Leaving Innovation at the Exam Room Door

Remarkable medical discoveries are being made nearly every day. New technologies, advanced medical therapies, and more accurate diagnostic modalities (such as genetic testing) are evolving at a rate never seen before. However, what one sees in the news or on the internet is not always available once a patient walks into the doctor's office. Many assume it is because doctors are dinosaurs and technology-phobic. But this is simply not true.

Doctors are continually changing the way we treat diseases based on new evidence that emerges. Robotics in surgery is a booming field and many of those using this technology learned how to do so years after their residency training. As the person the patients looks to for answers and treatment, we want improved tools to be able to do this. We yearn for new medications to treat not only advanced cancers, but simple things like infections that are now becoming resistant to new antibiotics. We want a cure for diabetes and not just an expensive cache of drugs to try to control it. Develop that artificial pancreas and I'll be the first to recommend it.

And about those EHRs everyone claims doctors are too archaic to implement, we want those too but only after the interoperability problem has been addressed and fixed. We don't want to work with subpar instruments just like anyone else in any other sector.

What is really slowing the implication of innovation into clinical practice?

• The FDA: In order for a new medication to come to market, the review process by the FDA can take years. Yes, we only want medications that are safe and effective but many patients simply don't have years. We need a speedier process that maintains the integrity of the review.

• Third-party insurance companies: Insurance companies cover services based on guidelines they develop. These guidelines serve to curb cost and are typically outdated.  When a new product becomes available, new guidelines are not created. It is only after battles from doctors, patients, medical organizations, and manufacturers do insurance companies reconsider. I still have trouble with some insurances getting coverage for BRCA1/BRCA2 genetic tests done on patients with multiple first-degree relatives with breast cancer. This is decades old-evidence.

• Money: There is much money to be had in the healthcare system. Start-ups and new products have been flourishing for years. Everyone wants a piece of the healthcare pie. Those people producing these products want to maximize their profits. As a result, some new marvels of medicine are just too expensive to implement. We live in a capitalist society and there is nothing wrong with making a profit. But there needs to be a way that it doesn't further burden those already struggling.

• Lack of track record: Many people look to reviews when purchasing new products. With innovation, there are no reviews and there is no track record. Doctors are hesitant to jump on the bandwagon of many new products for fear of liability reasons as well as safety issues. There is no guarantee that knowledge of a side effect will not be revealed later on when a product is being used. Despite the fact that there was no knowledge of this complication, we are still liable. Similarly, patients are often reluctant to try new therapies/procedures as well.

• Approvals: In a large hospital system or medical organization, there is a certain approval process that must be navigated before a decision can be made to make the purchase. Often, one disagreeing party can sink the whole sale. We all know how hard it is to get doctors to agree on anything.

• Past history: Most of us have had bad experiences with a new product and this makes us more reluctant to be the first to try something. A good example is the opioid crisis and Purdue Pharma's role in it (among many other guilty parties). For years, their reps told prescribers that their product, MS Contin, was non-addictive. We now know this is false and we have an opioid crisis. Sure, they paid big fines for misbranding their product. But, we still have an opioid crisis.  The trust between big pharma and doctors has been broken.

There are many other obstacles in incorporating new innovations into practice: training, lack of support, etc. Yet, the medical knowledge we possess today is very different than just a few years ago. We do our patients a disservice when we fail to evolve with it. Many lives can potentially be saved by coming out of the cave. We need all parties to step up and address how innovation is made available to patients.