On Wednesday, The New York Times reported (“What Money Doesn’t Buy in Health Care“) reported on the relative ineffectiveness of drug-coated stents (aka drug-eluting stents). (For more information regarding what is a stent, visit the Angioplasty.org webpage.) On Friday, December 8th, the FDA recommended that “…doctors and patients be given stronger warnings about the dangers associated with the use of drug-coated stents in high-risk patients.” Why is this recommendation being given?
“After listening to testimony, they concluded that for healthier patients with simple forms of heart disease, the benefits of drug-coated stents appeared to outweigh the risks. The picture was less clear for people with diabetes, multiple blocked arteries or other complications. In the end, the panel concluded that doctors and patients needed to be aware of the risks and that researchers should continue collecting data. The entire affair — from the invention of the new stent to the willingness to reconsider it — was in many ways an impressive display of American medicine.
Yet it was also a nearly perfect example of what’s wrong with our health care system.
See, there was an elephant in the hearing room last week that went almost entirely ignored. One study after another has found that whether or not a stent is coated, angioplasty — the process of opening up an artery before a stent is inserted — and stenting do not actually reduce the risk of heart attack or extend life span for most patients.”
If angioplasties and stents aren’t helping patients, why are they being preformed?
“Ah, yes — money. Medicare typically pays $12,000 to $15,000 for a coated stent procedure, according to Thomas Gunderson of Piper Jaffray. Angioplasty and stenting have accounted for almost 10 percent of the increase in Medicare spending since the mid-1990s, Jonathan S. Skinner, a Dartmouth economist, estimates.”
Probably the most insightful comment of the entire article are the following two sentences:
“But we patients deserve some of the blame, too. We’ve come to believe that aggressive treatment somehow offers us the best chance to stay healthy, even when the evidence says otherwise.”
What can be done regarding patients who desire aggressive medical treatment where the average outcome of the procedure is no better than no treatment at all? The libertarian in me says, ‘if they want the treatment, let them have it.’ The problem is, individuals are not paying for these procedures out of pocket; private insurance companies or the government is paying for the treatment in most cases. A private insurance company or government agency who properly rationed care only when it was beneficial to the patient is the obvious solution. But will the private insurance companies and government ration care in the best interests of the patients or will they simply try to save money? This is a question at the heart of the current healthy care debate and one which I will be investigating throughout my career as a healthcare economist. There is no easy answer.