It still costs money to run a trial, even when the treatment itself is inexpensive. The people doing the enrolling need to be paid, the biostatisticians need to be paid, the doctors get paid research comp time, etc. It all adds up to a lot of money. A big trial could run into the millions easily. Hospitals operate on margins that are frighteningly low, 1-2% in many cases, if not at a loss. A doctor can't decide to start doing this procedure to patients on their own without a considerable amount of evidence supporting it as a best practice, even if it seems likely that it is better than the current status quo.

So here's the dilemma. A hospital or consortium invests millions of dollars in a treatment that can't be patented, costs nothing to startup, and can be easily replicated by others. So they've made the investment with the return being spread out among all their competitors. It's a losing proposition, even in the case of hospitals or universities that could afford it. There is simply no for-profit enterprise that would engage in it. Maybe a foundation (Kidney Foundation, for example) would be interested, but typically the budgets of the national foundations are pretty paltry compared to NIH. That is the main reason why a foundation might look away; I disagree with the author that it's about sexiness (and I say this with some authority, as I'm fairly heavily involved in the American Heart Association).

Now, if NIH were to fund a project that can't be directly capitalized on, but whose returns would be spread broadly through the economy, that makes sense, because it's you and I who are putting up the money and reaping the rewards. That's a value proposition. Even if it's ideologically untenable to you that the government fund biomedical research, it's still a pragmatic position to take, given that NIH dollars have a real impact on national health spending--by far our biggest outlay. We can talk about spending all day long, but the conversations will amount to nothing if health and military aren't on the table. Funding NIH is a way to reduce health spending, counterintuitive as it may seem.

This doesn't surprise me. Although a hospital might be able to benefit from claiming less kidney complications, if they were doing something that was considered to be outside of SOP, it might open them up to malpractice costs if there were something to go wrong. That, and the delayed benefit might be enough inertia.

Of course, in this case (and in many others) this is a bad thing. However, on the other hand, such caution can prevent doctors from taking unfounded risks with patients.

Medical treatment is muddy water. Ethics, money, and lives.

As an aside, work hard to get the best medical advice and treatment you can. Be proactive. It is a very imperfect system, and a little effort can make all the difference. A patient that was to undergo cardiac surgery could suggest doing this, and a doctor could agree to it.

Started a few different replies, but here I am with nothing. Let's see.

I did not like this article very much. I'm sure the author, as an insider, has witnessed funding fail to align with optimal benefit in the medical research field. But I disagree with him (and with b_b^) that such a cheap -- and yes, it is comparatively damn cheap overall no matter how much the trials will cost -- and effective treatment will be completely ignored. I wonder if, were the author to go through and name individual cases in which he thinks this phenomenon occurred, I wouldn't be able to pick apart each one, or at least raise ceteris paribus doubts.

Health care as a science is about a million times more developed than it was 50 years ago, which in turn was a million times better than 1915, etc. This is because health is the one thing that will never fail to be demanded, so in a sense the health care industry is the last place I would look for cost/benefit misalignments (on the producers' side only! obviously).

^hospital margins fall in the weird science category; they may seem low on paper but that does not equate to a lack of liquidity or an unwillingness to invest like it might in another industry

Shows ONE part of the problem with the medical industry.