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TECH: Stents and the lack of technology assessment in action

CabgNewer Stents Pose Dangers, 2 Doctors Say. That would be the drug eluting stents, now racking up a $6bn odd in US revenue for their manufacturers.

Well what did you expect? Oh, and by the way, still no evidence that stents are better than CABGs for the payer or the patient, in fact it’s still probably the other way around —as THCB has been saying for a while. But don’t expect much to change. After all you need more than evidence to stop this ball rolling downhill.

For example, I met someone with a new and better drug-eluting stent (from ex-BSX but now with Abbott) only last week, so if we decide that Cypher and Taxus aren’t the best answer, I’m sure the real answer will be something new—not something old.

 

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  1. Matt:
    A really provocative article. I want to respond to your final line: “so if we decide that Cypher and Taxus aren’t the best answer, I’m sure the real answer will be something new—not something old.”
    Reminds me that the late Robert Mendelsohn, MD, who wrote the wonderful book, “Confessions of a Medical Heretic,” once said, “Doctors don’t let go of one medication until they find a more dangerous one to replace it.”
    Still true today, no?
    Julia Schopick
    http://www.honestmedicine.com

  2. As one who had both CABG (1999) and a DES (Cypher, last year), I can tell you that there is an enormous difference in both complexity of the procedure and recovery time. Furthermore, at the time of my CABG, even in the best hospitals, 2% of patients did not survive the operation. The reading I’ve done, combined with information provided to me by my cardiologist, suggest that a long term regimen of Plavix and aspirin can largely prevent subsequent clots after a DES is inserted. CABG should be the last resort if none of the less invasive options are feasible or if CABG offers a significantly better long term pronosis in a particular patient based on where the blockages are and how many stents might be required.

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