Posted by Gary Schwitzer in Evidence-based medicine
Terrific piece in the Wall Street Journal headlined, “A Simple Health Care Fix Fizzles Out.”
It documents how the “blockbuster” COURAGE trial three years ago that questioned the effectiveness of “the most common heart surgery” – coronary artery stent placement – had a brief impact on clinical practice but “as the headlines faded,” stentings soon began to rise again.
The graph at left is from the WSJ piece, showing that stenting “is now back at peak levels of about one million a year.” Excerpts from the article:
“Sanjay Kaul, a prominent cardiologist and researcher at Cedars-Sinai Heart Institute in Los Angeles, estimates that the U.S. could save $5 billion of the $15 billion it spends on stent procedures each year if all doctors followed Courage’s guidance–that is, putting certain heart patients on generic drugs and turning to stents only if the pains persists. …
Ajay Kirtane, a cardiologist at Columbia University, believes that American expectations about medical “fixes” makes it hard to follow recommendations such as Courage’s. If a doctor attempted to persuade a patient to delay stenting in order to see whether drug treatment would work by itself, he says, the patient would likely drop him and see another cardiologist instead.”
Read the entire piece. And thanks to the WSJ for still allowing reporters to write 2,000-word articles like this.