The Bleeding Edge Page #7

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that are unretrieveable.

They cannot get them.

Ah.

Okay, guys, nice to talk to you. Okay?

Good luck.

There's a lot of uncertainty

in medicine.

I think, as physicians, we're not very

good at saying, "We don't know," at times.

It's fine for you

to shout about the benefits

or overstate the benefits of a treatment.

The minute you raise concerns

that something might not be working

as well as it should,

you are often criticized.

You're told

you're unnecessarily scaring patients.

It doesn't seem like doctors

are requiring a high level of evidence

in order to implant a new device.

Yet in order to abandon that device,

they're requiring

a greater level of evidence.

than it took them

to decide to implant the device.

That's turning everything on its head.

We attract good people

in health care,

but there's this tremendous hunger

to have the latest gadgets,

the newest technology,

without the proper evaluation

of that technology.

We shouldn't be surprised

when some of the health care goes wrong.

If I knew this business...

when I got into it X amount of years ago,

I would have done something else.

I worked for one of the largest

medical device companies in the world.

My ultimate job was to make surethat

the surgeons used my implants in surgery.

It's all about usage.

So the more implants you use,

the more money they're going to make.

It's gotten worse over time

because of greed.

Most doctors do the right thing and

always will tothe best of their ability.

But some fraction of doctors

respond to the perverse incentives

of getting paid more for the more you do,

regardless of the appropriateness

of that medical care.

There are kickbacks in the United States

today that are entirely legal.

It doesn't have to necessarily be,

"Dr. Jones, I'm giving you money."

It could be consulting,

it could be teaching.

It could be providing money

for a fellowship program.

There's some doctors that are good,

some doctors that aren't.

I had one surgeon recently who said,

"You make the best products,

but you don't do enough for me,

so I'm using somebody else

because they do more for me."

Welcome to the business.

In days gone by,

surgery was all about blood and guts.

In the future,

surgery will be about bits and bytes.

Is the future already here?

It's a blend of science fiction

and medical reality.

The robot will see you now.

Tonight, a story

from the cutting edge.

The million-dollar Da Vinci system,

a revolutionary tool

for surgeries of all kinds.

The Da Vinci is a large,

fairly complicated robot

able to bring a camera and instruments

in together through one small tube.

The Da Vinci is able to reach anywhere

Very exciting to think

where we get to go with this.

Da Vinci allows us

to do remote surgery

from about seven feetaway

from the patient.

We work in a remote control console,

sort of like a video game machine.

We look on the screen,

at the image from inside the abdomen.

And we can perform the operation

with remote control hands.

Da Vinci, by Intuitive Surgical.

They're now in 64 countries.

Intuitive is absolutely

the dominant market leader in this field

with a turnover last year

of over $2 billion.

We're an innovative company.

We will continue to innovate,

put new products out.

Intuitive is motivated by the opportunity

to invent new things, create the future.

That is my vision for your future.

Thank you.

The story of how the robot

came into health care

is the story of what's wrong with medicine

in America today.

Massive adoption of a new technology

with little evaluation of the outcomes.

The Da Vinci robot

was marketed with a strategy

of approaching doctors and communities

and telling those doctors,

"We can help drive business to you.

We can market you as the robot doctor."

The robot is better

for certain operations.

But in many situations,

it provides no benefit to the patient,

and it may add operation time

and it may add some risks.

"You need surgery."

Three words no one wants to hear.

This video will explain your surgical

options for a hysterectomy...

Hysterectomies are a very high-volume,

common procedure in the US.

About 500,000 women

have their uterus removed every year.

During a hysterectomy,

doctors remove part or all of the uterus,

the cervix, both fallopian tubes,

and both ovaries.

The surgeon then stitches

the internal opening closed.

If you're told you need a hysterectomy...

ask your doctor about Da Vinci surgery.

I had a biopsy,

and it came back positive

for, um, endometrial cancer.

I was having a lot of female trouble,

a lot of ovarian cysts.

They sent me for a vaginal ultrasound

because we couldn't figure out

why my blood counts were so low,

and I had a tumor.

I was diagnosed with uterine cancer.

I actually was kind of happy,

because I said,

if I have to have cancer anywhere,

that's the place to have it,

because I can have it taken out.

The doctor recommended a hysterectomy.

And the only type that he said he did

was the Da Vinci.

He said, "Well the best way to do this,

the fastest way and the quickest recovery

would be to use the Da Vinci robot."

It just sounded like the newest,

greatest thing,

and I had no reason to believe otherwise.

Originally,

Intuitive Surgical told the FDA

that a huge amount of training

would be provided

as part of the sale of the machine

to the hospitals,

but shortly after

the FDA gave permission to market,

Intuitive scaled back

all of the training requirements.

And the reason is,

if they said, "Your surgeons can use it,

but they need nine weeks of training,"

no one's gonna buy the machine.

So you have surgeons who

operate for half a day on pigs,

take a ten-question multiple-choice test,

and have a proctor, another surgeon,

watch them do two surgeries,

then they're turned loose

with the machine.

I was told that it takes ten cases

to get good at robotics.

But I know now, in retrospect,

that I didn't really start

to feel comfortable

until I was about 200 or 300 cases.

In other words, that area

where you'd call yourself proficient.

The surgical robot in inexperienced hands

adds complication or injury rates

to the patient.

A lot of surgeons

that shouldn't be using it are using it.

That's the problem.

So I had the hysterectomy, go home.

I'm thinking, "Wow, This is smooth, easy."

Within a day or two,

I was running up and down the stairs.

And then a couple of weeks later,

I started to not feel so great.

I was getting up in the morning,

I sat down to go to the bathroom,

I felt all this pressure.

I looked down

and this huge...

pomegranate-looking thing

was protruding from my legs.

I think I was actually at my clothesline,

putting something...

I think I'd washed a load of sheets,

and I heard a pop.

I go to the restroom

and I feel something emerge

from my vagina.

A whoosh of liquid came out.

And now there was about three inches

of my insides coming out of me.

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