Physicians

A classic from a cardiologist

The NY Times has a long piece on the fast spread of 64 slice CT scans and their using in cardiac imaging. This is all pretty much taken straight from Shannon Brownlee’s fabulous book Overtreated which has a whole chapter on the topic. But it’s good to get the debate out there.

It appears that essentially there’s no real reason to use these scanners for the vast majority of patients. And in fact they’re use probably leads to more unnecessary angioplasties and stenting (which in itself doesn’t seem to reduce the number of heart attacks). But of course once a practice buys a 64 slice CT it’s an ATM machine sitting in the corner—not much good if you don’t use it, but very profitable if you do. Of course, the more conservative approach gets short shrift and those waiting for evidence to justify all this spending get ignored in the rush by both doctors, hospitals and manufacturers to get at the taxpayer’s coffers.

I was though vastly amused by this quote from an Manhattan cardiologist which will bring joy to the ears of those fuddy-duddies in the pay for performance movement:

Cardiologists like Dr. Brindis hurt their patients by being overly conservative and setting unrealistic standards for the use of new technology, Dr. Hecht said. “It’s incumbent on the community to dispense with the need for evidence-based medicine,” he said. “Thousands of people are dying unnecessarily.”

Of course he just knows that thousands are dying due to lack of these scans, so why do we need any evidence!

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Dan GebowGreg PawelskiMatthew Holttcoyotedocanon Recent comment authors
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Dan Gebow
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Dan Gebow

There is a deeper story to the entir article. Anybody feel the NYT article was a bit suspicious? No new studies and 5 asymptomatic patients anecdotal stories to highlight the abuse of one new imaging modality? If you look into who critics Rita Redberg and Sean Tunis are, you’ll see they actually represent the private payers via a psuedo-non profit called CMTP. They are looking to take down all new medical technology (i.e. save payers $). Dig deeper and you’ll find that Tunis influenced his former subordinates at CMS to try to cut funding and require clinical trials. Tunis and… Read more »

Greg Pawelski
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Greg Pawelski

One reason medical costs are getting way out of control: GE employs too many good salesmen.
http://www.forbes.com/forbes/2008/0225/032.html

Matthew Holt
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tcoyote–of course “it’s the payment system, stupid.” But no reason not to keep banging on about the reverse ludditism of the current system, while it’s still here and still in control.

tcoyote
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tcoyote

Brownlee blundered into the next huge turf fight- between cardiologists and their gold standard invasive technology, angiography (threading a catheter into one of heart’s arteries, squirting in some contrast medium and taking an X-ray of the flow pattern) and radiologists/cardiologists using a medium which produces a better picture of the actual organ (with no catheter or squirting dye) than what you can see if you’re holding the damned thing in your hands. The legacy technology was seriously overused as well (some places routinely had very high, eg 25% or better, “normal” caths, meaning that people did not do the appropriate… Read more »

docanon
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docanon

Completely agree…best quote of the entire article. This guy is a complete idiot, a shill, a reckless danger to patients, and an embarrassment the medical profession. I mean, why doesn’t he just finish the thought: let’s bring back patent medicines, cupping, and leeching. Insulin overdoses for schizophrenia? You go, dog! Let’s un-invent modern standards of measuring efficacy and effectiveness…not to mention the ethical principle of beneficence. His ability to continue practicing medicine demonstrates physicians’ inability, as a professional group, to regulate ourselves. The horrifying thing this article brings to light isn’t the proof–yet again–that physicians, like anybody else, will tend… Read more »