Then, in 1960, surgeons at Johns Hopkins reported their experience with 20 patients with whom they had used a new CPR technique called closed-chest cardiac massage. Extraordinarily heroic, such “open-chest” cardiac massage was attempted rarely-and succeeded even more rarely. Before 1960, the only way to treat cardiac arrest required surgical opening of the chest cavity and manual cardiac massage, whereby the surgeon holds the heart in his hands and squeezes it rhythmically to pump blood to the brain and other vital organs.

But medical creep sometimes saves lives.Ĭardiopulmonary resuscitation (CPR), the procedure used to treat many patients who suffer cardiac arrest, is an example of medical creep. Government regulatory agencies and insurers tend to take the opposite view creep blows budgets and, sometimes, harms patients. Not surprisingly, pharmaceutical companies and medical device manufacturers promote this kind of creep, sometimes called “off-label” usage. For example, doctors often use drugs or devices approved by the Federal Drug Administration for treatment of one condition (based on strong science evidence) to treat patients with other conditions (lacking any scientific evidence).

Medical creep happens when doctors practice “outside the box.” They perform procedures or prescribe treatments in the absence of clear evidence that patients will benefit.

One Doctor by Brendan Reilly