What Works in Medicine?

Hillary Clinton is releasing her comprehensive health care proposal today. It appears that she is doing all she can to make it not look like another "big government" proposal. For instance, she preserves a role for large private health insurance companies.

One proposal, would create a public-private institute to evaluate and compare drugs, devices and medical treatments. We used to have a government agency that did this. It was called the Agency for Health Care Policy and Research (AHCPR). It no longer exists thanks to Republican Newt Gingrich.

The fact of the matter is that we really don't know as much as we should about which medical treatments are most effective for a given problem. Shannon Brownlee at Washington Monthly has a great article about this problem. The article is mostly about treatment for lower back pain which is why the AHCPR was originally mandated.

One new "unproven" medical treatment is the use of robotic surgery. I was completely unaware of the advances in robotic surgery until recently. For example, removal of the prostate gland can be done using several methods. The current favored method at our local hospital is the use of microwave therapy.

But robotic surgery makes sense to me, and it would be my choice if ever needed. The daVinci surgical system seems to have many advantages over even laparoscopic techniques. In the case of prostate surgery, nerve damage during surgery can result in impotence. The daVinci system provides increased visualization, precision, and dexterity. It has the added advantage of the possibility of someday being used remotely.

Newly trained up and coming surgeons have been brought up playing video games. The use of robotic surgery should come naturally to them.