1. Do Medical Research And New Technology Actually Make Our Lives Better? Darrell G. Kirch, M.D. March 31, 2004

2. Cardiovascular Disease chest pain  myocardial ischemia  myocardial infarction  heart failure  myocardial ischemia  myocardial infarction  heart failure

3. Cardiovascular Disease - Then chest pain with an abnormal EKG  the 3-day “R/O MI” admission

4. Cardiovascular Disease - Now chest pain with an abnormal EKG  coronary angiography  angioplasty with stenting  coronary artery bypass grafting (CABG)  left ventricular assist device (LVAD)  coronary angiography  angioplasty with stenting  coronary artery bypass grafting (CABG)  left ventricular assist device (LVAD)

6. Cardiovascular Disease - Now chest pain with an abnormal EKG$345  coronary angiography$5,100  angioplasty with stenting$11,250  coronary artery bypass grafting (CABG)$43,900  left ventricular assist device (LVAD)$205,000  coronary angiography$5,100  angioplasty with stenting$11,250  coronary artery bypass grafting (CABG)$43,900  left ventricular assist device (LVAD)$205,000

7. Does Advancing Medical Science… …increase longevity? ALMOST ALWAYS …improve quality of life? OFTEN …decrease the cost of health care? USUALLY NOT …increase longevity? ALMOST ALWAYS …improve quality of life? OFTEN …decrease the cost of health care? USUALLY NOT

8. If science is so great, why don’t we always get increased quality of life and decreased costs? The problem of choices!

9. Three Types Of Choices That Increase Health Care Costs l The choice not to alter lifestyle l The choice to exhaust tests and treatments l The choice to extend life as long as possible… …whatever its quality l The choice not to alter lifestyle l The choice to exhaust tests and treatments l The choice to extend life as long as possible… …whatever its quality

10. Advances in medical research and technology are truly wonderful! But their impact would be even more positive if combined with wiser choices on our part!