5 ms·

Excellent read. One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the

by ISL 13y ago

Excellent read. One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the shop buys new tooling. It's lower in cost, especially time, than verifying that a tool is sharp and correct. At first, it seems wasteful to throw away a once-used tool, but if all you do is critical work, you must be certain that your tools are reliable and correct. Once you have a complete set of nice hand-me-down spares squirreled away for coarse work, any subsequent used tools go in the recycle bin. For the computer-inclined, this practice is no different from taking a perfectly functional linux installation you've used for a little while for a side project and using it on a mission-critical task. It's easier and more reliable to reformat and reinstall than to inherit whatever curiosities might emerge from the past. When quality matters, provenance matters.

angersock 13y ago
To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.
- larrys 13y ago
  "Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal" Very well could be some liability potential wrapped into reuse of a device. After all part of the cost does go toward covering things that go wrong for whatever reason. If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something happened to it? An inverse analogy might be the difference in potential problems from using a hard drive that has been previously used where something is later found vs. using a brand new hard drive.
  - ricree 13y ago
    >If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something happened to it? There's something on the order of 100,000 ACL tears per year. Even with no reuse, it seems odd that economies of scale can't get that well below $900.
    - jonknee 13y ago
      Economies of scale have nothing to do with medical billing in the US. For example, IV bags of saline don't cost $100 in the real world (more like $1).
      - reeses 13y ago
        This becomes readily apparent with medical care for animals. Your vet will send you home with bags of Ringer's, line, and a bunch of cannulae for $50. It's not as simple as insurance alone driving the cost, but having a throat to choke if something goes wrong does contribute to it. As has been mentioned elsewhere, random overhead is covered in weird places, as well.
        jonknee 13y ago
        And human medical procedures that aren't typically covered by insurance. LASIK for example, imagine what laser eye surgery would cost if it was billed like an ACL reconstruction. Instead you have to pay yourself and doctors compete, the entire bill (at a nice place) ends up being what a couple of ACL knives cost.
        reeses 13y ago
        Gah, excellent point. Elective retail procedures such as vision improvement surgery and dental crowns, bonding, veneers, etc., all seem to top out around the average FSA limits of $5,000 or so. It's especially notable around the end of the year when advertisements encouraging people not to waste their FSA funds start picking up on the radio. Now that the IRS has apparently imposed a limit of $2,500 on FSA deductions, I wonder if that's going to create pricing pressure on the "high end" procedures such as custom/wave/whatever LASIK here in the USA. If I weren't a lazy sod, I'd look up capital equipment costs for medical procedures such as those and compare them to MRI, EKG, and other items used primarily for "need" based, insurance paid, procedures. (Actually, I haven't used any fancyhands requests in a couple months. I'll be lazy and have someone google for me.)
- dragonwriter 13y ago
  > The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Hospitals aren't machine shops, though, so it would be a significant additional cost to equip and staff them to evaluate tools for reuse. There's also particular costs around requiring additional handling of used surgical tools rather than disposing of them that may not exist to the same extent with used machine tools. And its quite possible that even breaing all those additional costs, a large percentage of tools would be out of tolerance or otherwise unusable after being used once, so you'd be paying the additional cost and still disposing of them.
  - angersock 13y ago
    Right, right--but the point here is that economies of scale have driven the cost of machine tools low enough that they can treat them as disposable for the type of work they're doing. This whole thing seems more a collection of specialized widgets that offer only marginal utility over a stock scalpel, and which aren't priced to reflect the sheer triviality of their manufacture. Maybe somebody finally needs to be enough of an asshole to say: "Look, we're done with stupid one-off tools. Shit doesn't scale." It sounds like medicine is trying it's hardest to be the same sort of logistical nightmare as maintaining automobiles.
    - jonknee 13y ago
      How special are we talking about? There are 100,000 of these surgeries in the US every year (and then tons more globally). It's not like this is a part for the space station.
    - jrabone 13y ago
      I guess part of the one-off nature is that post-op sterilization isn't cost effective; perhaps you simply can't remove the bits of the previous patient from the tool cheaply enough or without degrading it in some way) to justify not just opening another one. Another point is that this tool (to take an example) offers one huge advantage over a scalpel; it will make both cuts simultaneously, reducing the margin of error. I wouldn't want to hear "Well, we messed up taking the first piece, so we need to do it again on the other side". It HAS to be right first time.
- reeses 13y ago
  A quick search on ebay turns up, for example, a set of 4 for $35. They're plastic with (I hope) steel blades. In general, though, the cost is certification (+ liability insurance) and documentation of provenance. Basically, every time it's touched by a human, add $100, because the person has to be "trained", they have to log any actions they've taken with it, and they have to make sure the certificates go with the tool wherever it goes. Plus, random upcharge.
MPSimmons 13y ago
In the case of medical equipment, the gold standard to prevent contamination from previous patients' biomatter is to use new equipment each time. There's a demonstrably lower rate of infection than even if the equipment is cleaned to approved standards. I believe I should be able to find the paper I read discussing a while back, if you'd like.

by ISL 13y ago

angersock 13y ago

To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.

larrys 13y ago
"Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal" Very well could be some liability potential wrapped into reuse of a device. After all part of the cost does go toward covering things that go wrong for whatever reason. If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something happened to it? An inverse analogy might be the difference in potential problems from using a hard drive that has been previously used where something is later found vs. using a brand new hard drive.
- ricree 13y ago
  >If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something happened to it? There's something on the order of 100,000 ACL tears per year. Even with no reuse, it seems odd that economies of scale can't get that well below $900.
  - jonknee 13y ago
    Economies of scale have nothing to do with medical billing in the US. For example, IV bags of saline don't cost $100 in the real world (more like $1).
    - reeses 13y ago
      This becomes readily apparent with medical care for animals. Your vet will send you home with bags of Ringer's, line, and a bunch of cannulae for $50. It's not as simple as insurance alone driving the cost, but having a throat to choke if something goes wrong does contribute to it. As has been mentioned elsewhere, random overhead is covered in weird places, as well.
      - jonknee 13y ago
        And human medical procedures that aren't typically covered by insurance. LASIK for example, imagine what laser eye surgery would cost if it was billed like an ACL reconstruction. Instead you have to pay yourself and doctors compete, the entire bill (at a nice place) ends up being what a couple of ACL knives cost.
        reeses 13y ago
        Gah, excellent point. Elective retail procedures such as vision improvement surgery and dental crowns, bonding, veneers, etc., all seem to top out around the average FSA limits of $5,000 or so. It's especially notable around the end of the year when advertisements encouraging people not to waste their FSA funds start picking up on the radio. Now that the IRS has apparently imposed a limit of $2,500 on FSA deductions, I wonder if that's going to create pricing pressure on the "high end" procedures such as custom/wave/whatever LASIK here in the USA. If I weren't a lazy sod, I'd look up capital equipment costs for medical procedures such as those and compare them to MRI, EKG, and other items used primarily for "need" based, insurance paid, procedures. (Actually, I haven't used any fancyhands requests in a couple months. I'll be lazy and have someone google for me.)
dragonwriter 13y ago
> The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Hospitals aren't machine shops, though, so it would be a significant additional cost to equip and staff them to evaluate tools for reuse. There's also particular costs around requiring additional handling of used surgical tools rather than disposing of them that may not exist to the same extent with used machine tools. And its quite possible that even breaing all those additional costs, a large percentage of tools would be out of tolerance or otherwise unusable after being used once, so you'd be paying the additional cost and still disposing of them.
- angersock 13y ago
  Right, right--but the point here is that economies of scale have driven the cost of machine tools low enough that they can treat them as disposable for the type of work they're doing. This whole thing seems more a collection of specialized widgets that offer only marginal utility over a stock scalpel, and which aren't priced to reflect the sheer triviality of their manufacture. Maybe somebody finally needs to be enough of an asshole to say: "Look, we're done with stupid one-off tools. Shit doesn't scale." It sounds like medicine is trying it's hardest to be the same sort of logistical nightmare as maintaining automobiles.
  - jonknee 13y ago
    How special are we talking about? There are 100,000 of these surgeries in the US every year (and then tons more globally). It's not like this is a part for the space station.
  - jrabone 13y ago
    I guess part of the one-off nature is that post-op sterilization isn't cost effective; perhaps you simply can't remove the bits of the previous patient from the tool cheaply enough or without degrading it in some way) to justify not just opening another one. Another point is that this tool (to take an example) offers one huge advantage over a scalpel; it will make both cuts simultaneously, reducing the margin of error. I wouldn't want to hear "Well, we messed up taking the first piece, so we need to do it again on the other side". It HAS to be right first time.
reeses 13y ago
A quick search on ebay turns up, for example, a set of 4 for $35. They're plastic with (I hope) steel blades. In general, though, the cost is certification (+ liability insurance) and documentation of provenance. Basically, every time it's touched by a human, add $100, because the person has to be "trained", they have to log any actions they've taken with it, and they have to make sure the certificates go with the tool wherever it goes. Plus, random upcharge.

MPSimmons 13y ago

In the case of medical equipment, the gold standard to prevent contamination from previous patients' biomatter is to use new equipment each time. There's a demonstrably lower rate of infection than even if the equipment is cleaned to approved standards. I believe I should be able to find the paper I read discussing a while back, if you'd like.