Friday, June 20, 2014

Whenever I promise myself not to write another post about robotic surgery, I see an ad or an interview doubling as an ad so full of misrepresentations that I have to reach out for an antiemetic.

Here's the latest, a June 18 piece on Bloomberg TV.  It is shocking because Bloomberg is so careful about accuracy in its news reports.  Of course, the video starts with a short ad, which is clearly labeled as such.  But they really should have kept that label in place for the duration of the video.

Did Intuitive Surgical pay for this piece or just provide the visuals?  For surely they did provide the visuals, as is clearly disclosed.

It appears that they also provided some answers.  When the interviewer asks at, 3:56, "What about the costs?" Dr. Michael Stifelman from NYU's  Langone Robotic Surgery Center responds, "There is a perception that robotics is going to be more costly. What we're finding is that, when put into experienced hands . . . those increased cost are somewhat nominal if anything.  The benefit for the patient is they're going to get out of the hospital earlier . . . less risk of blood loss, less pain, and most importantly . . . the costs to society.  Each patient will be able to get back to work more quickly than they would using a more traditional technique for these procedures."

Sorry, Dr. Stifelman, but all of those assertions are not supported by objective, peer-reviewed studies.  Your point about cost also ignores the purchase cost, disposables, and maintenance contracts associated with this equipment. You also appear to be subtly offering a comparison of robotic surgery with open surgery, as opposed to manual laparoscopic surgery.  Here's a more objective recent portrayal of the issue in a recent New Yorker article.  An excerpt:

Many hospitals, faced with the pressure to compete with high-tech programs, are advertising robots aggressively—on billboards, on YouTube, even at baseball games. Some may be overselling the benefits of the technology. Researchers at Johns Hopkins University analyzed the Web sites of four hundred U.S. hospitals and, in a study published in the Journal for Healthcare Quality, reported that the majority of sites claimed that robotic surgery offered an “overall better outcome,” and a third of the sites touted “improved cancer control.” (None of the Web sites mentioned risks.) A study by researchers at Columbia University investigated the marketing of robotic gynecological procedures and found that many hospital Web sites described robotic surgery as the “most effective treatment.”
Jason Wright, who worked on the Columbia University study and is the chief of gynecologic oncology at the university, told me that many claims made about robotic surgery aren’t based on clinical evidence. “When you see an ad for a drug on television, the claims that are made have to be backed up by scientific data,” he said. “There’s not the same level of scrutiny for devices.”

Intuitive Surgical loves Dr. Stifelman:

Dr. Michael Stifelman, Associate Professor of Urology and Director of Robotic Surgery at NYU Langone Medical Center, has been named the 2011 recipient of the Crystal Award, given by Intuitive Surgical, Inc., to surgeons who have contributed significantly to the advancement of clinical knowledge in the field of robot-assisted surgery. The company, which manufactures the da Vinci Si robotic surgical system, gave the award to Dr. Stifelman in a ceremony at its annual meeting in Boca Raton, Florida.

And the company also promoted his interview with Diane Sawyer as well as numerous entries on its DaVinci Surgery Community site.

But here's the great part.  While Dr. Stifelman talks, the video meticulously presents the visual story of a grape being peeled.  I wondered if a surgeon might tell us how relevant that is to prostatectomies, hysterectomies, and the like, so I did a Google search on the question, "Is surgery like peeling a grape?"

I was overwhelmed by the response.  What good fortune.  Here's a portion of that page from my browser, with videos going all the way back to 2010.  Surgery is like peeling a grape, and how lucky we are to be able to do that robotically.


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