Monday, October 01, 2007

Pardon Me While I Puke

I've got a brilliant idea.

I want to set up a study to determine is panic attacks cause an increased incidence of heart attacks.

So I developed the "Big Important Trial" sponsored by the world's Most Important Drug Company to see if a relationship exists.

So I ask a bunch of older women (especially since this is a major health care problem in just women), are you anxious? And some of them say "yes."

Now of those, I decide to ask them to describe the symptoms they feel when they're anxious, and when they check at least one quarter of my twelve-symptoms list, I will call them a bonafide full-blown, Katie-bar-the-door panic attack.

For the ones that check a few less boxes, heck, we'll call them panic attack "lite."

Then I follow them for five years.

And lo and behold statistically, more of 'em drop dead, or have a heart attack or stroke than the folks who said they weren't anxious.

The drug company thanks me after I publish my results in a medical journal and leaked the results to the Wall Street Journal, so now they can sell more drugs to anxious women and I can go on a speaking circuit for the drug company and make lots of money.

But there's a little issue I'd rather not discuss: did anyone in my Big Important Trial screen for heart disease before they took the questionaire to see if these women might have already had heart disease? I heard that it is well established that the symptoms for heart disease are dramatically different for women than men! Did we screw up?

I'm getting nauseous.
* * *

I can't overemphasize the number of women I have treated with supraventricular tachycardia that were originally diagnosed as "anxious" or with "panic attacks" or from "mitral valve prolapse" by their primary care physicians only to discover years later that they had been inappropriately labeled due to sexist practices relying on presumptions about the reduced prevalence of heart disease in women compared to men. What's to say in this trial that these women didn't already have heart disease that was undiagnosed and was manifested as "panic attacks?" In other words, maybe the egg came before the chicken?



TBTAM said...

Hey - If it sells Paxil, who cares, right? Get with then program, Dr Wes!

DrWes said...


Aw shucks, I suppose you're right.

But the study design was SO bad, it never should have been accepted for publication, in my view. This study shows the problems with substudies developed from other larger studies.