Gizmo Idolatry Poem by gershon hepner

Gizmo idolatry is why
a cardiologist will scan your heart.
Eventually we all must die,
but being gizmo-scanned before we part
helps us provide our doctors with
a method to campaign, they say, for health.
The gizmo idol is no myth,
since it provides them with a means for wealth.
Immutable as laws of Moses,
the grounds for stenting greed will rule,
in search for ocular stenosis
that is the goalpost of the gizmo ghoul.

Alex Berenson and Reed Abelson wrote inn the NYT on June 29,2008 (“Weighing the Cost of a CT Scan’s Look Inside the Heart”) :
Fees from imaging have become a significant part of cardiologists’ income — accounting for half or more of the $400,000 or so that cardiologists typically make in this country, said Jean M. Mitchell, an economist at Georgetown University who studies the way financial incentives influence doctors. Besides generating profits themselves, the scans enable cardiologists to find blockages in patients who have no symptoms of heart problems. Doctors can then place stents in patients who would not otherwise have received them, generating additional revenue of $7,500 to $20,000 per patient. While clinical trials have not shown that stents benefit patients with no symptoms of heart disease, they are still routinely inserted in such patients when tests find significant blockages. Cardiologists joke that the phenomenon is “ocular stenosis” — blockages that can be seen are stented. “You find a lot of asymptomatic disease, ” said John O. Goodman, a business consultant to cardiologists. “It will put more patients in the cath lab” — medical shorthand for a cardiac catheterization laboratory, where conventional angiograms and stenting procedures take place. Ms. Mitchell said cardiologists simply practice medicine the way the health system rewards them to. Given the opportunity to recommend a test for which they will make money, the doctors will. “This is not greed, ” she said. “This is normal economic behavior.”
Bruce Leff, an Associate Professor of Medicine at Johns Hopkins, responded on July 1,2008:
As a geriatrician and health services researcher, I believe that the demand for cardiac CT scans is a textbook example of gizmo idolatry, or the implicit conviction that a more technological approach is intrinsically better than one that is less technological. Factors in addition to faith in innovation and economic incentives for gizmo purveyors encourage their use and include the common-sense appeal of gizmo, use of the technology as proof of physician competence, and protection against claims of negligent care, to name but a few. The harms from gizmo idolatry are absolutely real: patients and the advancement of science are put at risk. Medicine, as a public trust, is tarnished. New regulation is urgently needed to require clear proof of benefit before cardiac CTs and other gizmos are widely disseminated. Bruce Leff, Baltimore, June 29,2008.


7/1/08