I ask once more: What is wrong with these doctors?

Michael Rothberg and colleagues surveyed some cardiologists and their patients who had undergone so-called percutaneous coronary intervention. That basically means sticking a long tube into the femoral artery in the groin, and guiding it to the site of a blockage in a coronary artery where various implements can then be used to open the channel.

It is an absolutely accepted fact that in people with stable angina (as opposed to acute rupture of a plaque) this procedure does not reduce the risk of a future heart attack, or fatality from a heart attack. Its only benefit is that in some cases, it can relieve symptoms of angina. Get that straight folks.

It often happens that people go for a cardiac catheterization, intended to visualize any obstructions in the coronary arteries, and if one is found, they get the PCI right then and there. These investigators found that 88% of patients who underwent catheterization, and 85% of those who actually had a PCI, believed it would reduce their risk of a heart attack -- even though they all said their cardiologists has discussed the risks and benefits of the procedure with them. Some of them might have misunderstood what the doctor said, but it turns out that 37% of the doctors also believed that -- and remember, it isn't true.

Oh yeah -- presented with two scenarios, 70% of cardiologists correctly stated that there would be no benefit of PCI, but 43% said they would do it anyway. Commenting on this mystery, the authors write:

Lin and colleagues* have attempted to explain why cardiologists continue to perform elective PCI for patients without clinically significant angina. They found that cardiologists' decisions were based on factors other than perceived benefit, such as patient expectations; medicolegal concerns; and the “oculostenotic reflex,” in which any amenable lesion receives a stent. Although cardiologists acknowledged that there was no evidence to support the practice, they believed that arteries should be opened if the procedure was technically feasible and low risk.

Shorter version: They just do it for the heck of it. And even better, they get paid!

So let's bring on the death panel, and put a stop to this. It's our money, and our hearts.

*Lin GA, Dudley RA, Redberg RF. Why physicians favor use of percutaneous coronary intervention to medical therapy: a focus group study. J Gen Intern Med. 2008;23:1458-63