Any change in medicine, whether a new surgical technique, drug, technology or health-care policy, is going to face a variety of questions. There’s one question that one might think is always asked, but not so. Though everyone would agree it’s an important question, there’s an odd reality to it: An affirmative answer to it is no guarantee the proposed change will take hold, just as a negative response may have little connection to successful adoption of the change.

The question: Is it better medicine?

Pharmaceutical companies have been flayed for years for introducing new drugs with minimal or no improvement over existing products. Indeed, the clinical trial system is set up to answer the better-than-placebo question, not the better medicine question. Now, medicine has always been a business, a highly complex one, that must address a host of questions beyond the simple one posed here when change is proposed. But there are two good examples right in our current issue that warrant at least including this simple question in the discussion.

It’s big news that Kentucky has become the second state to allow optometrists to use lasers. The commonwealth was papered with political contributions, the legislative game was played according to the rules by all accounts, and the laser bill went from introduction to governor’s signature in less time than in takes to decide the NCAA men’s basketball championship. We had questions for optometry’s national leadership about it, but they declined to speak to us. Their prerogative. But I’d like to know the legislators’ thoughts on that one, simple question. And please spare me the letters: Yes, there are issues to be addressed about access and levels of training and on and on, that have been hashed about for 30 years. They all have a place in the final analysis. Did better access trump better medicine? That’s the legislators’ prerogative. But I think their constituents deserve to know. For now, the better medicine question rests in the hands of the people of
Kentucky. I wish them well.

Closer to our own backyard, this month comes news of the continuing march of femtosecond laser technology in cataract surgery, with an FDA clearance for LensAR (See p. 6). And we look at some of the larger questions about cost and other issues in our feature article on femtosecond cataract on p. 52. What’s a little stunning about this technology is that it seems to have gone from an interesting, novel technology looking for a home to being mentioned in the same sentence as standard of care for routine cataract surgery—in less than a year.

Once the clearances are in place and the marketing machines are in full throttle, the better medicine question starts to drop down the list of priorities. Imagine the effect of those almost magical words “laser cataract surgery” on a population that includes patients who have already been coming in to ophthalmologists’ offices for years now saying they want that laser for their cataracts—long before such a thing even existed.

As you and your patients weigh and prioritize all of the important questions that go into the decision to adopt a new technology, a new drug, or any other advance in medicine, let’s hope that the notion of at least raising the better medicine question doesn’t become quaint.