is beneficial, only faster and to a selected appropriate patient population. As Damon Runyan once said, “The race does not always go to the fleetest, but that’s where I’d put my money.”
By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton