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Comment by philipps | Hacker News Reader

> This year the trial published a further set of its results, showing what had happened to the patients five years after their treatment.

> This found for every 100 who died after having open heart surgery, 135 people with stents died. Overall, 10% of people who had surgery died in the trial compared with 13% who had stents

I don’t know enough about other aspects of the surgery, but if it’s just a small percentage point difference, and we are talking about a choice between minimally invasive vs weeks of recuperation and pain, I’d think twice about it.

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Fair criticism, but I think the point is the public is being mislead to believe that they are equal in all aspects so you should always pick the stent because it is so less invasive.

Personally, 10% vs 13% of overall people who were in the trial is significant and would give me pause. I would trade pain and recuperation for 3% less mortality.

I'd definitely have a safe but painful surgery for a condition that has a 3% chance of killing me if untreated. I'd also have surgery that had a 3% chance of success for an otherwise terminal condition (if I could find a surgeon willing to operate...)

But 10% vs 13% doesn't feel as significant to me. Maybe this is irrational.

If you hear, people with a stent are 30% more likely to die than people who have open heart surgery, does that put it in perspective?

I would personally think a 3% difference in overal mortality is certainly worth a little while recovering.

I don't think it's irrational at all. It's risk tolerance.

For myself, I believe the pain and anguish is worth the 3%, given all other things equal. Others like yourself, might not.

Maybe I'm the irrational one.

At the end of the day, the point of the article is exactly that - so you can make an informed decision.

I choose to have my 3% back; You get less pain/recovery.

Pre whistleblowing, there was no choice. It was stent 100% and, oversimplified, 3% more people died without having gotten to make that choice because the study was funded by the stent guys. It was decided for them.

Results like this are hard to interpret locally. Anything that gets you out of the hospital more quickly is worthwhile... there are any number of hazards in the hospital that are best avoided.

What are the error bars on those percentages? It might not be a significant difference.

>I would trade pain and recuperation for 3% less mortality.

May not only be pain, a relative had open heart surgery and can’t read anymore. Some risk of permanent brain and/or lung damage from surgery itself from strokes or pulmonary embolism (although not sure how that compares long term to stents).

I’d also take into account the percent of remaining life expectancy the recovery period takes up (although if it’s a few months that’s probably less than 3%).

Most worrying was another comment pointed out that lifestyle changes take better in the open heart surgery patients. Dietary intervention is effective for heart disease but most people can’t follow through. So it seems very plausible that some or all of the benefit (or even more than all) could come from essentially torturing people enough to scare them into making a lifestyle change. Which is still a real effect I guess, but some people may be capable of following through without that.

I'm not sure if you meant that you would take the surgery or not. But Heart disease isn't a few weeks of recuperation. It's life. I'm at 25 percent after 8 months. I'll never be above 70 percent. I'd roll the dice and take the surgery. I'm already getting an implant in two weeks which is slightly beyond experimental but definitely not wide spread.

> between minimally invasive vs weeks of recuperation and pain

This is an important aspect.

Is the study considering the mortality of the surgery itself? It seems so, but nonetheless it is not a simple procedure.

Second potential bias is possibly how many patients continued with "bad behaviours" after the surgery vs. the stent.

>Second potential bias is possibly how many patients continued with "bad behaviours" after the surgery vs. the stent.

My understanding is that open heart surgical intervention is much more effective at inducing behavior change.

If so, what does that imply that cardiologists should recommend? Should a more invasive procedure be used, simply for the fact it is more invasive? Should the stenting procedure be made more painful?

> My understanding is that open heart surgical intervention is much more effective at inducing behavior change.

Maybe we should just cane people for eating high-cholesterol diets? Safer than either surgical option! /s

Compliance is the biggest challenge w.r.t. becoming healthier. You need either a really compelling reward at the end, or a severe enough punishment to enforce compliance.

Even though this may be true, it still has little bearing medical policy and treatment.

I don't know about that (meaning I really don't know, not that I think you're wrong). I know that a lot of time (and money) in nursing and hospital policy is aimed at the huge problem of patient compliance and what can be done to increase it. And I wouldn't doubt for a minute that insurance companies wouldn't love to "influence" policies toward lower-cost interventions using compliance issues as their leverage.

A really compelling reward: Life

A terribly severe punishment: Death

I don’t think we can really improve upon these to be honest...

Those are very abstract, I didn't start watching my sugar intake until a close relative got diabetes, despite the fact I had distant relatives with the disease, I saw it every day, and I consciously understood that it was something to avoid. Unfortunately people don't "get" things until they are too close to avoid, a lot of the time.

The problem is that the feedback from the behaviour is not immediate. This is ultimately why it is not easy to be disciplined about a lot of things for which the results are only apparent after a long time. There is no easy way.

Typically heart patients stick to Dr orders according to numerous people on my cardiac team. Kidney patients are apparently the worst with a very YOLO attitude

I think "weeks of recuperation" vs. "higher chance of dying" might focus people's minds on not dying.

As I posted earlier. It's not weeks. It's your life regardless of surgery. Im 37 and have it. I would absolutely take the risk if it improved my quality of life. Sign me up tomorrow.

For what? Surgery?

The point here is that they say that surgery has actually a higher survival rate than stents.

I agree with your take.

Surgeons only get paid if they do surgery, it feels like this is the first option I'm offered when there is a problem.

So far "waiting" saved us 2000 dollars.

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