BunsenBurner, these were the people it was supposed to help. And it didn’t.
but there could be other reasons for the stents not helping as much as predicted.
In the study, the stents did nothing.
Originally, when doctors were inserting these stents, they said they’d make people healthier. But then it was discovered that stents in these cases (when people aren’t having a heart attack and don’t have unstable angina) don’t prevent heart attacks at all. So then the doctors continued to insert them, saying, OK they don’t make people healthier but they make people feel better.
Well, now we see they don’t make people feel better, either. Surgeons are still casting about to find a way to justify this expensive no-better-than-sham surgery that has some side effects, but we shouldn’t believe them until they demonstrate an effect, which they have not done.
Typically a cardiac catheterization is not done unless someone fails a stress test or has blood chemistry makers of cardiac damage or EKG changes suggestive of decreased blood flow to cardiac muscle. Even then, stents are not inserted unless there is narrowing in a coronary artery of a sufficient percentage to cause reduced flow to the area of the heart behind the blockage, or the area of blockage is in a critical vessel or spot. There is so much variability in what is found in a cardiac catheterization. At least in my institution, feel better has not been brought up as the point of stents. Avoiding a fatal heart attack, or further cardiac damage is the point. I will be interested to talk to the cardiologists to see their take on this news.
But to avoid this scenario, risk factor reduction is the key. Still, those with poor family history sometimes need treatment with stents or bypass regardless.
Point is, we have no evidence that a stent in someone not now having a heart attack, and who does not have unstable angina, prevents future heart attacks.
Horrible #1 post. Retired MD here, as is cardiologist H. Most physicians are NOT trying to make money by doing unneeded things. Plus- it is the manufacturers making bigger bucks. Money earned for time (and stress, thinking et al) nowhere near what businessmen make.
The jury is still out. One small study as mentioned. Need a lot more (and better) studies before abandoning the procedure. Medicine is not an exact science and one size does not fit all. Different treatments can go in and out of favor. Will wait and see when I am old and may want this.
The jury is still out??? We need to wait for the jury to come in before we do any more surgeries.
We shouldn’t cut someone up even though the studies so far say it doesn’t work, just in case maybe further studies might find some effect that the studies so far have failed to detect.
So they keep telling us, as they keep raking in the bucks doing knee surgeries that have not proved to be beneficial, back surgeries that have not proved to be beneficial, and stent surgeries that have not proved to be beneficial.
“I propose to do this heart surgery on you. So far the studies have shown that it does no good whatsoever, but who knows, it might work!” has got to be the worst justification for surgery ever.
I’m sympathetic to the origin of this position, but…how can we have confidence that we aren’t going to face a steady stream of “you don’t really need this” research politically motivated by the single payers (or insurance companies)? The answer is we can’t. The nightly news in this country is filled with medical “research” results that are aimed at influencing what we will accept or demand (and/or pay for). We all need to take our Diogenes pills. They’ll be needed.
Yes, there is a great deal of paranoia out there about physicians doing procedures for the money. Historically, there has been a certain amount of regional variation in how medicine is practiced. In my decades working in hospitals, I see physicians doing the best job they know how to do, given research, training and experience to that point. Over a number of years the emphasis has shifted to evidence based practice, which is treating with the best evidence at the time. Evidence changes, and practice changes over time. Excellence and best practice is a moving target. A physician can probably elaborate on this more.
Personally, I have had two arthroscopies, back when both sets of kids were 2 years old. Now they’d probably say to give it time as that was one of the “non beneficial” procedures. I was in misery with torn cartilage and unbending knees at a time when I really needed to be constantly active These days they’d probably have me wait longer, given the research. After surgery, my knees worked again, as they still do. Not exactly a sham procedure in my book, though the research saying the opposite is interesting.
Shouldn’t the people advocating the surgery exhibit studies showing it works, before we start doing it? They have not done this. Time enough to worry about dueling studies when we have dueling studies.
Also I’d like to point out, for those who will trot out anecdotes, that this particular study was genius. They actually did sham surgery. They compared real surgery inserting stents and sham surgery where they acted like they were inserting a stent, but didn’t actually put it in. If you want to point to someone who felt better after having this surgery, I’m going to point to the people who felt better after the sham surgery.