SPINA BIFIDA: Experimental Surgery Raises Questions
A front-page article in today's Wall Street Journal takes a look at a controversial new fetal surgery to correct spina bifida. The procedure raises the question of "[w]hen does an elaborate and experimental treatment cross the threshold into mainstream medicine, and become something insurers pay for?" The operation, which involves operating on the fetus while still in the uterus to seal the open skin over the spine that characterizes spina bifida, costs nearly $30,000. The major risk to the fetus is premature birth. Although doctors "are encouraged by indications the infants are benefitting," they have not made any "firm conclusions." Aetna U.S. Healthcare decided to cover the surgery based on its own data that showed the typical spina bifida infant incurs medical costs of up to $30,000 in its first year and the same amount each year through age five. For Aetna's CMO, Dr. Arthur Leibowitz, the decision to cover the treatment was a "no-brainer." He said, "This made as great sense from an economic perspective as it did from a human perspective." However, other insurers have held off. Prudential Health Care ruled the surgery experimental and has denied coverage for its members. Some 2,000 babies are born with spina bifida each year, making it the "most common birth defect that leads to permanent disabilities" -- including paralysis from the waist down and lack of bladder and bowel control. Another 2,000 are estimated to be aborted each year.
Bring 'Em on Down
The new surgery also underscores the "great pressure that academic medical centers face nowadays to convert innovation quickly into revenue," as Vanderbilt University has done by "unabashedly promoting this surgery." Touting the surgery on its Web site, the university has taken an "entrepreneurial approach," the Journal reports. "Our short-term goal is to brand the name Vanderbilt for this procedure," said Dr. Stephen Entman, chair of obstetrics and gynecology, adding, "We want to be recognized as the place where this is done." An article in Woman's Day, the launch of the Web site and a "Dateline NBC" segment propelled the little-known surgery into the spotlight, and the Vanderbilt team welcomed the response. "What we're talking about is creating a totally new health care market, and there is huge incentive for institutions and departments to do this," said surgeon Dr. Joseph Bruner, who has preformed the surgery on 40 women "with few complications." He said, "You get the revenue, the media attention, the prestige and the respect that comes from being on the cutting edge" (Winslow, 4/20).