George W. Bush’s angioplasty: Did he receive the best care? (With Lively Discussion on Pros/Cons of Medical Screening)

 

Polygon Medical Animation – Angioplasty Procedure (Photo credit: Polygon Medical Animation)

 

 

 

 

 

 

 

From the 19 August 2013 Kevin MD article by ALBERT FUCHS, MD

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The press coverage of Bush’s angioplasty had frequent questions about the necessity of the angioplasty and the cost of such a procedure. That is precisely not the point, and gives the public the incorrect idea that angioplasties are expensive and beneficial luxuries. BMWs, after all, are unnecessary and expensive, but very nice. And if a VIP gets something unnecessary and expensive, shouldn’t I want one too? The point of the evidence about angioplasties is that in most patients they have no benefit. Focusing on “necessity” misses that point.

It is entirely possible that Bush’s care was flawless. One possibility was that his stress test was extremely abnormal. Such very abnormal tests were excluded from the COURAGE trial, and we have no definitive evidence whether medications or stenting is best in those cases.

The important thing for the public to understand is that VIPs sometimes get terrible care. I’ve personally seen that myself. Physicians often over-test and over-treat celebrities, wrongly thinking that this will protect them from blame for any adverse outcome later. It’s much easier to tell a prominent patient that we will fix your problem with a high-tech and very expensive solution, rather than taking the time to educate the patient that we should start a few very old and very inexpensive medicines which have been proven to save lives. Paradoxically, we’re frequently much more comfortable doing the right thing for patients who will not draw public attention.

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Read the entire article here

The comments section was very interesting and lively.
Pap testing was one topic.  An excerpt

For those women interested, in my opinion, the best screening program in the world for cervical cancer is the new Dutch program. They’ll scrap their 7 pap test program, 5 yearly from 30 to 60, and offer instead 5 hrHPV primary tests at ages 30,35,40,50 and 60 and ONLY the roughly 5% of women who are HPV+ and at risk will be offered a 5 yearly pap test. (until they clear the virus) This will save more lives and take most women out of pap testing and harms way. (damage to the cervix can mean miscarriages, premature babies, c-sections etc.)

Those HPV- and no longer sexually active or confidently monogamous might choose to stop all further testing. Dutch women are already using a HPV self-test option/device, the Delphi Screener. (also, available in Singapore and elsewhere)
I’ve also, declined breast screening even though that cancer is far more common. Weighing up the risks and actual benefits, it doesn’t get over the line for me. (The Nordic Cochrane Institute brochure on breast screening and Professor Michael Baum’s informative articles and lecture helped me make an informed decision to decline testing)

Speaking generally:

We need to stop telling women what to do and start respecting informed consent. Give women real information on risk and ACTUAL benefit, respect them as competent adults/individuals and offer evidence-based testing that focuses on what’s best for them AND, leave the final decision to women, to accept or decline screening as they see fit.

Related Resources (just a few from many!)

• Cochrane Reviews  (require subscription, available at many academic/health science libraries…however free summaries are here)

systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in The Cochrane Library.

Example of a free summary
Screening for breast cancer with mammography (2013) –[scroll down for link to abstract]

• AHRQ-Patient Involvement
• Evaluating Health Information (with links)
• Research papers summarized for us all (links to resources)
• Evidence based practice   (LibGuide with links to tutorials, databases, web resources and more)
• Crunching Numbers: What Cancer Screening Statistics Really Tell Us (National Cancer Institute)
• AHRQ-For Professionals-Prevention and Chronic Care
  • Evidence Based Decision Making
    • US Preventive Services Task Force
      • What Not to Do in Primary Care: Overuse of Preventive Services (  Microsoft PowerPoint version – 1.12 MB )
        Michael LeFevre, University of Missouri-Columbia

Related articles

• UDoTest, HPV Virus Home Screening Kit, Launches In South Africa; Doctor Says It’s ‘More Effective Than A Pap Smear’ (medicaldaily.com)
• Many Docs Don’t Follow HPV/Pap Test Guidelines (nlm.nih.gov)
• Women may not need pap smears every two years according to University of NSW research (abc.net.au)
• Outdated practice of annual cervical-cancer screenings may cause more harm than good (eurekalert.org)
• Why Some Parents Are Refusing HPV Vaccine For Their Children (shotofprevention.com)
• On Self-Advocacy and Paying It Forward (draemadden.wordpress.com)