Who is the Winner of the Dose Debate?

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Sean Ruck, editor-in-chief, DOTmed Healthcare Business News

Hospitals have a duty to treat patients, but in order to do so, they have to get them in the door. Even though we’ve entered an era of consolidation, there’s still enough competition out there for medical facilities to strive to differentiate themselves and to one-up their rivals. One way to do that is to tout the latest and greatest equipment. In ideal situations, the equipment they tout should be equipment that actually means something to the public. Low-dose CT fits that bill.

Although there were murmurings for some time about patient radiation dose and discussions about ways to lower dose for years, it wasn’t until 2010 when the New York Times broke a story about patients being exposed to excessive radiation from CT scans that the public really got involved in the discussion.

The infamous 2010 New York Times article about CT scans and radiation dose.

Since that time, the public outcry has increased as more instances of excessive dosing have come to light. After all, “excessive” and “radiation” are not two words that should ever go together. It has caused many to question any imaging that utilizes radiation and rightfully so. Even if some health care officials (certainly some in the hospitals initially reported on) have downplayed the seriousness of excess dose, it’s ultimately to the public’s benefit to keep dose to a minimum — at least in terms of physical health.

That begs the question: in what ways wouldn’t limiting dose benefit the public? Well, the new low-dose CTs aren’t free of course and someone has to foot the bill and hospitals need to turn a profit to stay in business. So if they’re not saving money somehow, they’re raising prices.

Who’s ultimately responsible for the increased demand in low-dose solutions? The way I see it, there are four players in the story. First, there is the press that informed the public about dose and in a way that was hard to ignore — the story’s intro described one patient’s hair loss and offered images of other patients who lost hair due to excessive dose.

The second and third parties are the public and health care providers. The public of course demanded answers and many readily questioned their health care providers when it came time for an imaging procedure. Hospitals listened to patients and, the fourth party, manufacturers, listened to the hospitals.

I believe in this case, it was a trickle-up effect.  But the winners and losers don’t follow the same line. Manufacturers stand to win big because they’re not spending insane amounts of money to create some new modality to fit a need. They’re improving existing technology, so the hoops they have to jump through are easier to deal with. Patients come in second — costs may be passed on to them, but in theory, they should end up healthier. Finally, the hospitals probably make out the worst. Some with funds to quickly shift to the lower-dose solutions might do alright from an advertising standpoint, but eventually their competition will catch up and the benefit will be nullified. And of course the press did well — four years later and we’re still talking about the story.