…but doctors say “yes”:
WHAT THE PATIENTS IN BOTH STORIES had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine — imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few — it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
Even if a drug you take was studied in thousands of people and shown truly to save lives, chances are it won’t do that for you. The good news is, it probably won’t harm you, either. Some of the most widely prescribed medications do little of anything meaningful, good or bad, for most people who take them.
My faith in the medical profession has never been high, and stories like this do nothing to raise it. If you want to be healthy (and in some cases just stay alive), you have to be pro-active.
[Update a while later]
I hadn’t read the whole thing when I posted this (I still haven’t; it’s long), but I found this interesting:
In the late 1980s, with evidence already mounting that forcing open blood vessels was less effective and more dangerous than noninvasive treatments, cardiologist Eric Topol coined the term, “oculostenotic reflex.” Oculo, from the Latin for “eye,” and stenotic, from the Greek for “narrow,” as in a narrowed artery. The meaning: If you see a blockage, you’ll reflexively fix a blockage. Topol described “what appears to be an irresistible temptation among some invasive cardiologists” to place a stent any time they see a narrowed artery, evidence from thousands of patients in randomized trials be damned. Stenting is what scientists call “bio-plausible” — intuition suggests it should work. It’s just that the human body is a little more Book of Job and a little less household plumbing: Humans didn’t invent it, it’s really complicated, and people often have remarkably little insight into cause and effect.
“Bioplausible” also applies to terrible dietary advice: If you don’t understand biochemistry (and unfortunately, most nutritionists and even many MDs don’t) it makes sense that eating cholesterol gives you high cholesterol and eating fat makes you fat. You are, after all, what you eat, right?
Note also the story about the blood-pressure meds that have no measurable effect on reducing rates of heart attacks. I suspect that, like cholesterol lowering, such drugs are treating a symptom. It’s why despite my life-long high BP (really, my only health risk other than bad choice of parents), I resist using drugs to lower it, because I really have never had any evidence of other issues, and keep a close eye on things like peripheral arteries, carotid blockage, liver function, eye health, etc.
I blame, in part, 3rd party health care payments that insulate consumers from the direct costs of their individual health care decisions.
That would have been about the time my mother’s angioplasty procedure resulted in a ruptured artery and her almost dying on the table.
Death panels!
Owing to time spent having the end stages of the progressive neurological diseases of old age explained to me sitting across from a doctor’s desk, along with the “treatment decisions” regarding an untreatable condition that were encouraged from family members, I regarded “Obamacare Death Panels” as humorous in a battlefield veteran sort of way.
Any mention of “Death Panels” in front of a liberal supporter of Mr. Obama and his signature Health Care Act (cough, Jim, cough) could induce quite the emotional reaction. There were or are no “Death Panels” in “Obamacare” where an old person would be seated in front of a group of doctors and insurance company representatives, and someone would stand “Denied” on a request for insurance coverage of a life-saving procedure because that person was too old.
But even before the Health Care Act, let’s just say that whereas the health care sector hadn’t gone full Kevorkian (dude, you never go full Kevorkian), they had reacted to the horror stories of people with terminal illness being kept alive with if not extraordinary at least expensive measures. The modern emphasis, especially in long-term care settings, is on Do-Not-Resuscitate orders, Advanced Directives, palliative care, healthcare power-of-attorney documents, and gentle persuasion of the family.
So Jim, you are right, as always, there are no “Death Panels” in the Affordable Care Act legislation, rather, Death Panels are like the Deep State — they are informal “arrangements.” On the other hand, the Mayor Chicago has this brother, a physician, an advisor to drafters of the Affordable Care Act, who takes the Advanced Directive and End-of-Life-Planning and don’t prolong the suffering of the terminally ill aged farther than, say, the most avant garde docs of the avant garde neurology specialty I had encountered. Let’s say Dr. Ezekiel Emanuel’s enthusiasm on this topic gave applause lines to Sarah Palin speeches.
But the Affordable Care Act does have “health care efficacy” has one of its underpinnings. There is no “Death Panel” telling your grandma that she cannot have the surgery, but there is supposed to be some kind of efficacy board telling grandmas across the land that procedures with marginal or zero provable efficacy should not be made available.
There is also a positive outcome of “efficacy” in that your colonoscopy is supposed to be fully funded by your healthcare plan. Perhaps a “negative” outcome of Obamacare (I mean this only in the best way, negative as in avoiding something, not doing something bad) might be on the efficacy of stents in the population mentioned in the article?
Stenting is what scientists call “bio-plausible” — intuition suggests it should work. It’s just that the human body is a little more Book of Job and a little less household plumbing:
A few years back my Mom had, still does, some blockage. Apparently this is common knowledge but new to me, the heart reacted to the reduced blood flow by growing new veins around the blockage. It took a long time and it probably didn’t help that she didn’t exercise as much as she should but her doctor was happy with the heart’s ability to reroute the blood flow.
I’ve been through similar experiences, but would have to give much more thought to the sweeping conclusions the author draws. Yes, I knew one person who went in for a “routine” stent insertion, and the doctor who was doing the procedure for the first time pierced his arterial wall and killed him (it was later determined that he didn’t need the stent, anyway). Yes, I went through 15 years of a score of doctors being unable to diagnose the cause of my ex-wife’s heart problems (though only one even acknowledged there was a problem), only to find the complete (and accurate) diagnosis in a first year nursing school book. She had heart valve surgery, and all of her very real, awful symptoms went away.
But I’ve also been in the hands of some real pros, and they were spot-on in diagnosis and treatment. The thing I’m struggling with is the idea that a large percentage of doctors could be given proof that a treatment was ineffective and dangerous, yet still prescribe it. That just doesn’t compute.
I did, however, really like the section on relative risk. That is absolutely on the money.
While it may be true the blood pressure medicines don’t reduce the risk of heart attack, they apparently don’t mention those with hypertension and suffered a stroke.
I had a stroke almost a year ago, and was fortunate in that my biggest challenge was learning how to walk again. My balance was completely shot, and to this date I can no longer ride a regular bicycle.
I am however taking blood pressure medicine to avoid experiencing another stroke.
There is no “one size fits all” approach. Some drugs are useful for some people under certain circumstances. Others not so much.