The angioplasty study found that at $30,000 to $40,000 a pop, the procedure fixes only one arterial blockage at a time, while combinations of drugs such as aspirin; statins; nitrates; angiotensin-converting enzyme, or ACE, inhibitors; beta blockers; and calcium channel blockers attack all blockages. Most such drugs cost no more than a few hundred dollars. Also, for reasons still unknown, the total blockages addressed by angioplasty and stents are not as indicative of future heart attacks as partial occlusions treated by drugs. In severe cases, bypass graft surgery is recommended.
Despite such study findings, some prominent cardiologists are adamant that stents and angioplasty are still preferable, for rather obvious reasons. These are highly lucrative procedures, and these doctors are paid huge consulting fees by devicemakers to attend conferences and talk up the virtues of the products.
The study was financed by the U.S. Veterans Affairs Department, the Medical Research Council of Canada and a host of drug companies. Stentmakers refused to help pay for the research, said the lead authors.
More studies financed by impartial institutions are needed, but we are in the midst of growing cost pressures. After a doubling of the National Institutes of Health budget from the late 90s up to 2003, inflation and budget cuts have eroded the budget by some 13%, and the institute is preparing to trim operations by as much as 10% this year, the result of venal Bush administration priorities. Congressional Democrats have added about $2 billion to the NIH budget, enough for the agency to tread water for a year.
Elias Zerhouni, the NIH director and one of the few bright spots in the Bush administrations firmament, has risked being fired over his public disagreements with the budget cuts and the presidents opposition to embryonic stem-cell research, a technology with huge promise for preventing and treating high-cost illnesses.
Weve given up our ability to do clinical trials to change medicine, Zerhouni told a recent congressional hearing.
The angioplasty study and other research calls into question another reality of todays medicinethe reimbursement system. Many doctors perform procedures and defend them because they help pay the bills. Many of these same doctors lose money on other procedures that may be more efficacious.
Why is it that no presidential candidate or congressional leader is seriously exploring ways to fix a payment system so wildly out of skew? Not only are doctors forced to push expensive treatments, but also current Medicare rates are forcing them to ramp up their volume to make up for per-case reductions.
We need to find a way to pay providers to keep people healthy and treat chronic disease efficiently. The current system is more about keeping providers fiscally sound.