Maria Bartiromo talks health care at Cleveland Clinic
— -- There has been much talk recently that America is on the decline. That we have lost our edge in innovation and growth, as emerging economies such as China, Brazil and India grow much faster than the U.S. A recent study by the Kaiser Foundation said medical innovation gains will increasingly come from Asia in the coming years. So I went to one of the leading health care institutions today, the Cleveland Clinic, and caught up with leading cardiologist and surgeon Dr. Steven Nissen to talk about health care, innovation and robots, which are increasingly being used throughout health care and technology. Our conversation follows and has been edited for clarity and length.
Q: Where is America in terms of health care innovation? Why are we seeing this gravitation away from America?
A: I don't think we're declining, The rest of the world is catching up. The finest medicine in the world is practiced in this country. We spend more than everybody else does, and that's a problem, but I think we also offer more. The clinical outcomes for patients in the U.S., for any disease, tend to be better in America than almost anywhere else in the world.
Q: There's a lot of debate over devices and drugs being stalled. Some say the U.S. Food and Drug Administration is dysfunctional.
A: Everybody likes to pick on the FDA, and I've been known to do that myself. But the problem is not regulatory. The difficulty is that we are victims of our own success. We have developed classes of drugs in cardiovascular medicine that have revolutionized patient care. The statin drugs to lower cholesterol, now taken by 25 or 30 million Americans, have lowered the risk of heart attack, stroke and death substantially. The drugs that we have for high blood pressure, like ace inhibitors, many of which are now generic, we've had 20 years of an extraordinary run. We've reduced the age-related mortality in cardiovascular disease by 50%. There's no other field of medicine where we've done as well. And so it's harder now to innovate because the easy things have been done, and the bar is higher.
Q: Some investors say the real innovation in America is coming from technology — the iPad, the iPhone — not biotech, not medical technology. Why?
A: I can't agree with that. The leaders in the world are American companies. There are other companies in other parts of the world that are innovating, but we're still the envy of the world when it comes to medical technology. Things like the magnetic resonance imagers and the CT scanners, a lot of those are being developed and made in the U.S. I don't think we've lost our luster.
Q: How do we get health care costs to stop rising?
A: We have to be more disciplined about doing things that benefit the patient, rather than the physician. We have very perverse incentives. The way our payment system works is if you put more stents on coronary arteries, you make more money. If you do more studies, you make more money. The physicians are largely well-intentioned, but the incentives are driving over-utilization. You're twice as likely to get a CAT scan in the U.S. as you are in most Western European countries. You're twice as likely to have a heart catheterization. Our population isn't that much different.
If we avoid the overuse of some of these procedures, we can streamline care, and if we can invest in prevention, we can lower health care costs. And we must do that because we can't continue to spend money like drunken sailors on shore leave and expect to be able to care for people. The problems that existed before health care reform are still there. There are Americans who are dying because they don't have access to health care. That is a national shame that we need to correct. We haven't fixed it. Health care reform doesn't fix it. We need to change the system. I don't think health care reform went nearly far enough. And that's the problem.
Q: CEOs tell me the new health care reform is too expensive. Some say they can't offer health care. The GOP candidates say they will repeal it. Should it be repealed?
A: Absolutely not, and we should add to it. We should extend it and tweak it. I liked some of the proposals that didn't make it into the plan, such as the idea of allowing people to buy into Medicare at age 55. I liked the public option.
Q: Where are we in the fight against the two big killers: heart disease and cancer?
A: We've won some enormous victories. If you were to go back and look at the rates of cardiovascular disease and how they've fallen steadily over the last 25 years, there were two big factors. Changes in lifestyle, such as less consumption in meat, saturated fat, and smoking rates that have declined substantially. That's had a huge impact. And fabulous developments by industry. The modern pacemakers and defibrillators, the statin drugs, the better blood pressure drugs. All of these things have had enormous impact. Now the progress has slowed. Cancer has been a tougher road. There have been a lot of improvements, but they've been small and incremental. The really bad actors in cancer are still bad actors: pancreatic cancer, certain forms of lung cancer. We are extending lives of those patients, but we're not yet curing most patients. We need some breakthroughs here.
Q: What kind of breakthroughs in medicine are you seeing? IBM's supercomputer Watson is one of them?
A: We suffer from information overload. When you take care of very sick patients, there are pages and pages of data, laboratory tests, imaging studies, somebody's written report about what the patient said or what happened to them. Having a system that can sort through a written text, can sort through numbers, present the information in a logical, ordered fashion, should let us take better care of patients. Now, if it goes further and helps us with diagnosis, well, that's another story entirely.
Q: So Watson is not only organizing data, but it's analyzing data?
A: Every physician's judgment is colored by our personal experience. If you've encountered a certain type of patient and you've had certain experiences with them, you tend to assume as an individual that that's how everybody with that disease appears and that's how they respond to therapies. But it may not be true. Watson has the ability to aggregate information on diagnoses and show us what the typical patient looks like, and what happened to those other patients. Watson, in an instant, can give me access to that kind of information.
Q: Is there a downside here for patient care?
A: (Not) as long as physicians are wise enough to understand that you don't want to turn over your judgment to a computer. And physicians are not going to do that.
Q: So how is Watson different from the experience and the judgment of a human being, of a doctor?
A: Medicine is advancing at a breakneck speed. So if I encounter a patient, I don't have the world's medical literature at my fingertips. I can go and research it, and that takes time and energy, which is very hard to muster when you've got a lot of patients to see. A computer system that can aggregate that information and give you some probabilities will enable you to zero in on the most likely diagnoses more quickly. The health care system could save a lot of money.
Q: How many robots vs. humans are going to be in the operating room in the next five to 10 years?
A: I don't think surgeons are going to be replaced with robots, but as you know, there's now a robotic approach to doing some kinds of heart surgery. And the robot is the hands of the surgeon, and the surgeon can manipulate those hands and can do a very, very good job of doing an operation through a very small, tiny little incision, not with a larger procedure that's been so historically done. The robot that's currently available and widely used is primarily to repair mitral valves. That same robot is being used for prostate operations and is much less traumatic, and prostate cancer is a very important and growing diagnosis. We will see more of those.
Of course there is nothing like the touch of a nurse or the smile of a physician, and the engagement with patients. But if it'll make us more effective at getting you better, then we ought to use it.
Bartiromo is anchor of CNBC's Closing Bell and anchor and managing editor of the nationally syndicated Wall Street Journal Report with Maria Bartiromo. Follow her on Twitter @mariabartiromo. To see previous columns, go to bartiromo.usatoday.com.