

Building a better heart valve - zabramow
http://www.nytimes.com/2015/06/22/health/heart-failure-aortic-valve-disease-tavr.html

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neuro_imager
Not surprising that cardiac surgeons were reluctant to see this performed and
are doing as much as they can to limit the extent of its use.

Because interventional cardiologists are performing the procedure (not
surgeons, at least initially) this hurts the cardiac surgeons' revenue (and
could ultimately replace open surgery - making the expertise that surgeons
have achieved over decades become redundant, thus lowering their power,
prestige and influence).

Of course, when surgeons start training in these techniques, they'll start
swearing by them (whilst stating emphatically that they're the only doctors
that should be doing them).

This is an enormous problem across medicine - specialists (especially
surgeons) not wanting to lose turf to other less invasive options, which harms
patient care across the board - see also intracranial aneurysm treatment
(surgical clipping vs endovascular treatment), abdominal aortic aneurysm
treatment (open surgery vs. endovascular), fibroid treatment (hysterectomy vs.
minimally invasive options) and oncology treatments (surgery and radiotherapy
vs. interventional minimally invasive procedures).

Always get a second (and third) opinion and look for alternatives before
agreeing to have an invasive surgery - that's not an endorsement of new age
alternative BS though, do your own research.

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agumonkey
Isn't it a 'natural' issue everywhere ? systems are against their own death.
Rare are systems (businesses, artisans) that will keep focusing on evolving
toward better solutions rather than building a nest.

So far is there a solution which is not to let nature/market decide what is
available ?

Doctors are in a weird position. They're rightly reluctant to change (like
aerospace) because they can't risk death. They're a black box, no patient can
contradict, they're saviors. Their word is often final. I'd love to trust them
fully, but I've seen too many errors (innocent or greedy) to not think about
how we could avoid the problem (similar to self-driven cars, manufacturers and
injuries).

ps: non invasive surgery is trendy though now, this is becoming a public idea,
in these economically troubled days, cheaper and safer medical options will be
loved.

~~~
neuro_imager
Like a lot of things it depends on incentives. Individuals should be
incentivised to obtain the best outcomes not to maintain the status quo.

One way to alleviate this type of thing is to pay doctors a flat rate salary,
adjusted according to patient outcome (ie. significant improvement in outcomes
through a novel innovation - you get a percentage raise). Paying per procedure
is part of the intrinsic problem.

The system also needs to change, like many systems. Innovation and capability
needs to be valued over seniority. Hard to do in the current healthcare model
though (and no doubt there will always be those who figure out a way to game
any system).

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wyldfire
I work for a company that benefits from the TAVR procedure becoming approved,
so I've heard a lot about it in the context of our growth. It's great to see
the clinical benefits described here.

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placeybordeaux
Talking about a procedure that is used on people with failing hearts:

> It is not for the fainthearted.

