Monday, September 14, 2009

ICDs in Women: The New York Times Gets It Wrong

If there are potential "shortcomings in the data," then you shouldn't print a misleading title: "Survey Shows Heart Device Aids Men More Than Women." Rather, a better title would have been, "More Data are Needed to Understand the Effectiveness of Defibrillators in Women." Do we really want to withhold defibrillators from women on the basis of such a retrospective literature meta-analysis?

But then, it's the New York Times.

A much better review, including a comment on the study in question by yours truly and fellow EP blogger Dr. Rich Fogoros, can be found over at Larry Husten's Cardiobrief blog.

-Wes

5 comments:

Keith said...

Wes,

Once again, the question is why are we implanting tthese devices at enormous cost if we do not have the data as to their effectiveness to begin with!?

Bring on the Dept of Comparitive Effectiveness Research before we spend ourselves into oblivion!

DrWes said...

Keith-

Can't wait! Sign me up! How many millions can I soak, er, get from our government for studying this? An ICD trial?! Yeee haaa! Performed, of course, as a humanitarian gesture for our country... Oh, and for all the other research the government wants to conduct in the name of every clinical question out there, I'm sure there are infinite financial resources available from our government for that, too!

Never pass up a good boondoggle that presents itself, right Keith?

Keith said...

Wes,

Forgive me gfor assuming that western medicine was predicated on science where we prove the benefit of a treatment before foisting it upon our patients. I would feel much more confident about this research if it was done by some independent entity rather than our wonderful device and pharmaceutical industry which does not have a very good track record of properly vetting its products. And if you don't belive me, I've got some leftover Vioxx I'd like to sell you along with some Zyprexa that works for every known psychiatric condition known to man (at least according to the pharmaceutical industry).

DrWes said...

Keith-

Yep, you're right. We all know how effective the government is at regulating our pharmaceutical and medical device industry: just look at the FDA! They receive funds in the from the pharamceutical industry in the form of the Prescription Drug User-Fee Act (PDUFA), and then make sure that untoward individuals who might vote against drugs with "favored nation" status in the eyes of pharma aren't present at their safety and risk management committee meetings.

Yep, I'm SURE the government will do a better job at assuring similar impartiality over the results of research trials designed to save the government money.

Keith said...

Wes,

Ther is no question that governance and oversight are important aspects of proper management, whether in the goverment or private business realm. I am sure we can trade stories about health care companies in the private sector that have committed egregious acts that have caused real harm, as well as public entities that have not exercised proper oversight. All I can say is most of the issues you raise were committed during a republican administration that put ultimate (and undoubtedly too much) faith in the free market system with little or no oversight of the buisinesses they were regulating. There has clearly been a major shift in this respect. There have been major changes at the FDA; I cannot say the same for most pharmaceutical compainies and insurance companies where the latter seems more focused on turning out me too drugs as patent extenders and the latter continues to conduct buisiness in unethical ways with both consumers and providers.

Maybe we have a difference in how this comparitive research would be conducted, where I see the goverment identifying issues of efficacy that have not been answered and funding the research to answer these questions. This is actually something they have been doing all along; witness the anti hypertensive trials that showed good old HCTZ was as good as that expensive ARB for lowering the blood pressure, or the ongoing trial of early idnetification and treatment of prostate cancer. The prostate cnacer study is a case in point where no for profit interest is going to step forward and conduct a study that may actually prove no benefit to early detection and treatemnt with PSA (except possibly the insurance industry which has avoided this field to date), yet could save an enormous amount of money if indeed we found no benefit to PSA screening. Why would you not want to see this type of study funded and if you do, who would you see as the entity that would pay for the study?

The goverment can enlist medical schools and research centers to conduct this research much as they do now. What could you posibly see as the downside to answering these questions in the hopes of using our health care dollars more wisely? You could even do studies of other "preventive care measures" that you have railed against previously in your arguments, stating they will not likely save the health care system any money and may ultimately cost us more. Lets do a study to see if your argument is correct. But presently you are just stating a point of contention with no clear proof. How about some science to back it up!!