Why I support the idea of a technology assessment board

The National Cancer Institute (NCI) is not shy to recommend screening for various forms of cancer - unless screening offers little benefit when compared to the risk.

A colleague of mine sent along an email.  He'd heard about a new screening tool.  Primary care docs like us could do a good thing for our patients.... right? The new gizmo that we'd buy from this company would allow us to look down a patient's esophagus to see if the have any indications that they might develop cancer of the esophagus.  

An announcement to docs in the region:  Esophageal cancer "has increased 350%," "has a very poor survival rate."  "Attractive reimbursement is available for this 5 minute examination that saves your patient a trip to the hospital and an expensive procedure." (read the full notice - scroll down to "A new Office/Clinical Procedure...")

So what does the NCI have to say about screening for esophageal cancer?

Benefits:  Based on fair evidence, screening would result in no (or minimal) decrease in mortality from esophageal cancer in the U.S. population.

Harms:  Based on solid evidence, screening would result in uncommon but serious side effects associated with endoscopy which may include perforation, cardiopulmonary events and aspiration, and bleeding requiring hospitalization. Potential psychological harms may occur in those identified as having Barrett esophagus who may consider themselves to be ill even though their risk of developing cancer is low.

The marketing pitch seems so compelling: help your patients avoid this deadly disease.  Too bad the evidence does not support the intervention.  According to the National Institutes of Health there are studies under way, maybe we'll find out that this is really a good test and the company who makes the machines will be happy, the docs will be happy, and the patients will be happy, but for now all I see is yet another opportunity for a company to be happy soaking up health care dollars that might have been spent on interventions with better proven worth.

I'd rather not have to chase around the internet doing research for every new gizmo throw onto the market, and I'm tired of finding out two years down the pike that the latest new drug or intervention turns out to have dreadful side effects or lacks any real benefit when compared to stuff that costs one tenth as much.

L. Gordon Moore