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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