SAS/ISASS would like to alert you to a recent article in the Wall Street Journal covering Congressman Darrell Issa’s (incoming chairman of the House’s chief investigative committee) goal of “cutting the overuse of expensive medical procedures…. …data came in a report suggesting that expensive cardiovascular and orthopedic implants are overused by doctors, sometimes after aggressive promotion by device makers.”
The Wall Street Journal article can be viewed at the following link:
SAS/ISASS President Dr. Thomas Errico’s response to the Wall Street Journal article (pending publication):
December 9, 2010
The Wall Street Journal
1211 Avenue of the Americas
New York, NY, 10036
To the Editor,
Cong. Darrell Issa’s assertions (“Republican Targets Use of Costly Medical Devices,” Dec. 9th) that spine surgeons are inappropriately inserting “joint and bone screws to support patients’ spines” are misguided and unfair. In fact, there are many clinically appropriate and scientifically valid instances where surgical spine treatment is the very best option to return a patient to a healthy, productive life. Implying that spine surgeons are unduly influenced by misaligned incentives is simply inflammatory rhetoric.
We as spine surgeons welcome comparative effectiveness research that provides decision support tools for the best treatment options for our patients, so long as the government and commercial payers don’t use that information as decision control mechanisms to prioritize the cheapest options above those that provide the best outcomes. As Sackett, one of the fathers of evidence-based medicine, pointed out, the evidence alone is never sufficient to make a clinical decision. Decision makers must always trade the benefits and risks, the inconvenience and costs associated with alternative management strategies, and in doing so, consider the patient’s values.*
Further, it is our belief that the medical device industry, demonized by Cong. Issa, in fact provides innovative and life-changing products that alleviate suffering, increase mobility and productivity, and improve lives. Our goal as surgeons is to prioritize the needs of our patients and make choices that will lead to the best outcomes.
Thomas Errico, MD
SAS-International Society for the Advancement of Spine Surgery
New York, NY
[*Haynes RB, Sackett RB, Gray JMA, Cook DC, Guyatt GH. Transferring evidence from research into practice, 1:the role of clinical care research evidence in clinical decisions. ACP Journal Club. Nov-Dec 1996; 125: A-14-15.]