The Developing Heart in Health and Disease

This lecture was interesting, for more than one reason. The lecture is about pediatric cardiology. You’ll learn some stuff about how much things have changed, how far ‘we’ have come. You’ll learn about some new and interesting techniques. But you’ll implicitly also learn a little about how much money is thrown after children who, if costs were not shared quite as widely as is the case now, would never, ever be allowed to survive. There are various ways to argue that such costs are nevertheless justified and I could easily come up with a few, but I’ve worked with cost-efficiency stuff before and the justifications I can come up with for at least some of these procedures look, well, sketchy, to me. A couple of quotes from the lecture:

“she had been spending, oh, at the time where she was nine months old I think she had spent three or four months of her life in the intensive care unit off and on because she was so sick […]
she’s actually now […] four or five years out after the procedure and she’s done well and she’s not yet have had to have another procedure, although she will at some point. […] The problem with these valves is that they’re not living tissue so they don’t grow, and they also tend to deteriorate very quickly, within four or five years. […] even if I had a perfect valve that I could put in my little nine-month old, by the time she was four years of age I’d have to go in and replace it again, and by the time she was, oh, eight-nine years of age, I’d have to go and replace it again. And then maybe if I’m lucky I’ll get one more operation when she’s a teenager, and then finally when she’s an adult I can put in one of those mechanical valves which will last her thirty years. But that’s four or five open heart surgeries.”

After this, he does ask the question if there isn’t a better way to do things – and they’re working on that now. But there isn’t a better way to do things now, and it seems like these kids actually do get all those operations. This study from 2011 (page 6) provides average baseline costs of roughly $5.000 per day of PICU (pediatric intensive care unit) admission; this should give you some idea of how much money we’re actually talking about when we’re discussing 3 month long stays in a PICU. Cost-estimates of open-heart surgeries are not easy to find, but I think it’s safe to say that those aren’t exactly cheap either.

Here’s the lecture:

September 16, 2013 - Posted by | Cardiology, Lectures, Medicine

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