Recently, a colleague told me about a family member who saw his physician for back pain. At the end of the visit the doctor sent him to get his blood drawn. This patient wasn't sure what the blood test was for, but he complied. Two weeks later he got a call from his insurance company asking about a bill they'd received for a $5,000 proprietary test for heart disease risk.
This story raises several curious questions, but I'm going to focus on the fact that there's a company out there marketing a $5,000 cardiac risk test. It turns out that the best preventive care expert in the country, the nonprofit advisory group known as the U.S. Preventive Services Task Force, has extensively analyzed the evidence for cardiac risk assessment in healthy adults.
They concluded that we should periodically check our cholesterol levels (HDL and LDL forms) along with checking blood pressure and quitting smoking. The generic blood test for HDL and LDL cholesterol has a retail value of maybe $50. So how could that company get away with selling their patented alternative for 100 times the price without convincing clinical evidence that it's any better?
The simple answer is that they have a huge sales force that markets their testing aggressively to physicians. Sadly, this is a recurrent theme in health care. Medical device companies promote certain types of orthopedic implants for lower back pain and jaw pain despite the lack of clinical evidence for long-term benefit. Pharmaceutical companies have a long history of marketing drugs for unproven uses (although they may be cleaning up their act in response to some recent breathtaking fines by the FDA; $3 billion just this week for GlaxoSmithKline and $2.3 billion for Pfizer two years ago).
In the medical laboratory industry where I work, we regularly encounter business models based on patenting and promoting expensive tests that haven't been proven better than older, less expensive ones. This isn't just a national phenomenon; it's a local one as well. I am saddened each time I hear local entrepreneurs and academics praised in industry meetings or the local press for hawking the modern equivalent of snake oil.
I believe the solution is two-fold. First of all, we need wider recognition that most new pharmaceutic, device and diagnostic inventions turn out in the end to be no better (or worse) than older technologies. This isn't the inventors' fault; it's the fault of biologic complexity. It is impossible to know the true impact of a new medical technology until it has undergone extensive clinical evaluation.
It takes years of diligent effort to sift out the small proportion of inventions that truly benefit patients from the larger proportion that don't. Beneficial innovations can be truly life-changing for patients, and it's ironic when we can't afford them in part because we're spending so much money on the more common non-beneficial ones.
Second, we all need to raise our expectations of the biotechnology industry. Physicians, hospitals and insurers can do a much better job holding medical companies accountable for their sales and marketing practices.
Companies with a history of overpromoting early-stage, unproven technologies can and should be actively excluded from the clinical marketplace. Investors need to recognize that although premature aggressive marketing can produce short-term profits, the only path to long-term sustainable biomedical businesses is by generating true clinical value for patients.
With appropriate constraints, market capitalism can, I believe, promote high-value, high-quality health care. But we're not there yet.
Brian R. Jackson, M.D., M.S., is associate professor of pathology (clinical) at the University of Utah. He is also the medical director of informatics at ARUP Laboratories.