The New York Times recently published a great article by Barry Meier on metal-on-metal hip implants - a supposed improvement over designs using both metal and plastic, but one that also, as it turns out, "can shed dangerous metallic debris through wear". The article suggests that these new designs were promoted before doctors had a good understanding of the risks involved, and patients began to ask for the new implants because they thought new had to be better.
The article provides several examples of other new products in health care that claimed to be technological breakthroughs but ended up no better - and sometimes worse - than the products they were supposed to reply: some artificial spinal disks, a diabetes drug, a heart device component. It also underlines the business motivation of health care companies to keep bringing new products to market rather than sticking to old models in fields where these old designs already have high success rates. (As mentioned by an expert in the article, novel approaches, with the high level of uncertainty they entail, are much more justifiable for diseases such as cancer which continue to claim many lives.) In their defense, some of these new innovations had indeed been proved more effective for a subset of the population (taller, middle-age men in the case of the new hip implants) but they were later marketed for everybody.
I found the history of the metal-on-metal hip particularly fascinating, especially the part where this design had been abandoned before on the grounds that "patients had metal particles in their blood or organs". The part of the article at the end of the first online page and the beginning of the second one is riveting. Excerpt: "In essence, the old technology was repackaged as new and cutting-edge, and warnings like Mr. Black’s were ignored and considered no longer relevant."
It is to the doctors' credit that they sounded the alarm when they noticed some of their patients develop unusual conditions, in spite of the upside marketing their practice as "on the cutting-edge of innovation" can have on their own revenues. On the other hand, it would have been infinitely better if this sad mess had not developed in the first place.
Not only were these innovations little tested, but (see the top of the third online page) computer simulations are also in part to blame, for the unrealistically optimistic conditions they assume. Specifically, "Under F.D.A. rules, most all-metal hips don’t have to undergo clinical trials before sale. Instead, they are tested in labs on machines that simulate millions of steps to study the forces exerted by years of motion... [T]ests of the all-metal implants did not point to problems, [...because they] were apparently based on idealized conditions... For example, all-metal devices proved less forgiving than metal-and-plastic ones to small variations in how they were implanted."
Ultimately, some say that "lawsuits against... makers of all-metal hips may emerge as the largest product liability cases of this decade."
Again, this is a fantastic article and I encourage everyone to read it, as an important lesson on the medical industry and what can happen when patients let themselves be convinced that innovation can only make a product better.
Whatever happened to the saying "if it ain't broke...don't fix it!"?
Silicon Valley companies innovate because they legitimately do something better. In this case, not so much -.-...
Posted by: Ilyaquant.wordpress.com | July 11, 2011 at 03:36 PM