April 12, 2010

FIRST, DO NO...THING:

More treatment doesn't always mean better health (Steve Sternberg, 4/11/10, USA TODAY)


Doctors have long been rewarded for providing more care, though more isn't always better. Three recent studies show that a doctor's instincts are no match for hard science:

• ASTRAL, a study of about 800 patients with high blood pressure from clogged kidney arteries, found that propping arteries open with stents didn't lower blood pressure and raised patients' risk of side effects, including deaths.

• ACCORD, a $300 million study sponsored by the National Institutes of Health, found that patients with type 2 diabetes who take the billion-dollar Abbott drug called Tricor don't live any longer than patients who don't. Doctors have been prescribing Tricor since the mid-'70s; Abbott is now advertising a newer, more expensive, patent-protected version called Trilipix. A second arm of the study showed that pushing blood pressure below the usual floor in diabetic patients not only failed to help them but also raised their risk of premature death.

• NAVIGATOR, a 9,000-patient study sponsored by Novartis, found that the drug valsartan, sold as Diovan, kept 14% of diabetes-prone people who were given the drug from developing diabetes. But neither valsartan nor nateglinide, sold as Starlix, prevented the heart attacks, strokes or other cardiovascular events that make diabetes so devastating.

"The good news for patients is that you don't have to take a bunch of medications to try to improve your outcome," says Robert Califf, chancellor for clinical research at Duke University.

Doctors and patients often groan when a study yields negative results rather than new hope in an easy-to-swallow pill. Negative results often contradict conventional wisdom, the pet theories of academics and costly ad campaigns for billion-dollar drugs, argues Yale cardiologist Harlan Krumholz. But they reinforce a humbler message, he says, by showing that doctors can sometimes achieve more by doing less — and spending less — and by convincing patients that prevention always trumps medication.

Starting today, Redberg plans to make the case in her journal. Under a new heading, "Less is More," she'll feature studies showing widely used tests, drugs and procedures that don't pass muster.


What does modern health care have to do with health?

Posted by Orrin Judd at April 12, 2010 6:09 AM
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