Ethics in Medicine

Study Debunks Operation to Prevent Strokes

Kristen Sparrow • November 11, 2011

I’m sorry to see that this attempt also failed. I discussed the failed use of stents to prevent strokes here. But I just want to emphasize that $20 million is quite a bit of money that could have gone to health clinics to avail patients of exercise machinery, or subsidies to provide better nutrition, education, or even improved drug compliance. $20 million is not nothing. And it was used to subsidize the study of a very expensive procedure that made logical sense, but turned out to be bust. I commented on the persistence of the medical establishment to use treatments that don’t work here. There is a tyranny of “logic,” or “what makes sense” even though it turns out to be dangerous. Maybe we need to rethink our models. Just sayin’.
info on my practice here. Excerpts from the article follow, emphases mine.
November 8, 2011

Study Debunks Operation to Prevent Strokes

An operation that doctors hoped would prevent strokes in people with poor circulation to the brain does not work, researchers are reporting. A $20 million study, paid for by the government, was cut short when it became apparent that the surgery was not helping patients who had complete blockages in one of their two carotid arteries, which run up either side of the neck and feed 80 percent of the brain.

The surgery was a bypass that connected a scalp artery to a deeper vessel to improve blood flow to the brain.

The new study, published on Wednesday in The Journal of the American Medical Association, is the second in recent months to find that a costly treatment, one that doctors had high hopes for, did not prevent strokes. In September, researchers reported that stents being used to prop open blocked arteries deep in the brain were actually causing strokes. That study was also cut short.

Both the stents and the bypass operation seemed to make sense medically, and doctors thought they should work. Their failure highlights the peril of assuming that an apparent improvement on a lab test or X-ray, like better blood flow or a wider artery, will translate into something that actually helps patients, warned an editorial that accompanied the new findings. Only rigorous studies can tell for sure.

The editorial writer, Dr. Joseph P. Broderick, chairman of neurology at the University of Cincinnati College of Medicine, also cautioned that other stroke treatments were being used without sufficient study, particularly devices to remove clots. Dr. Broderick said doctors liked new technology, were paid well to use it and tended to believe in what they were doing, even without data.

The bypass operations were performed at 49 hospitals in the United States and Canada. All the patients given the surgery had had a stroke or transient ischemic attack (sometimes called a mini-stroke) during the previous 120 days, and were at high risk for another stroke. About 24,000 people a year in the United States were thought to be candidates for the operation.

The surgery costs about $40,000, probably 10 times the price of a year’s worth of medicine to reduce the risk of stroke, according to Dr. William J. Powers, the lead author of the study and chairman of neurology at the University of North Carolina in Chapel Hill…

Dr. David Langer, a brain surgeon and associate professor at the Hofstra North Shore-Long Island Jewish School of Medicine, said the study was well done and important.

“Surgeons don’t want to be doing bad operations,” Dr. Langer said. “Whenever you have a paper like this, we’re all disappointed, because we like to operate. But in the end it’s a good thing…”