Last week columnist Sam Fields wrote a scathing article for Broward Beat berating the current healthcare system which saved a child’s life through an experimental procedure performed atJackson Memorial.
The procedure was costly at $1 million along with eight months in the hospital, but the child’s life has been extended from several days to an estimated four or five years. There’s no guarantee that it won’t fall short of that goal or even be extended beyond through additional treatment.
The article suggests that the procedure was too costly and there are better uses for the money. It’s essentially a rehash of the old “why go to the moon when the money’s better spent here” argument from the 1960s.
Sam referred to the event as “everything that’s wrong with American healthcare.” In doing so, he correctly points out that healthcare dollars are not unlimited and that Jackson Memorial is already financially underwater. Even so, I disagree with his characterization of the system, and thousands, if not hundreds of thousands of beneficiaries of that same healthcare system will agree with me.
In that light I have no choice but to own up to something: I was the one who posted on Broward Beat under the pseudonyme of “so let me get this straight.”
Back to the question; Was the procedure a waste?
Sam says yes, I say no. Admittedly, the procedure is new and experimental. But then so were the first few heart transplants, liver transplants and artificial heart implants. Ditto for every other major procedure developed over the last half century.
Hell, the pacemaker/defibrillator that controls my own heartbeat is an example of new technology and recent advances in medical therapy.
At the beginning, the lives of heart transplant patients were measured in days with costs that were pretty much similar to the child’s treatment that now lights the opinion fire under Sam. Those early patients never left the hospital at all. Today, heart transplants are routine and the life span of most recipients can be measured in tens of years. Some as long as 25 years.
The lifespan of artificial heart recipients was also measured in days at the beginning. After the first two rather spectacular failures, the research and efforts went pretty much underground as far as the major media was concerned. But the research never stopped, and the researchers just changed their scope.
The Jarvik 7 artificial heart is as ancient a technology as is black and white television today.
The goal of the technology is now keeping a patient alive while waiting for a new heart. Advances since the Jarvik 7 now have recipients living with either a Ventricle Assist Device or a complete artifical heart for up to two years tethered to the machinery.
And here’s the good news. Battery technology and miniaturization have reduced the size of the support equipment from the size of a roll around cart to the size of a small child’s school backpack. Patients with an implant can now go home and at least partially resume normal lives.
In each case the first few were spectacular failures especially considering bang for the buck. But we learned. Today they’re routine and they save lives. They’re also expensive. Should we have followed Sam’s idea and just pulled the plug on those folks too?
Let me remind you of another child who led the way. In 1982, 2 year old Trine Engebretsen had the first liver transplanted given to a child. It just wasn’t done before that because the procedure was still new and risky in adults. That was 29 years ago and today Trine is alive and healthy. Trine’s transplant along with the massive publicity that was generated at the time was probably the watershed event for all organ transplants.
So which of us would have pulled the plug on this little girl at Jackson Memorial to save that million dollars as Sam suggests? And if we choose to pull that plug to save money, where else do we start pulling plugs?
Do we start rating people according to their medical histories? Sam argues that half of the medical expenditures for most people come in the last six months of their lives. It’s a statistic, and it isn’t always the case. Do we keep charts and have a medical board rate a patient’s expenditures through charts and graphs?
Do we rate people based on age or estimated lifespan? After all, the little girl at the beginning of this article had only a day or two. 60 year olds have only about ten years remaining on average. Cut the cord and let the dice fall where they may? 80 year olds are beyond average life expectancy. Their future treatment is bound to get expensive. Should we just tell them sorry, but they’re on their own for the greater good? Who makes that decision? Doctors? Lawyers? A panel composed of political hacks?
I challenged Sam to answer such questions. I’m still waiting.
Oh, and the biggest question of all: Do we stop expensive experimental medicine because the cost outweighs the possible advances in saving lives?