Conveyor-belt cardiology puts profits first

[Celebration]

http://www.msnbc.msn.com/id/22882555/

In the battle of stents vs. bypass surgery, the best care may be neither

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One of the doctors who argued first and loudest that many angioplasties and surgeries were unnecessary was Dr. Thomas Graboys of Harvard Medical School. About decade ago, after years of struggle, he finally got the American Heart Association to allow him to present a seminar on the subject at its annual scientific sessions. Almost no one showed up. Few have an interest in the less profitable path. (Sadly, Graboys is now fighting a particularly aggressive form of Parkinson’s disease.)

Then last March, Dr. William Boden of Buffalo General Hospital in New York announced the results of a trial called by the appropriate acronym COURAGE. He randomized more than 2,200 patients with significant blockages. All were treated with heart medicines to control their cholesterol and blood pressure and minimize blood clots and were counseled to diet, exercise and quit smoking. Half of the participants also were assigned to get angioplasty.

After four and a half years there were slightly more deaths and heart attacks in the group that got angioplasty. Interestingly, the U.S. Veteran’s Administration and the Canadian Health Service — organizations interested in providing the best, but not necessarily the most costly care — funded the research. So far the impact of this powerful evidence on medical care has been minimal.

In fact the United States has twice the rate of bypass and angioplasties as other wealthy countries with no evidence of improved survival or less distress from heart disease. Any patient who is told he or she needs a stent or bypass surgery would be well advised to ask — from another doctor if possible — what happens if I wait?

[Warpy]

1. It's a case of, "Well, as long as we're already in here..."

When a person shows up in the ER with all the classic symptoms of a heart attack, the big city hospital shoves him right into the catheterization lab as soon as the event is confirmed by an EKG. This is done to see the extent and location(s) of the blockages. Generally, the blockage(s) are low grade, but the temptation is to go ahead and stent anything they can, since they've already done 90% of the work by the time they locate the arterial blockages. The patient could probably have been treated more conservatively with nitrates and other medications and lasted a long time before he actually required surgical intervention, but it was a case of "Well, while we're here." The catheterization itself is the hugely expensive part of the procedure, so it's not a question of gigging the insurance. It's more a temptation to fix the problem completely, once and for all, when more conservative intervention could have done the trick for a very long time.

They often don't know that until they get in there. An EKG can tell them what part of the heart is being damaged, but not where the blockage(s) might be.

[screembloodymurder]

2. I asked.

It didn't do any good, and in the end they convinced me to have stents. I must say, I do feel better with the stents. Quality of life may be an issue.