Wednesday, April 4, 2012

Another treatment 'advancement'

The latest suggestion for breast surgery is to use ultrasound guidance during surgery to improve odds for clean margins and therefore local or regional recurrences and the requirement for a second surgery. This sounds good. It is based on a small European study but is now suggested as being the newest standard of treatment.

Well that is just ducky. I mean who wouldn't want an advancement in treatment. But (and of course there is a big but here), I have a few questions on this:
  1. When would this become the standard of treatment? Does the FDA have to approve it? Probably not, but probably the Surgeon's Standard Board Association or whatever they are called - the people who set the surgical standards. So this will probably take a while. Hospitals would need to adopt the standard and then individual surgeons would need to be trained -  how do you hold the ultrasound thingy and cut into someone? Even if its held by someone else, isn't it be held on top of the thing the doctor is trying to remove? Maybe its a good idea I'm not a surgeon. (Not that I am any better off as being the patient.)
  2. While this has the potential for saving some lives,  is there an increased cost involved? Do all hospital surgery rooms have the right kind of ultrasound machines for this or do new machines need to be purchased? In the age of eyes on increasing medical costs, increased expenses go under the microscope. While I am not trying to put a value on an individual's life but we have to consider this. If hospitals need to purchase more ultrasound machines for this surgery, could that money be better used by them for hiring more nurses to provide better care or a different machine for another use? Yes in an ideal world, hospitals would all have all the money, personnel, and machines they need - but we live in reality, not an ideal place.
  3. This was based on a TINY study of 124 patients and one group of surgeons? Is this representative of all patients and all surgeons? Maybe more studies are needed - or at least at more than one hospital.
I am a tad skeptical but would welcome the progress - and just hope I would never need it.

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