May 27, 2012

FIRST, DO NO HARM:

PSA Testing, Like a Lot of Other Procedures, May Do More Harm Than Good (Casey Schwartz and Clark Merrefield, May 26, 2012, Daily Beast)

Avoidable care is an issue the medical profession has been aware of for decades. But until recently, physicians who have tried to talk about the problem have not found a receptive audience, even among fellow physicians. In a recent interview with The Daily Beast, Dr. Bernard Lown recalled a lecture he delivered in New York City 30 years ago to 600 physicians (including a "good sprinkling" of heart specialists, he said). Lown, whose International Physicians for the Prevention of Nuclear War won the 1985 Nobel Peace Prize, asked how many of the doctors in the room who ordered coronary bypass surgery had told their patients the procedure would not prolong their lives. Most of the doctors bowed their heads a bit and looked about. Nobody raised a hand. The paramount motive for unnecessary bypass surgeries was profit, Lown explained in the interview at his home in Chestnut Hill, Mass. But another key component, he said, was cultural. 
 
"It's the way we train people in medical school and the way we indoctrinate them in hospitals. It's the way you want to do something that is decisive. When you're a young person, you cannot tolerate uncertainty, and when you get older you learn that you have to live by it," Lown said. "The bypass, the stent, is a definite answer to a problem, you have it done and it's over, it's ended--that ain't so. A patient still has coronary disease, he still has risk factors, and the lifestyle that brought him to the doctor in the first place will bring him to the doctor a second and third time." 
 
Research today continues to confirm what some doctors recognized decades ago: widespread, expensive procedures exist that show no benefit for the patient. The price tag for hospitalization after a coronary-disease diagnosis is more than $16,000 (PDF), and more than 400,000 angioplasties are performed each year on stable patients. But a recent article in the Archives of Internal Medicine shows that for patients with stable coronary-artery disease, the current medical therapies--such as aspirin, beta-blockers, ACE-inhibitors, and statins--don't reduce death rate, chest pain, and other cardiac events any better when combined with stent angioplasty. It is the first research to look at the outcomes of patients who received modern angioplasties. In short, the study found that adding an invasive, expensive procedure to prescribed therapy regimens has no apparent benefit. According to the study, up to 76 percent of stable patients can avoid angioplasties, with nearly $10,000 per patient in lifetime health-care cost savings.

Posted by at May 27, 2012 8:25 PM
  

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