Johnson & Johnson proposes to replace anesthesiologists during simple procedures such as colonoscopies -- not with nurse practitioners, but with machines. Sedasys, which dispenses propofol and monitors a patient automatically, was recently approved for use in healthy adult patients who have no particular risk of complications. Johnson & Johnson will lease the machines to doctor's offices for $150 per procedure -- cleverly set well below the $600 to $2,000 that anesthesiologists usually charge.
Anesthesiologists warn about complications, but the company says that in 1,700 trials, no patients have required rescue by an anesthesiologist. (In fact, the Food and Drug Administration granted approval in part on data showing that the system reduced the risks associated with over-sedation.) The doctors will continue to fight this incursion on their turf. In today's cost-cutting environment, however, these machines may well become standard for more and more procedures. Just using them for uncomplicated colonoscopies could save more than $1 billion a year.
One possibility is that we'll discover unsuspected issues with these machines when they get into widespread use. 1,700 patients is a lot, but it's tiny compared with the millions of people who have colonoscopiesevery year. The sad fact about healthcare innovation is that you often can't discover whether something will kill patients until you give it to a lot of patients. Vioxx looked fantastic in initial trials; its problems came to light after it hadalready been approved by the FDA. Fen-Phen's troubles also appeared well after the initial trials suggesting it aided weight loss. Only after they'd been used by lots and lots of people did their side effects for some patients become clear.
Another possibility is that this will work as well as, or better than, a doctor and replaces anesthesiologists -- not just for colonoscopies, but for more and more procedures. The health-care cost curve bends, and a bunch of doctors lose a very good living.
But the third possibility is that this procedure will dramatically control costs, at a slightly elevated risk of patient death. And that's a tough one. Are we willing to pay billions every year to prevent a handful of deaths? On a strict cost-benefit calculation, perhaps we should be; after all, we probably would not be willing to add $1,000 to the cost of every new car to prevent a couple of highway fatalities every year. Those sorts of calculations are, in fact, how Britain decides what treatments will be covered.
Americans are not very good at abiding by this sort of cold logic -- at least not explicitly. But with the government taking over more health care spending, we might have to be.
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