Becoming cyborg: Beware inequalities ahead
Most of the big news in medical technology seems these days to revolve around genetic discoveries. Nevertheless, the first kind of commonly used advanced medical technologies will be in medical devices. In fact, if you have an older relative, they probably already have an artificial knee, hip or device that assists in the operation of key bodily functions. We'll all be somewhat cyborg before we ever start routinely relying on gene therapies, which are many years from widespread use.
Most people I talk to about this expect something from the Six Million Dollar Man when they think of replacement joints. No, I will not be able to jack up a car with my neck after this surgery. I'll just have the neck of a younger person, one made of nickel, stainless steel and plastics.
Like 27 million American adults, I have osteoarthritis. In my case, the vertebrae in my neck are expanding and have needles of calcium growing into the muscles and nerves in my neck. But the real problem is my degenerative disc disease, which 85 percent of adults begin to experience by age 50. A piece of what's left of three completely destroyed cervical discs began compressing the nerve that leads to my left arm.
I'm 47 and have had Degenerative Disc Disease for years. During October, it became unendurable, causing searing pain all day and night. I lost the feeling in several fingers of my left hand. It is awful. I needed a body upgrade like the one in the image to the right above, a ProDisc cervical disc replacement.
Now, here's where the inequalities start to kick in. My insurer doesn't particularly like paying for the disc replacement surgery, preferring the established treatment, which is fusing the discs into place with a piece of bone from the patient's leg. Fusion takes longer to heal, fails at a rate slightly higher than disc replacement according to FDA studies, and, most importantly, merely transmits extra motion to other diseased joints.
In other words, after fusion more discs start to crumble, requiring additional fusion, which leaves you with an immobile neck at a cost of approximately $73,000 per surgery. My share of a fusion bill would be about $3,500. (I highly recommend doing research on medical costs before going to the doctor, just like when you buy a car -- HealthGrades.com is a solid resource that provides a breakdown of costs and hospital and doctor's expertise in different treatments).
The fact that disc replacement promises improved mobility in the joint isn't a "benefit" insurers recognize. The operation was only FDA approved for a single disc until a few weeks ago, and I am in the midst of gaining approval for a "multi-level disc replacement" from my insurance provider. Unfortunately, my doctor tells me another of his patients, who works for and is insured by the same insurer I have, was just turned down for the single-disc surgery.
The other barrier to access is the Food and Drug Administration, which is consistently under-funded for product reviews. In medical technology, "beta" isn't good enough, so we need a well-funded review process that doesn't rely entirely on company research or company-defined FDA protocols. We also need to recognize that these are risky procedures that can lead to death, paralysis and lifelong pain if things go wrong -- we can't go lightly into cyborg markets like we play with gadgets.
Nevertheless, we do need the market forces that have turned advanced information technology into affordable gadgets to start to work in a world where 85 percent of us will suffer from degenerative disc disease. The cost of these procedures limits access to the very wealthy, because insurers treat them as elective surgeries compared to what they currently pay for, like a decades-old approach such as cervical disc fusion.
I don't know if I'll get a new neck this year. I make a good living and have excellent insurance coverage. That should scare all of us, because if the insurance industry is going to limit access to advancing medical technology until they can extract the highest profit, all of us will be forced to make less-than-optimal health decisions about the simplest thing, like one's ability to raise their hand to their mouth or type a blog posting.
