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.”
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.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like