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. 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). Not surprisingly, pharmaceutical companies and medical device manufacturers promote this kind of creep, sometimes called “off-label” usage. Government regulatory agencies and insurers tend to take the opposite view; creep blows budgets and, sometimes, harms patients. But medical creep sometimes saves lives.
Cardiopulmonary resuscitation (CPR), the procedure used to treat many patients who suffer cardiac arrest, is an example of medical creep. 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. Extraordinarily heroic, such “open-chest” cardiac massage was attempted rarely—and succeeded even more rarely. 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. This team of surgeons, who had also developed the external cardiac defibrillator, had devised a way to pump the arrested heart without opening the chest surgically. They successfully resuscitated every one of the first 20 patients they treated, 14 of whom (70 percent) survived without brain damage or other ill effects. They concluded that “the method… can be used wherever the emergency arises, whether that is in or out of the hospital.”