Terrific context – reminding readers of the North American Spine Society’s publication last week of a study showing conflicts of interest in a spinal procedure, and stating that “As health-care costs continue to soar, reaching $2.5 trillion in the U.S. in 2009, medical societies are becoming more open to self-scrutiny for fear that the federal government and private health insurers will make medical decisions for them. Some organizations are also mindful that conflicts of interest undermine the credibility of their fields.”
And the story of the physician who was suspended for performing unnecessary procedures – and who was “feted .. with a $1,407 pig roast when he implanted 30 stents in a single day, setting what may have been a company record” – by a stent-making company – was priceless.
The story not only establishes the troublesome overtreatment. It goes further upstream to overscreening. It quotes one expert:
“We suspect that part of the [problem] may be driven by a huge push for screening patients who don’t have symptoms but have risk factors for disease,” he said. In a screening, some test may show an abnormality which leads to a cardiac catheterization to look at a patient’s arteries, he said. In that diagnostic procedure, a doctor may see a narrowing and decide to treat it even though it isn’t causing any problems for the patient.”
The $20,000 procedure cost is in the first sentence. Many stories never get there at all.
Let’s look at appropriate use as the “benefit” here – and, yes, the story quantified this – and the inappropriate use.
As good as this story was, there was no direct discussion of harms, although the harm of inappropriate use should be clear. However, patients who undergo cardiac catheterization face well known risks including kidney damage and failure, damage to blood vessels in the groin, sometimes requiring surgery. There is also a risk of heart damage and risks associated with the antiplatelet drugs used to prevent blood clots from forming. All of these risks are balanced out by the benefit in the right patients.
Excellent analysis – “some results that are reassuring and others that are troubling.”
No disease-mongering here.
Several independent sources gave helpful perspectives in the story.
The story cited the COURAGE study – “he Courage study, which tracked 2,287 patients for five years, showed stents weren’t any better than a cocktail of medicines to treat patients suffering from chronic but stable chest pain.”
The story makes the widespread availability – too widespread – of stenting quite clear.
In the story Yale cardiologist Harlan Krumholz “said it represents one of the first times a professional medical society has looked at the appropriateness of its care in such a comprehensive fashion. “It needs to be a wake-up call for the rest of medicine to say this is what we need,” he said.
It’s clear that this story employed independent reporting to tell the story.