DO DOLLARS ADD UP
TO THE BEST MEDICAL DECISION?
Journal of Healing – March 14, 2007

By Mary Koch

            “Follow the money,” the confidential source “Deep Throat” famously advised probing reporters during the Watergate era. Money is a strong – sometimes even scandalous – motivator. But we shouldn’t have to follow the money to discover the “why” behind life-and-death medical decisions. Should we?

A recent New York Times article about choosing between a stent or bypass surgery for heart patients followed the money. It was, well, disheartening.

            The lengthy report detailed how some doctors are beginning to wonder if too many patients are getting stents – a less invasive procedure – when long-term studies indicate some of them would be better off (translation: live longer) with by-pass surgery.

            For once you can’t blame the insurance companies, infamous for promoting cheaper options. Both surgery and stent procedures are comparably priced, the Times reported – on average about $30,000.

*     *     *

            BUT YOU CAN follow the money to manufacturers such as Boston Scientific and Johnson & Johnson, whose stent sales totaled about $2.9 billion last year.

“They, along with competitors trying to catch up, have invested heavily in expanding the use of stents,” said the newspaper report. Translation: Scores of cardiologists attending free “stent seminars” at world-class resorts with first-rate golf courses.

The number of bypass surgeries fell by a third over the past decade to about 365,000 last year, while stent procedures soared to nearly a million in 2006.

And what next? I envision TV commercials featuring an animated Stephanie Stent piloting a stream-lined catheter and Roto-Rootering her way through an artery, while an alluring voice-over urges viewers to “bypass that bypass.”

            For the most part, patients are better off. The financial losers are surgeons, who after adjusting for inflation, have seen their annual incomes dwindle from $1.02 million in 1990 to $425,000 last year. Dwindle? Did I say dwindle?

            During that same period, interventional cardiologists – the folks who install stents – have enjoyed a pay raise, again inflation adjusted, from  $392,000 to $550,000 annually. The thing is, in a case where surgery would be preferable (studies suggest for the sickest patients), it’s up to that cardiologist to pass a patient on to the surgeon.

“How often that happens may depend on the degree of respect and collaboration between a hospital’s cardiologists and surgeons,” the newspaper reported. Whew. Thank goodness it’s a matter of mutual respect and collaboration and not a tug of war over who gets the patient’s dollar.

*     *     *

            I VISITED my mother last week and was reminded of a decision she faced a few years ago. She had to decide whether to undergo a procedure similar to a heart stent, though this involved her brain.

            The neurosurgeon said frankly, “I wouldn’t want my mother to do it.” That was good enough for Mom, but the surgeon continued that if we wanted to pursue it, she’d already called another surgeon at a different clinic and he’d “be happy” to talk with us.

Why did I instantly have a vision of a bright red Lamborghini parked in the other surgeon’s clinic garage? Too cynical of me. Certainly he was just being accommodating, keeping all options on the table. The Medicare-financed table.

            Mother, now 90, has thrived without that particular intervention. 

            The moral of my story? Well, that’s the problem. It’s hard to find a moral when you’re following the money.

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