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March 27, 2007

The stent thing

So by now everyone has heard/read about the end of cardiac care as we know it.  Stents don't save lives.  (See, e.g., the post from the WSJ Health Blog including a link to the "Courage" study released this week, and be sure to check out the comments.)  Boston Scientific stock dropped.  (See the post at The Health Care Blog for an in-depth look at the story.) 

Folks seem to be taking issue with the claim in the study that stents don't do much for management of symptoms (pain) either.  These folks are also saying that angioplasties and stents were never intended to improve anything but comfort.  Remind me, when the Veep was getting a stent put in, did all the page one coverage say we're doing this procedure just to make him comfortable?  I don't think so. (There's a whole other story there, I know; off-label use of the stent in his case.)

Up until now, in the public eye, angioplasties and stents have been sold as medical miracles, not as comfort care.  Some would say that this revisionism on the part of the medical device manufacturers and their apologists in response to the Courage study could be read as signaling a new openness to evidence-based medicine. 

Such folks may be anticipating that the industry and the specialists will change behaviors based on this one trial.  Seems to me it's too soon to tell whether we can pass judgment on angioplasties and stents based on a single study.

-- David Harlow


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