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The current issue of Annals of Internal Medicine has a great article on individualization of mammography recommendations -more on that in the next few days.
There is another article demonstrating that an inexpensive ultrasound machine that fits in a pocket is almost as good at certain measurements of heart anatomy as a conventional ultrasound machine - which would frequently generate a health care bill of $1500.
When I saw the abstract, I thought that Clay Christensen's predictions about disruptive innovation in health care were finally coming to pass - and we were going to use technology that was a little bit inferior to existing technology, but perfectly adequate for many indications - and save big bucks. This could be the cardiac imaging equivalent of the personal computer going up against mainframe computers!
Alas, this was not to be. The authors position the pocket echocardiograph to replace not the expensive conventional echocardiogram, but instead to replace the lowly stethoscope. They don't want this to replace a $1500 scan, but instead to replace a low-tech device whose use is currently bundled into other cognitive services.
While other industries produce more value with disruptive innovation, in medicine we use technology only to further escalate the medical arms race. I think of this as accretive innovation.