The Vast Majority of Recommendations Given to Heart Patients Are NOT Supported by Good Science!

March 24, 2009
Category: Uncategorized

A new Wall Street Journal article reveals that even though heart disease is among the most studied illnesses in all of medicine, only 11% of more than 2,700 recommendations approved by conventional (non-integrative) cardiologists for treating heart patients are supported by high-quality scientific testing.

About half the medical recommendations for heart patients are based mostly on “expert opinion”—subjective viewpoints where consensus is often lacking, according to a study published in the Journal of the American Medical Association.

Even conventional recommendations that are alleged to have firm scientific grounding are not without controversy. People who have previously had a heart attack and take an aspirin daily to help avert a second one can rest assured that the treatment is supported by rigorous scientific studies. But there is valid debate about aspirin side effects, in particular its link to damage of the gastro-intestinal tract and internal bleeding. There are also serious questions about another common recommendation that patients treated with artery-opening stents remain on a potent blood thinner for a year to avoid a rare but potentially life-threatening blood clot. The downside: Patients who stay on blood thinners for an extended time risk potential complications if they need urgent surgery. And the blood thinner damages bones.
Another example: It’s unclear at what point patients who suffer excess bleeding during a heart procedure should get a blood transfusion. And debate rages among cardiologists over two new tools for assessing a patient’s long-term risk of a heart attack. When does a blood test for a marker called C-reactive protein aid in making such a prediction? How about a scan to check for calcium buildup in a patient’s arteries?
Harlan Krumholz, a cardiologist at Yale University School of Medicine, says doctors should disclose to patients the strength of the evidence behind the care they recommend. “Treatment decisions are often made very dogmatically even when the level of evidence isn’t very strong,” he says.
One reason for the lack of stronger evidence is that the large “megatrials” that have dominated cardiovascular research in the past decade were sponsored by drug and device companies. While those studies provide an important source of information, they are typically designed  to win approval for a treatment or to widen the market for a therapy already on the market, and not to guide treatment decisions, according to the JAMA study.
Pierluigi Tricoci, a cardiologist at Duke University’s Duke Clinical Research Institute and lead author of the study, says he and his colleagues also observed that guideline writers are picked for their expertise in the field—but they are also often those who consult regularly with industry. Such possible conflict of interest raises the potential to introduce bias into the guidelines, undermining their credibility.
The findings from the JAMA study reflect the challenge doctors and patients face in choosing the best course of treatment for a variety of conditions. “In most situations that we encounter when we see patients, it isn’t so clear what is the best thing to do,” Dr. Tricoci says.
Sidney Smith, a medical guidelines expert and cardiologist at University of North Carolina, Chapel Hill and senior author of the JAMA paper, said, “We need those studies [with high-quality scientific backing] to make the kind of changes in healthcare that are being talked about—being sure we get the best possible care for our patients in the most cost-effective manner.”
This comes on the heels of the Obama administration’s plans for a council on Comparative Effectiveness Research (CER), which would determine which healthcare treatment options are the most effective—and the most cost-effective. As we’ve noted in previous issues of Pulse of Health Freedom, critics of CER within the integrative medicine community fear that it will be a prelude to a completely government controlled medical system which will be dominated and manipulated by the big drug companies with their lobbyists and campaign contributions and their control over the FDA. On the other hand, CER can provide a place for integrative medicine to make it case outside the FDA, to prove its potential for successful treatment and huge cost savings based on the thousands of scientific studies that have been done. It is also an opportunity to educate the general public.
We need to explain that while the government and insurance companies pay $10,000 to amputate a diabetic patient’s foot, they currently won’t pay the small fraction of that amount needed treat with nutraceuticals or to educate a patient about the benefits of a healthy diet and lifestyle changes that in many cases will prevent or even reverse diabetes.
No matter how uncomfortable we may be at the thought of government controlled medicine, it is a fact that CER has enormous potential to define what medicine is. Integrative medicine needs to speak up now, early in the process, and get a seat at this table. In future issues of this newsletter, we will tell you how you can help.

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