The medical device company must back up its recommendations with scientific research.

I certainly understand why a hospital would be skeptical of Bosi e Faora’s solutions-selling strategy, given that the company doesn’t seem to be backing up its recommendations with scientific proof.

Before planning to disseminate inexpensive blood-pressure monitors for home use, a medical device manufacturer should study whether patients are likely to participate in such a program, how much training of medical and support staff would be required, and whether the new practice would improve health outcomes. Before marketing the device, the company should run pilot studies, either on its own or in partnership with academic researchers, that set up the data-transmission process and monitor progress. The studies should be published for all to see.

Cash-strapped hospitals like Santa Casa de Misericórdia are entitled to see proof of efficacy and cost-effectiveness before committing to a new “solution.” If hard evidence is lacking, the hospital should oppose the plan. Price is simply not the paramount issue. But Sergio Lins doesn’t seem to share my reservations about the lack of evidence for Bosi e Faora’s proposal. For him, it’s all about price.

True, the cost of equipment is a crucial consideration, particularly in developing economies. In many countries, hospitals and medical practices are severely constrained by limited revenue streams, whether they originate from private or government insurance, or, as in many parts of India, patients’ own pockets. The best Indian hospitals have been so successful in driving down costs that even though their level of care is comparable with that of institutions in the developed world, they can offer radically lower rates. For example, a coronary artery bypass procedure that might cost $50,000 in the United States can be had for one-tenth that price in India.

Nevertheless, India’s better hospitals often are very willing to work with medical device manufacturers to implement a solution like the one proposed by Bosi e Faora. Examples abound. Diabetes patients, for instance, can now receive automated reminders to check their blood sugar and then send the results to a hospital by phone or over the internet. The technology is furnished by a device maker, which also provides training and ongoing education for patients and the hospital. Another manufacturer has started to work with a finance company to offer patients the opportunity to pay for their cardiac stents in small monthly installments.

Programs like these not only give device manufacturers a chance to expand their business and improve their margins; they also allow hospitals to offer services that they cannot provide on their own. Many hospitals welcome such solutions, as long as they have been scientifically tested. If Bosi e Faora wants to pursue its new strategy, it must start backing it up with sound research. That’s a solution everyone can embrace.

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