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Stanford Report, October 10, 2001

Primary care physicians share views on importance of 30 medical innovations


A recent study co-authored by a Stanford University researcher reveals a strong consensus among primary care physicians as to the relative importance of 30 major medical innovations. Among the top-ranking innovations were interventions for cardio-vascular disease and high-tech scanning devices such as MRI and CT. At the bottom of the list were the drug Sildenafil (Viagra) and bone marrow transplant.

General internists were given a list of 30 innovations and asked to select five to seven that would have the most adverse effect on their patients if the innovations did not exist, as well as the five to seven that would have the least adverse effect. The result was a ranking of the 30 innovations based on the physicians' ratings.

The study appears in the September/October issue of the journal Health Affairs in a special section titled, "The Value of Innovation."

"This is the first study to look at the relative value to patients of different medical innovations, as judged by leading general internists actively involved in patient care," said Victor R. Fuchs, PhD, the Henry J. Kaiser Jr. Professor Emeritus at Stanford and a noted health care economist. Fuchs co-authored the study with Harold C. Sox. Jr., MD, former chair of the Department of Medicine at Dartmouth and current editor of Annals of Internal Medicine.

The study may have implications for evaluating physician practice style, expanding the criterion for quality assessment and shifting the allocation of research funds, said Fuchs.

He said the most surprising finding was "the extent to which the leading innovations were an outgrowth of the physical sciences (physics, engineering, and computer science) rather than disciplines traditionally associated with the ‘biomedical sciences.'"

On average, diagnostic and surgical procedures were ranked significantly higher than medications. Fuchs said that was somewhat unexpected given that internists are "in the business of prescribing medications." To explain this apparent incongruity, he speculated that physicians place high value on innovations that relieve some of the uncertainties involved in practicing medicine.

The 30 innovations were chosen based on the frequency with which they appeared as the principal focus of articles published in the Journal of the American Medical Association and the New England Journal of Medicine in the past 25 years.

The 225 physicians surveyed were chosen for the length and breadth of their experience, distinction among their peers and active involvement in patient care. Physicians who graduated medical school after 1980 were excluded, as were those who spent less than half their time in face-to-face patient care.

The study was funded by the Robert Wood Johnson and Henry J. Kaiser Family Foundations.

The ranking of the top 10 medical innovations in the study are:
1. MRI and CT (magnetic resonance imaging and computed tomography)
2. ACE inhibitors – for treatment of high blood pressure
3. Balloon angioplasty – procedure to open blocked blood vessels of the heart
4. Statins – drugs used for coronary heart disease
5. Mammography
6. Coronary artery bypass graft
7. Proton pump inhibitors and H2 blockers – used to treat gastroesophageal reflux disease
8. SSRIs (selective serotonin reuptake inhibitors) and new non-SSRI anti-depressants
9. Cataract extraction and lens implant
10. Hip and knee replacement