Healthcare - Stents

[Alan Klein]

There is no question that there is a great deal of truth to what you say.  The key thing is to continue the long term research into evidence-based medicine.  The paper under discussion in this thread excluded a lot of cardiac patients from the study as the investigators realized that there were some risk categories that will require intervention and stent implant.  the key outcome is the use of stents should not be considered 'routine' for all cardiac patients.  One of the difficulties with new medical advances is gathering long term outcome evidence.  In my own field of pharmaceuticals there is a considerable amount that we still don't know even about Rx products that have been on the market for many years.  Because we don't have good electronic medical records as many European county health systems do, it is difficult to do this type of outcome research.  One of my last projects prior to retirement was managing what ended up as a $40M research program to come up with better ways of data analysis into drug safety and outcomes.  It was really difficult as we realized from the outset that even common definitions don't exist.  the US systems of records is pretty much focused on reimbursement codes rather than medical outcomes.

The problem is nothing is simply black and white.  If that was the case, we could use computers instead of humans to determine what medical procedures are best in each case.  There are factors that cannot be inputting into decisions based on research.

Twenty five years ago I injured my left knee and ripped my meniscus.  being in business, I filed the issue with my Workmen's Compensation Insurance Company stating it occured at work and not elsewhere, a requirement for a Workmen's claim.  I was protected better with the Workmen's claim than a regular health insurance claim.  Let's just say I may have been confused as to whether it occurred at work.

Anyway, I went to the three top orthopedic surgeons in NYC including one who handled all injuries for the NY Rangers hockey team.  All three surgeons told me I need surgery on the knee to repair the meniscus.  Well, a few days later I had this epiphany of guilt about the claim I made.  I then sent a letter to the insurance company withdrawing the claim stating it occured in my home rather than at work.

The next day the pain went away.  I never had the surgery. That's was 25 years ago.  Every once in awhile, I get a twinge in my left knee.  I'm not sure if that is from the left over injury or God reminding me to do the right thing. 

[petermfiore]

That's good inspiration for others Peter.  The problem for most people is that until something horrible happens, they tend dismiss bad things happening to them from their personal habits, good or bad.  Such as in my case.  The expression is, " Nothing focuses a person's attention like the hangman's noose. "  It was good to hear about how you improve with diabetes 2, something I suffer from.  It probably complicated my heart disease.  So I'm paying more attention, not perfect though.  It's so hard to forgo good food.    I'm also not an exercise buff.  I'd rather stare at a computer screen and type posts than actually move a muscle.  But I have lost 35 pounds and that seems to help but still on medicine.  Just got a 6.4 on my A1C which ain't too bad.  Maybe my heart problem was God's way of telling me to straighten out and fly right.

 

Thats the point. All need to take better care of themselves and support the same in family and friends. A1C 6.4 that's great...keep it up. You can get there and keep clicking shutters.

Peter

[faberryman]

I'm not sure if that is from the left over injury or God reminding me to do the right thing.

You would think a loving God would just waive his magic wand and give you an epiphany rather than saddle you with diabetes and clog your arteries necessitating a heart bypass operation.

[petermfiore]

You would think a loving God would just waive his magic wand and give you an epiphany rather than saddle you with diabetes and clog your arteries necessitating a heart bypass operation.

"Magic Wand".....Interesting. That opens a whole other avenue of, I don't want to pursue.

Peter

[John R]

If you follow this guy in the video below, you will learn all about the new metabolic science. Many of his videos deal with the health issues you are discussing. It turns out the best indicator of heart attack risk is a coronary calcium test. And yes the heart and cardiology associations in the US did try to prevent governments and hospitals from adopting the test as a standard diagnostic tool. Well worth watching.

https://www.youtube.com/watch?v=WHPA6WX-2_k

https://www.youtube.com/watch?v=NSPcuGjstN4

[Jeremy Roussak]

If you follow this guy in the video below, you will learn all about the new metabolic science. Many of his videos deal with the health issues you are discussing. It turns out the best indicator of heart attack risk is a coronary calcium test. And yes the heart and cardiology associations in the US did try to prevent governments and hospitals from adopting the test as a standard diagnostic tool. Well worth watching.

I've many, many better things to do with my time than to watch two one-hour videos, but if that's an accurate representation of what they contain, they're somewhat misleading. A search in PubMed suggests that coronary artery calcium scoring correlates pretty well with the presence of coronary artery disease. It's not "the best indicator of heart attack risk"; it's just one more useful tool.

Jeremy

[John R]

I've many, many better things to do with my time than to watch two one-hour videos, but if that's an accurate representation of what they contain, they're somewhat misleading. A search in PubMed suggests that coronary artery calcium scoring correlates pretty well with the presence of coronary artery disease. It's not "the best indicator of heart attack risk"; it's just one more useful tool.

Jeremy

Yes I agree Jeremy. Your description of their views is more accurate than what I wrote. However, the second video is more like a documentary and includes the fight to get the calcium test adopted as an option in hospitals because it is such a useful tool. It is nice to get a break form the news and LuLa.

JR

[John Camp]

The problem with studies like these is that they're done on a mass basis; that is, they tell you what happens when you look at a mass of people, and compare outcomes. But a heart attack doesn't happen on a mass of people -- it happens on one person, and the idiosyncrasies of any particular case overwhelm indications from a mass study. Looked at as a mass, there may be no significant difference in outcomes between treatment with drugs, and treatment with stents. In one particular case, there may be huge differences -- a stent can prop open a clogged artery *right now* while drugs may take a course of treatment, and if you need the help right now, then there is a huge difference for you, even if it's not even a blip in a study.

I honestly think that many of these studies are driven by two things: costs, and warring cliques of doctors. If you can show there is a significant drop in costs with drugs, rather than surgery, then the government and insurance agencies will be pushing hard for drugs, and that will have an effect on treatments. And while costs may drop, in any particular case, you may have a death that wouldn't have happened if the other course were taken. One death among thousands of treatments may not be significant. But you're not a statistic; you're a human being. You're concerned with one particular outcome, while a mass study isn't.

And, of course, these studies have a direct impact on how mass treatments are done, driving patients one way or another, and thus effect medical incomes. Even doctors like money. I am aware of at least one such medical war (between board certified plastic surgeons and "cosmetic surgeons.") There are probably others, and the drugs/surgery case may well be one of them.

I have two stents in my heart, and don't regret them one bit. I had a heart attack in 2007 that was so mild that by the time I got to the hospital, they did an EKG and said I hadn't had a heart attack. Then they found some kind of chemical dude [dude=I don't know what it was] that is only produced by a heart attack, so yeah, I had one, but there was no detectable damage. The docs did an angiogram and found material narrowing in two heart arteries, and placed stents to prop the arteries open. No trouble at all the last 12 years and I work out hard. I do think things like personal habits are significant: if you don't smoke, drink very little, watch your diet, get some exercise, you'll probably stretch things out as long as is possible. Which is all you can ask for, IMHO.

[Alan Goldhammer]

I've many, many better things to do with my time than to watch two one-hour videos, but if that's an accurate representation of what they contain, they're somewhat misleading. A search in PubMed suggests that coronary artery calcium scoring correlates pretty well with the presence of coronary artery disease. It's not "the best indicator of heart attack risk"; it's just one more useful tool.

Jeremy

Correct assessment.  A useful lay review of this is here:  https://www.nytimes.com/2018/04/02/well/live/the-value-and-limitations-of-a-cardiac-calcium-scan.html written by Jane Brody who is a very good writer on health topics.

[LesPalenik]

As Bart says, if you need it, you need it. And if you get when you need it, it can save your life.
But if the blockage is on the border line, often the stent is not necessary. Not only the actual stent but everything what goes with it - being put on Plavix or other similar medication, possible breakdown of the stent, and other complications which don't address the real causes of the blockage. 

[Robert Roaldi]

That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.

Analysis by clickbait sound bite.

[Alan Klein]

You would think a loving God would just waive his magic wand and give you an epiphany rather than saddle you with diabetes and clog your arteries necessitating a heart bypass operation.

I'm stubborn.  I need to get hit over the head.  Even then I don't listen.  Last night I ate pizza.  The worse for me.  Very tasty though.  

[PeterAit]

That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.

What a crock of fecal material. The imaginary "death squads" were an invention of the cheesebrain Sarah Palin and her pals. They have never existed and do not now. Just another example of the right wing making things up to scare voters.

[Slobodan Blagojevic]

... The imaginary "death squads" ... They have never existed and do not now...

I am repeating a quote from the article referenced in my reply #16:

Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral.

[LesPalenik]

I'm stubborn.  I need to get hit over the head.  Even then I don't listen.  Last night I ate pizza.  The worse for me.  Very tasty though.

Eating a cheese and pepperoni pizza is effective for happy endorphins but not helpful to endothelium coating in your blood vessels. 

A single high-fat meal can induce endothelial dysfunction, whereas low-fat meals generally neither improve nor worsen.

https://care.diabetesjournals.org/content/29/10/2313

[Alan Klein]

Eating a cheese and pepperoni pizza is effective for happy endorphins but not helpful to endothelium coating in your blood vessels. 

https://care.diabetesjournals.org/content/29/10/2313

"Waiter, I'll have the anti-endothelial dysfunction hamburger please.  Medium-well. "

[LesPalenik]

A new report published last week in the Annals of Internal Medicine, shows that the per-capita cost of administering healthcare is more than four times higher in the U.S. than in Canada.

In the United States, a legion of administrative healthcare workers and health insurance employees who play no direct role in providing patient care costs every American man, woman and child an average of $2,497 per year.

Across the border in Canada, where a single-payer system has been in place since 1962, the cost of administering healthcare is just $551 per person — less than a quarter as much.

https://www.latimes.com/science/story/2020-01-07/u-s-health-system-costs-four-times-more-than-canadas-single-payer-system?fbclid=IwAR32DQNH5K8M06qQvDw_aLhgzHWzcxsIrwMmf3tR36qAz3VJRbt2Y3RoPRo

[Rob C]

Just found this thread.

I have had two heart attacks.

After the second one, I was give a stent which was all conducted under private insurance. I had to pay up front, and it cost me €3,000 of which the insurance returned €2,000. I don't know what this charge covered - whether just the stent or the surgery, too.

Some years after that, and now under the state system, the cardio told me I needed another stent. This cost me nothing at all.

I think that was pretty good service under both systems.

Folks here who can afford it, often take out private insurance too because it sometimes gets things done more quickly. We ran within a parallel system too for many years, but eventually, after my wife discovered how good the state system was, we stopped paying the heavy private fee.

Rob

[Alan Klein]

A new report published last week in the Annals of Internal Medicine, shows that the per-capita cost of administering healthcare is more than four times higher in the U.S. than in Canada.

https://www.latimes.com/science/story/2020-01-07/u-s-health-system-costs-four-times-more-than-canadas-single-payer-system?fbclid=IwAR32DQNH5K8M06qQvDw_aLhgzHWzcxsIrwMmf3tR36qAz3VJRbt2Y3RoPRo

What I;ve noticed is the huge number of clerk and doctor assistants in medical offices, many just sitting around.  Part of that may be due to the fact government picks up a lot of those costs.  For example, all the argument how it's cheaper for Medicare and Medicaid to be administered isn;t true.  The government contracts out all administrative work to private companies.  That's mentioned in the article.  But the article doesn;t mention how that affect costs. There's no incentive for medical groups to reduce staff as its paid for by government.  So overall private administration costs include government programs.  So the argument is silly because there is no comparison.  Government as well as private administrative costs are done by private companies.

The problem is government.  Now one really cares what things cost.  If our entire medical industry went to government, America would not lower its costs like other countries.  The government would just print money to cover additional deficits due to higher medical costs.  AFter all., half of medical costs are already handle by the US government through Medicare and Medicaid.  Just like colleges get handouts raising tuition cost 4x in the last couple of decades, the same will happen with a single payer medical plan.  Of course America will eventually go for it thinking its free.  We're suckers for things that we think we get for nothing.

[Alan Goldhammer]

What I;ve noticed is the huge number of clerk and doctor assistants in medical offices, many just sitting around.  Part of that may be due to the fact government picks up a lot of those costs.  For example, all the argument how it's cheaper for Medicare and Medicaid to be administered isn;t true.  The government contracts out all administrative work to private companies.  That's mentioned in the article.  But the article doesn;t mention how that affect costs. There's no incentive for medical groups to reduce staff as its paid for by government.  So overall private administration costs include government programs.  So the argument is silly because there is no comparison.  Government as well as private administrative costs are done by private companies.

Most of these people deal with billing which is incredibly complicated.  It's also a key reason why the US unlike other countries does not have an effective electronic medical records system (the VA is the one exception as their system is robust for the simple fact that they don't deal with billing issues).  All the ICD coding values focus on reimbursement rather than medical care and outcomes.  When I was at PhRMA we had a very big project that was designed to look at medical records for drug safety and outcomes.  Whole new vocabularies had to be designed to accomplish this and that work which began in 2008 is still going on.  Other countries can effectively identify adverse drug reactions and medical outcomes much faster than the US as their systems are outcome designed rather than payment designed.

The problem is government.  Now one really cares what things cost.  If our entire medical industry went to government, America would not lower its costs like other countries.  The government would just print money to cover additional deficits due to higher medical costs.  AFter all., half of medical costs are already handle by the US government through Medicare and Medicaid.  Just like colleges get handouts raising tuition cost 4x in the last couple of decades, the same will happen with a single payer medical plan.  Of course America will eventually go for it thinking its free.  We're suckers for things that we think we get for nothing.

This is just a silly statement.  Medicare really cares how much things cost and that's why their reimbursement rate is much lower than what private plans offer.  You also ignore the fact that private plans set up networks of hospitals and doctors who agree to set reimbursement fees.  We found this out the hard way some years ago when our excellent BlueCross plan would not fully reimburse the surgeon who did a gall bladder removal because she was not in network.