April 22, 2013

Doctors and New Technologies – Part 1

Part 1 of 2 Parts

This doctor has a lot to say about new technologies, some good and some bad. I agree with her for most of the statements and I must question some of her qualifiers. She is right that deciding if a new technology will help a patient or a patient's caregiver is important. Often this is as difficult for a physician as it is for the patient or caregiver. Since this doctor is working with the elderly, her decisions are compounded by what the patient or caregiver may be capable of managing.

One question that many people forget to ask or consider is, does this device communicate with other devices and if not, does this make the device less of a help. Too often, our high-tech devices are proprietary to the extreme and therefore useless except in very narrow limits. Until ethics can become part of doing business, most products available today are more of a hindrance because most data has to be transferred manually between devices. When time is important, devices that don't communicate are a fraud on the buying public to say nothing about medical care.

Here are her questions and my comments as a patient.
Does it help me do something I’m already trying to do for clinical reasons?
This is a question every doctor must ask and every patient should want to know. For the patient or caregiver, they also need to ask if it will meet their needs. Also, what does the device handle and is it a tool that would be useful.

What evidence is there that using it will improve the health and well being of an older adult (or of a caregiver)? This is the one question that this doctor fails, as she uses a meta-analysis study to say there is no clear benefit for non-insulin people with type 2 diabetes to regularly self-monitor blood glucose. I have blogged about rigged studies here and do not doubt that many of the studies in the USA were also constructed to give the desired results. Then in my email of Feb 5, 2013, I received my newsletter from The Behavioral Diabetes Institute, which has this link to information in Diabetes Care on the ADA website. The link is to a file that is a PDF and you will need to use Adobe Reader or a PDF compatible reader to download it. It has seven pages and is good reading with the ADA “experts” for the first three pages and the rest is written by Dr. William H. Polonsky and Dr. Lawrence Fisher. They are a voice of reason about self-monitoring of blood glucose (SMBG) and how important it is to all people with diabetes. Then they cover people with type 2 diabetes not on insulin as they are the ones not given the education and training in SMBG and could really benefit.

How does the data gathering compare to the gold standard? Talk about being vague, gold standard is what? When medical people refer to this, there are too many meanings that could be applied and this leaves all types of variables open for speculation. I sincerely wish they would use lay-speak. I do doubt that many devices actually meet gold standards since some may not have gone through FDA approval. If they have, then they should be more reliable, but maybe not reliable enough to meet a gold standard. Also, we need to remember that specifications for some devices will be more liberal simply because the manufacturer knows that the device may not be used under ideal conditions when used by patients or caregivers.

How exactly does it work? Come on doctor, they are not going to give away these secrets. They are only going to disclose what the device is made to do and if it communicates with other devices and which ones. If we are able to read through all the hype, we may discover what the outcome of its use is, but don't expect much until you get the device and instruction book in hand. As a doctor, you have to expect little information about clinical use, unless it is for clinical use. Most of the devices are not made for doctor use, but for patient use and many manufacturers could care less about what the doctors find useful. In fact, they might sell more devices if they did care about what doctors thought of the device.

How easy is it to use? Now this would be a good place to have a doctor's opinion and to know if it is easy to use by a wide range of patients including the elderly. For the elderly, ease of use is a must because often the elderly may have limited vision and or lack of dexterity in their hands.

How easy is it to try? This can be the key to many medical devices. Does it require a large financial outlay, or cost of training, as this could very easily send it to the back of the list of devices finding unfavorable recommendations and interest.

How cost-effective is using this technology? Here the doctor really nails it when she says, “Sometimes we have simpler and cheaper ways to get the job done almost as well.” Some devices will be overly complicated in what they can accomplish when a simpler method may work more effectively.

Can this technology provide multiple services to the patient? Many patients may have more than one medical condition. This is especially true among the elderly and knowing whether a device has only one function or multiple areas that it covers, may make it more desirable than a single function device. Here is where one device may have a clear advantage by being able to export or import information to or from another device.

Does this technology work well for someone who has lots of medical complexity? This is where a medical device will shine, or show that it is useless. It must be operable by patients having multiple medical problems. If it is too complicated, it will not be worth the money, unless it is operated by a caregiver that is with the patient every day.

While this may not be an exhaustive list of qualifications for a medical device, it is a great start and shows that the doctor has a good understanding of her patients. This will be a must for any doctor giving an opinion about medical devices. This should also be a strong consideration for patients and caregivers and serve as a way to avoid being misled by the inevitable hype on many websites.

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