The COURAGE study has caused a flutter. A perfect example of my continual assertion: American Healthcare is not about health or care: it’s about sickness and money.
Yesterday, for my radio show, I interviewed Dr. Robert Carhart, a cardiologist from University Hospital in Syracuse, NY. During the show we like to go behind the medical headlines to make sure we really understand them.
Dr. Carhart actually participated as one of the clinical investigators in the COURAGE study, and he was able to clarify many questions about the results, which showed that in non-emergency situations, drugs and medicine are just as effective as stenting for people with heart problems.
Don’t forget — I’m not a medical professional. I see things as they should be seen through a patients eyes. Well, let me tell you, my eyes were opened!
Stents came on the scene a number of years ago. They are little metal mesh sleeves that get inserted into an artery when a blockage occurs. A blockage will cause a heart attack. When someone is having the signs of heart problems, including heart attacks, a procedure called angioplasty is performed (a balloon that is inflated to clean out the artery), then a stent is installed where the blockage was to keep the artery cleaned out. Sounds like a miracle, right?
The COURAGE study weighed the use of stents against traditional medicines/drugs and found that the use of stents is no better than the use of medicine for non-emergency situations. In fact, because of the danger of problems with the stenting, which is surgical and invasive, the medicine may be a better choice.
Ohhh! But cardiologists who perform stenting procedures (called interventional cardiologists) make plenty of money when they perform an angioplasty and insert stents! They don’t make money from the drugs that can be prescribed instead. They are NOT happy with this study!
(And by the way — neither are the companies that manufacture the stents, all of which saw their stock prices drop big time this week.)
Another problem, according to Dr. Carhart, is that patients who have just had a heart attack get a stent put in as part of the blockage repair, and then, the interventional cardiologist will tell them, “Gee Mr. Patient, we noticed you have two more blockages. As long as you’re here, why don’t we stent them, too?” The patient says, “Sure, you might as well,” then goes on his merry way thinking he’s been protected — and he may not be.
And the interventional cardiologist just tripled his income from the procedure — to no real benefit to the patient. Such a deal (for the doctor, of course)!
While the stenting for the blockage that caused the heart attack may definitely be a life saver, additional stents may not help much. In fact, according to Dr. Carhart, too many patients think the additional stents will absolve them of any responsibility for compliance with other important aspects of heart health such as diet, exercise and drugs. Those patients think the additional stents will protect them — and they don’t.
Here’s the bottom line: if you are NOT in an emergency situation (no impending or immediate heart attack) and you are offered stenting, talk to a cardiologist who understands the COURAGE study and then research the benefits of medicine vs stenting for yourself. To the best of your ability, make sure the doctor who advises you is giving you a balanced recommendation — meaning — he isn’t profiting from whatever he is recommending to you.
If you are in an emergency situation — by all means — if the stenting is recommended, it may be a real life saver to you, so consider it seriously. BUT — additional stents? They won’t necessarily be the right choice for you. If you are someone who knows you are at risk for a heart attack, you may want to consult with your cardiologist sooner, rather than later, about the right choices for you.
Yup — it’s that “think like a consumer” thing again. Your health and pocketbook will both benefit.
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