Back in January, I blogged about seven ways to reduce our health care costs without limiting the rights of medical malpractice victims. One of the proposals was to educate patients about whether, according to surgical guidelines readily available through the National Guidelines Clearinghouse, surgery was indicated for someone with their particular condition.
The idea is that some specialists, responding to financial incentives, are wont to recommend surgery in situations even where the professional consensus is that surgery is not necessary. Having patients educate themselves via reading the guidelines might empower them to decline surgery and pursue a less invasive (and more promising) course of treatment than surgery.
Now comes a brand-new study, published in the Journal of the American Medical Association, showing that cardiac surgeons are ignoring evidenced-based guidelines and continuing to perform cardiac stent surgeries on patients who would be more likely to benefit from drug therapies.
In 2007, a massive clinical trial known as COURAGE, published its findings on the relative efficacy of stent surgeries known as Percutaneous Coronary Interventions (PCIs) and drug therapies.
The COURAGE study found that for patients who had never suffered a heart attack, drug therapies (cholesterol-lowering statins, aspirin, blood pressure medications) worked better than the PCI surgery.
In fact, the PCI surgery actually endangered patients who had never before suffered a heart attack because it put them at risk for complications such as stroke, emergency bypass surgery and death while under anesthesia.
The COURAGE study helped establish surgical guidelines that PCI surgery be used only after a patient fails to respond to drug-based therapy.
The JAMA study shows that cardiac surgeons are following the guidelines less than half of the time.
In other words, the majority of patients getting PCI surgery are having surgeries done that are actually contrary to what the research-based guidelines recommend.
Dr. William Borden, the lead author of the COURAGE study, thinks he knows why cardiac surgeons are continuing to order these unnecessary surgeries: surgeons have every financial incentive to order PCI over a course of drug therapy. Drug therapy is cheaper and pharmaceutical companies, not surgeons, profit from pills. As Dr. Borden told a Reuters news reporter, “There are no financial disincentives to avoiding PCI. On the contrary, in a fee-for-service model, physicians are paid for doing procedures.”

This blog in maintained by the Boston personal injury lawyers at The Law Office of Alan H. Crede, P.C.