…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.