Heart doctors 'held back stent death data'
bbc.com
bbc.com
I had to read the article twice to understand the main point. Sentences like this make me scratch my head: "The data suggested more people fitted with stents were dying after three years."
The doctors who carried out this research are, it sounds, blatantly in the wrong, for they withheld the data that appears to make clear that stents have worse outcomes past year 3 until after the guidelines were written while they had already gathered this data before the guidelines were written.
Sure they cannot openly share all their data because it is private, but it is very suspect that they do not share the external review that found them at fault
As Prof John Ioannadis points out in the article, there are wide systemic issues in the trials and guidelines process.
Couldn't they just anonymize the data?
Chasing down previous patients for retrospective consent would be difficult to impossible.
Interventional cardiologists chronically low-ball the dangers of stents and gloss-over their well-known short-term performance. Who'd a thunk that jamming a foreign body in a small artery ends up making it worse in the long-term?
Patients with coronary bypass often have a better long-term outlook, but in many cases the cardiologists simply don't refer to cardiac surgeons to line their own pockets (and admit "defeat").
Stents are quite routine and much, much, much easier to do than bypass surgery.
The problem is that outside of heart attacks, there isn’t good evidence for a mortality benefit from stents. So cardiologists are constantly searching for additional evidence that justifies stent use. And there isn’t much mortality benefit yet, but lots of other reasons why they might get used. But in those cases (like stable angina), almost no one would do bypass surgery, except for patients at very high risk of having a deadly heart attack.
So criticize indication creep but there are many clear times when stents absolutely should be used.
Is the choice really that simple?
They're about $5,000 each.
A couple times per year there is some news report similar to this story.
I have a feeling that, just like hip replacements took decades to find the right combination of materials to not disintegrate or be rejected, we're still researching what to make stents from and when to use them.
The problem is that patients aren't told they're guinea pigs, and stents aren't that reliable. Oh and doctors get to bill a fortune per operation regardless.
Regarding this particular story, rather than be outraged, we should have cardiac experts and statisticians sit down and figure out what's real and what isn't. There is valuable data in there somewhere.
Here's the thing. Every patient is a guinea pig in one way or another. Every medication has side-effects both known and unknown.
But yeah, maybe stents need to be replaced before 3 years or some better materials need to be found, and maybe they are used in situation where they're not really needed.
Still better than bypass surgery which is a very invasive surgery.
My point is not that stents > open heart surgery, but rather that they’re not at all easy to compare.
In a 2018 article in the New York Times, Marcia Angell wrote:
> Second, there’s good evidence that drug company involvement biases research in ways that are not always obvious, often by suppressing negative results.
And as I recall, her 2005 book The Truth About the Drug Companies discussed research which showed that the geographic distribution of stent usage correlated with the geographic distribution of capacity to do stents. With evidence, as I recall, that facilities basically bribed local cardiologists for referrals.
WTF? That is not where the human heart is located. :(
https://biology.stackexchange.com/questions/60718/why-is-the...
Patients are more likely to survive heart attacks while the cardiologists are all away at a conference, because that means the cardiologists are less able to interfere.
This effect has alternatively been written as an effect arising from the fact that “lesser” doctors would tend to follow established, standardized practices, be open to other opinions etc. while the higher status doctors may be less so
Because anecdotically I know 2 people with stents that are just fine(tm) after more than 3 years. I don’t know the specifics of their conditions though.