In this post, I examine the firestorm surrounding Dr. Lisa Rosenbaum’s article, N-of-1 Policymaking — Tragedy, Trade-offs, and the Demise of Morcellation, which was published in the New England Journal of Medicine in March 2016. To appease the medical pious everywhere, I disclose that I have never met Dr. Rosenbaum in person. I do follow her on twitter @LisaRosenbaum17. I have no financial stake in power morcellation, a medical procedure that I will discuss below. And, yes, I dislike bullies.
Mostly normal people leading normal lives don’t speak out very much.
They just sit there. They read stuff. They watch news stories.
They may very well be engaged with a topic. But, they will infrequently write reviews or give comments. That kind of stuff usually always comes from the extremes. And, as you know, the extremists either love you or they hate you.
Dr. Lisa Rosenbaum got the extremists juiced up earlier this month by writing an article about the tradeoffs and demise of a medical procedure known as power morcellation. If you’re a normal person that happens to run in my professional circle and have been following this saga, I suspect that you have moved on. That’s what normal people do with non-stories.
If, however, you are an extremist, you continue to write about it. That’s me.
I wrote previously about the ongoing federal approval process for a medical device known as the WATCHMAN™, now available to treat certain patients at risk of stroke.
As expected (and really just because it’s how things get done around here) the Centers for Medicare and Medicaid Services (CMS) has compiled a 32,000 word decision memo related to how it intends to pay (if at all) for patients receiving this approved device. This memo is commonly referred to as a coverage determination.
A thoughtful piece was also written recently by Dr. John Mandrola on this very topic. He and I usually share many of the same goals, although admittedly, we differ from time to time on how best to obtain them.
Regardless, Dr. Mandrola’s piece is full of clarity and is very supportive of CMS’s intent to require an evidence-based formal “decision tool” to be used by the physician and the patient prior to implanting the WATCHMAN™.