Map of life expectancy at birth from Global Education Project.

Wednesday, December 13, 2006

Yes, we take requests

Or at least we take hints. A reader wrote a couple of days ago. He has been diagnosed with heart disease but he is not interested in having bypass surgery. He's discovered that bypass surgery does not have a substantial benefit in terms of survival,and he's, let's say, a little bit irked that doctors push it on people.

He's basically right. Under most circumstances, the benefit of so-called "revascularization procedures" -- bypass grafts and angioplasty -- is not prevention of heart attacks, but amelioration of the symptoms of angina. It so happens that David Leonhardt, in the New York Times business section, has discussed this issue today, focusing on angioplasty and stents, but it's the same idea. And by the way, in the NYT, the business section is the place to read most of the health care news. Which tells you all you need to know. Controversies over drug approvals, labeling, prescribing and the latest biomedical research are all covered in the business section because they are more about money than they are about health.

Leonhardt writes, in discussing an FDA hearing on the risks of drug-coated stents (an issue much in the news lately):

See, there was an elephant in the hearing room last week that went almost entirely ignored. One study after another has found that whether or not a stent is coated, angioplasty — the process of opening up an artery before a stent is inserted — and stenting do not actually reduce the risk of heart attack or extend life span for most patients.

“There’s a much more liberal use of angioplasty and stenting than there needs to be,” Dr. Eric J. Topol, a member of the panel, told me last week. Dr. Calvin L. Weisberger, the top cardiologist at Kaiser Permanente, said, “A large pool of angioplasties and bypass surgeries are being done without scientific evidence.”

The problem is that there’s nobody whose job it is to say no. The F.D.A. steps in when there are safety concerns. But no federal agency or medical group takes action when an expensive form of treatment becomes far more common than it needs to be — which is a big reason that health care spending is rising so rapidly.

Yup. The Brits, who except for that little problem of having a poodle as Prime Minster are ahead of us in most areas, do have somebody whose job it is to say "no." It's called the National Institute for Clinical and Health Excellence, abreviated NICE because "Health" didn't used to be in the name and it's a better acronym anyway. If NICE says don't do it (NICEly, we hope), the UK National Health Service doesn't. Of course, they have a national health service, so that makes it easier. But we could have a similar institute that lets insurers off the hook for drugs and procedures that aren't worth it.

Only we don't. That would be "rationing" of health care. And we can't have that. Unless you're one of those 45 million people who has no health insurance at all. That's perfectly okay.

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