Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity.
If the face of our machines sag, we lift it up. If our pipes clog, we roto-rooter or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to remove something in the machine’s interior, we take it out through a laparoscope. If the fuel or metabolic mix is wrong, we alter the mix or correct the metabolic defect with drugs. If anything else goes wrong, we diagnose it and rearrange it electronically.
We are reluctant to let nature take its course. We rely on technology and machines to do the job of keeping us looking young, active, functioning , and alive. This fixation on machines and technology is the big reason American health care is 50% more costly than that of other nations. With rapid access to machines and our reliance on them, we deliver a different product than other countries — more technology and machines, faster and more often.
Give a specialist a machine, and he or she will do the job, and we or the government will pay for it.
We love machines — heart lung bypass machines, dialysis machines, heart rhythm machines, imaging machines, Internet-run machines, ventilation support machines to keep us alive at the end of life. Patients and lawyers expect us to use these machines, doctors constantly innovate to produce more machines, and we tend to use them — no matter what the cost.
Go to a cardiology convention, and you will witness display after display of heart rhythm pacemakers. Go to an orthopedic convention, and you will think you are in an industrial exhibit, with new devices as far as the eye can see and the mind can comprehend. Go to an orthopedic operating room, and you will hear the sounds of hammers and chisels and rods being inserted. Go to a hospital convention, and much of the chatter will be about new technologies and machines that attract more patients and more specialists, reverse the ravages of disease, and to enrich the bottom line.
The latest and most talked about machine in hospital marketing and in the hands of surgical specialists such as urologists, heart surgeons, and gynecologists is the da Vinci surgical robot, a $1.4 million machine. It is designed to be less invasive, to cut blood loss, to minimize complications, to increase hospital market share and revenues, and to attract both patients and specialists to hospitals.
The price is high, $1 million to $2.25 million per machine depending on the model, $140,000 a year for maintenance, and $1,500 to $2,000 per procedure for replacement parts. The manufacturer of da Vinci, Intuitive Surgical, Inc, must be doing something right. Last year it had a profit of $233 million on sales of $1.05 billion. It is deployed in 853 hospitals, large and small.
But, as with all medical machines, da Vinci is not infallible . It relies on the expertise and experience of its physician users.
The human body is not a machine, and not all of its problems and eccentricities lend themselves to automatic or flawless operation and correction.
Complications happen. Human judgment is still required.
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