Tuesday, July 12, 2011

Placebo...revisited?




One of
our regulars just left a comment (which I took to be private) that amounts to, "Dude, what happened to the Placebo series?" OK, maybe I'm taking liberties with the "dude," but that was the gist of his comment. It's actually a more timely question than he realized because of a study appearing in the current Journal of the American Medical Association and widely reported last week. JAMA, of course, is considered the gold standard of medical reportage.

The study by the National Cardiovascular Data
Registry (NCDR) focused on the cardiac intervention known formally as percutaneous coronary intervention (PCI) or less formally as angioplasty. About 600,000 such procedures are completed each year at nearly 1100 U.S. hospitals. According to the JAMA study, roughly 70% of those are performed on patients in the throes of an apparent cardiac event (though I've seen numbers that suggest a far, far lower percentage of "medically necessary" procedures). The same study, however, implies that half of the remaining 180,000 procedures are either of questionable value or no value whatsoever. When you consider that the 600,000 surgeries cost an aggregate $12 billion annually (most of that picked up by embattled health-care plans), the suspect 15% figure translates to as much as $1.8 billion wasted on medically dubious, inherently risky surgery. And let me emphasize again, the final scary number in the preceding sentence assumes that the NCDR is correct in posing that 70% of the surgery is warranted, an assumption thatother studies suggest*may be optimistic in the extreme.

The Wall Street Journal, in its coverage of the JAMA report, quoted Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, thusly: "This tends to confirm concerns that many people have expressed
that there are many thousands of patients who undergo coronary interventions for very questionable indications." What makes that sort of funny is that for decades, the Cleveland Clinic has been one of America's most prolific, aggressively self-promoting heart-surgery "mills," if you will.

But what makes such statements downright infuriating is that many of us have been saying similar things for some time now...and yet we've been mocked and marginalized by the medical establishment.

The simple fact is, shockingly often, we still don't know why people get sick, or why they get better, or why they don't, or what we can do to intervene in that process. And we really ought to stop pretending we do know.

* I compiled them in the course of researching my Placebo book proposal, and may go over them on this blog eventually.

No comments: