“Because It Costs More”: An Example of Medical Reasoning

Melody McLaren, a friend of mine, lives in London. Her husband has Parkinson’s Disease and receives treatment through the National Health Service. His treatment has included “deep brain stimulation” — implantation of an electrical device that stimulates subcortical brain areas. It is a standard treatment for Parkinson’s. It cost the National Health Service about £35,000.

She was surprised to discover that in the United States, the same procedure involved implantation of two batteries, one for each side of the brain. The device implanted in England has only one battery. It worked fine. My friend wondered why two batteries were used in the United States. She asked her husband’s neurologist, a French woman practicing in London. “Because it costs more,” she said. There was no other reason.

At the San Mateo Maker’s Faire a few weeks ago, I heard a talk by a doctor named Amy Baxter, who had developed a device for pediatricians that makes shots hurt less. (She had a child and noticed the problem.) She went to considerable trouble to develop a product that could be used by working doctors and presented the product several times to potential buyers. Again and again she was told It has to be disposable. Meaning one use per package. Nothing else will fit the supply chain. She did not say why she was told this, but the obvious reason was that disposable products are more profitable.

Steven Brill’s cover story in Time two months ago was about one way American health care takes advantage of sick people with little choice — hospitals, including nonprofits, charge patients for products and services far more than what they cost the hospital. This is another way.

10 Replies to ““Because It Costs More”: An Example of Medical Reasoning”

  1. Disposable, one use, needles are used for sanitation reasons. This became an issue back when AIDS first hit.

    Auto mechanics also charge customers for products and services far more than what they cost the garage.


    Seth: I’m not sure it’s that simple why needles are disposable. Lots of things are sterilized…there exist machines whose function it is to sterilize stuff. Needles did not have to be disposable to be sterile. In any case, sterility is far more important for something you stick into the body than Amy Baxter’s device, which touched the skin.

    With auto mechanics, consumers have far more choice.

  2. I was hospitalized briefly recently. One of the devices used to track you is called a pulse oximeter. It’s a small noninvasive device that clips on the end of a finger and shoots LED light through the fingertip toward a sensor on the other side (to track pulse, I think.)

    It was in a disposable adhesive form, which I thought strange because it could easily have been made to last fifty years. Another strange thing was that instead of leaving it on me (it was painless and as light as a bandaid), the nurse at the hospital put a new one on for each reading, requiring several rather than one. I couldn’t figure out why.

    Now I realize that fraud was why.

  3. Because of disposable needles, you can now get shots at drug stores – and much cheaper than going to the doctor. I don’t think they would take the risk of trying to keep a ready supply of syringes and needles sterilized. Besides, everything would have to be glass and stainless steel to withstand the sterilization process – and needles get dull after a few uses.

    I just took my dog to the local pet store for a by-annual shot – they have vaccination clinics once a week – all the needles were disposable – they couldn’t/wouldn’t provide this service if they had to sterilize everything in advance. All of the vaccines were pre-loaded in the syringe, in a sealed pack – very convenient for the vet when he has twenty dogs in line and a steady stream coming through the door – and, once again, it was way cheaper than going to the vet.

    I don’t think disposable needles and pre-loaded syringes are what’s driving up healthcare costs. And the risks of using non-disposable – soon to be bio hazard – equipment is too high.


    Seth: What about recyclable needles? In any case, I urge you to watch Amy Baxter’s talk and see if there are good reasons — besides profitability — for requiring her invention to be recyclable. It costs a lot more than a needle.

  4. “I just took my dog to the local pet store for a by-annual shot”

    Keeping with the spirit of Seth’s post, your dog doesn’t need by-annual shots. Do YOU need any bi-annual shots? Then why should your dog?

    It used to be annual shots for dogs, because that’s how vets made their money. Yes, at the expense of their canine patients’ health, because over-vaccination is a cause of many canine ailments.

    Now there’s a three-year protocol for pets that will eventually lead to even longer intervals.


  5. oximeter: if that’s what I think it is, the NHS method involves a clip-on device which is cleaned with an antiseptic swab – before your very eyes – before it grips your fingertip. If only the doctors cleaned their fingers as regularly.

    Seth: yes, Amy Baxter’s device could be cleaned that way. Yet somehow that was unacceptable.

  6. I’m a little leery of so quickly dismissing these as waste. There may be good engineering reasons (e.g., redundancy) for having two batteries, and that rationale may not have made it to the doctor in question.

    As for a reusable device somehow involved with injections, as others say, you have to consider the risk that the item will not be properly cleaned. I give blood somewhat regularly, and am frequently surprised at how many errors the nurses/phlebotimists make in their sterile procedures. In the computer field, we often know that rebooting or reinstalling computers is a good way to clear out entropy (viruses and other baddies). There’s a lot to be said for “rebooting” anything involved with injections by just using a new one.

  7. P.S. If you have any thought that Americans (at least) are any good at following safety procedures, five minutes on any freeway should disabuse you of that notion…

  8. Disposable needles reduce the risk of overdose and disease, and reusable needles generally have larger diameters, and get dull, which adds to discomfort. Disposable flu shot needles are now as thin as insulin needles. I don’t trust sterilization to get a used syringe clean. It has more in it than medicine, if they pull back on the plunger to be sure they aren’t in a vein.

    Premeasured, there’s less chance of the wrong dose, less chance of bottle contamination, and less chance of distraction causing a doctor to accidentally re-use a needle. That happened on a live TV demo of flu shots, the doctor accidentally refilled a used syringe. With disposables, empty means dirty. Plus, once you’ve broken the seal on a bottle, you have issues with shelf life and temperature control.

    A major concern of accidental needle sticks is hepatitis, the odds are extremely high. The odds are worse for injection vs. needle stick.

    I bet the dog vaccine was for kennel cough. Nose drops last a year, but dogs hate them. Shot only lasts 6 months.

  9. Not sure why everyone’s perseverating on needles. They weren’t mentioned in the post.

    Disposable needles aren’t where the fraud is.

    Seth: I agree, they are not where the fraud is.

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