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posted by martyb on Friday January 05 2018, @02:48AM   Printer-friendly
from the ask-your-doctor-if-this-medicine-is-right-for-you dept.

Submitted via IRC for Fnord666

The recent news that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking. Each year, hundreds of thousands of American patients receive stents for the relief of chest pain, and the cost of the procedure ranges from $11,000 to $41,000 in US hospitals.

But in fact, American doctors routinely prescribe medical treatments that are not based on sound science.

The stent controversy serves as a reminder that the United States struggles when it comes to winnowing evidence-based treatments from the ineffective chaff. As surgeon and health care researcher Atul Gawande observes, "Millions of people are receiving drugs that aren't helping them, operations that aren't going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm."

Of course, many Americans receive too little medicine, not too much. But the delivery of useless or low-value services should concern anyone who cares about improving the quality, safety and cost-effectiveness of medical care. Estimates vary about what fraction of the treatments provided to patients is supported by adequate evidence, but some reviews place the figure at under half.

Naturally that carries a heavy cost: One study found that overtreatment — one type of wasteful spending — added between $158 billion and $226 billion to US health care spending in 2011.

The stunning news about stents came in a landmark study published in November, in The Lancet. It found that patients who got stents to treat nonemergency chest pain improved no more in their treadmill stress tests (which measure how long exercise can be tolerated)than did patients who received a "sham" procedure that mimicked the real operation but actually involved no insertion of a stent.

There were also no clinically important differences between the two groups in other outcomes, such as chest pain. (Before being randomized to receive the operation or the sham, all patients received six weeks of optimal medical therapy for angina, like beta blockers). Cardiologists are still debating the study's implications, and more research needs to be done, but it appears that patients are benefitting from the placebo effect rather than from the procedure itself.

Source: https://www.vox.com/the-big-idea/2017/12/28/16823266/medical-treatments-evidence-based-expensive-cost-stents


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  • (Score: 2) by Geezer on Friday January 05 2018, @04:44PM (1 child)

    by Geezer (511) on Friday January 05 2018, @04:44PM (#618379)

    Kill all the lawyers.

    By way of anecdotal experience, being stuck on the cancer treatment treadmill myself, when I've questioned the necessity or efficacy of certain things, doctors have told me that the biggest driver of redundant and ineffective procedures is the malpractice insurance companies' lawyers. In true lawyerly fashion, they dictate protocols based on underwriters' loss prevention statistics rather than sound medical science.

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  • (Score: 2) by leftover on Friday January 05 2018, @05:46PM

    by leftover (2448) on Friday January 05 2018, @05:46PM (#618410)

    Oh so true! Remember that doctors have pointy-haired bosses too, drawn from the same pool as the C-suite denizens at insurance companies and other dens of ill repute. Somehow the 'C' in their titles empowers them to dictate some terms of medical policies, despite knowing or caring jack shit about doctoring and nursing.

    --
    Bent, folded, spindled, and mutilated.