SafetyJ2006
11-18-2006, 10:28 AM
How many times have you heard about someone who was told by their cardiologist, "Your coronary arteries are blocked. You will have to undergo bypass surgery immediately. If you don't you are going to have a massive heart attack at any moment and you may die! You have no other choice?" Perhaps your cardiologist made similar alarming claims. Over 3000 heart patients undergo a coronary bypass each day in the United States alone.
This causes enormous stress, fear and anxiety. It disrupts lives. Often complications occur following bypass surgery, causing more distress. These complications include: heart attack, heart failure,, infections of the heart and surrounding structures (sternum, lungs), stroke with paralysis of an arm or leg, loss of speech, loss of cognitive brain function, prolonged disability, even death. Finally, envision the crushing impact on the family's income and savings, for such surgery may cost as much as $100,000. Even if there is insurance, the co-pay and out-of-pocket costs can be phenomenal. Usually there is loss of inclome from inability to work for several months. Some may never be able to return to work.
The truth is, for the past 25 years, medication combined with contemporary imaging technology, has transformed this often lethal disease into a benign illness like so many other once fatal diseases of the past. Yet, tragically, such treatment is ignored for a number of reasons, not the least of which is economic. How then can doctors justify recommending surgery for almost every patient with CAD, even those who barely have symptoms or who have no symptoms at all and who enjoy a satisfactory quality of life? How is a cardiologist able to look a 40 or 50 year old in the eye and claim surgery is immediately required because death is imminent and medication will not work?
CAD is not a cancer that only has one outcome. All of us get CAD as we get older. It's a phenomenon of aging. It may even be found in people as young as 20. Experienced doctors have learned that sooner or later most patients with CAD will get better on their own -- without help from the surgeons. At least that is the experience in the rest of the world in countries that have no fee-for-service medicine nor the economic or medical resources to rush every patient with a little chest pain or an abnormal EKG to the operating room. They perform only a small fraction of the bypasses that we do in America.
American surgeons perform approximately five times the number of bypass surgeries per 100,000 people that their counterparts in the United Kingdom and other western European nations, and ten times the number compared to eastern Europe. Yet the survival rate of patients with CAD in such countries is just as good, if not better than in the USA. Even in the States, there may be as much as a tenfold variation in the number of procedures performed per 100,000 patients beteen such states as Wyoming and California.
What is so frustrating to noninvasive cardiologists, is the mountain of evidence that has accumulated over the past 25 years that documents the failure of surgery to increase survival benefits to the vast majority of people undergoing surgery. [Note I said noninvasive. It only has been in the past couple of years that cardiologists began identifying themselves ast noninvasive or interventional. It is good that they finally identify themselves. Truth in advertising.] Oh, an occassional patient may benefit from a bypass and sometimes you may win big in Vegas. Unfortunately, there is no reliable way to tell in advance who those few individuals may be. That might be acceptable if the treatment were harmless, like giving an antibiotic for a week. But the complications frequently encountered often make the treatment far worse than the disease. Besides, we know now there are over a dozen good reasons to explain why patients may have symptom relief and even lived longer after bypass surgery. However, those reasons have nothing to do with the surgical procedure itself.
If the cardiologist or cardio-thoracic surgeon told the absolute truth to the patient with CAD, this is what he'd say, "Look Mr. Patient, you have a heart problem. We might be able to help you, but we might make it worse. If you have surgery, you may die, have the very heart attack we are trying to prevent, have brain damage with loss of memory or reasoning, or have a strke and become a lifelong cripple. We can't predict what will happen or whether we can even save your life. The cumulative survival benefit for patients undergoing surgery is no better and is often worse than it is for medical treatment. Nor do we know who will and who will not improve. Eighty percent will have some relief of their symptoms, but those symptoms will return in 50% of the patients within 3 to 5 years. For the rest, surgery will be of no benefit. On the other hand, you can be treated with medication. It might be very successful and save your life, or it might fail and you would die. If you have surgery, you burn your brdiges behind you. If medication fails, you can still undergo bypass surgery. Finally, even surgery will not eliminate the need for you to take medication for the rest of your life."
But that's not what is said. Seeing a cardiologist is not like going to a store and selecting the merchandise you want. You may want it very much, but if the price is too high, you have the freedom to reject it. But in the physician's office or the emergency room, you don't have that freedom. He tells you what you need and often threatens imminent death unless surgery is performed immediately. You are swept along with the tide. You don't have a chance. After all, how can you argue with all that technology and all those impressive pictures of your clogged coronary arteries.
Take charge of your own body and health. When your cardiologist says "cut," you say, "I want a second opinion." When he scares you with imminent death, understand he is speaking out of his own self-interest. You represent a Mercedes or house payment. Always get a second opinion from a noninvasive cardiologist.
This causes enormous stress, fear and anxiety. It disrupts lives. Often complications occur following bypass surgery, causing more distress. These complications include: heart attack, heart failure,, infections of the heart and surrounding structures (sternum, lungs), stroke with paralysis of an arm or leg, loss of speech, loss of cognitive brain function, prolonged disability, even death. Finally, envision the crushing impact on the family's income and savings, for such surgery may cost as much as $100,000. Even if there is insurance, the co-pay and out-of-pocket costs can be phenomenal. Usually there is loss of inclome from inability to work for several months. Some may never be able to return to work.
The truth is, for the past 25 years, medication combined with contemporary imaging technology, has transformed this often lethal disease into a benign illness like so many other once fatal diseases of the past. Yet, tragically, such treatment is ignored for a number of reasons, not the least of which is economic. How then can doctors justify recommending surgery for almost every patient with CAD, even those who barely have symptoms or who have no symptoms at all and who enjoy a satisfactory quality of life? How is a cardiologist able to look a 40 or 50 year old in the eye and claim surgery is immediately required because death is imminent and medication will not work?
CAD is not a cancer that only has one outcome. All of us get CAD as we get older. It's a phenomenon of aging. It may even be found in people as young as 20. Experienced doctors have learned that sooner or later most patients with CAD will get better on their own -- without help from the surgeons. At least that is the experience in the rest of the world in countries that have no fee-for-service medicine nor the economic or medical resources to rush every patient with a little chest pain or an abnormal EKG to the operating room. They perform only a small fraction of the bypasses that we do in America.
American surgeons perform approximately five times the number of bypass surgeries per 100,000 people that their counterparts in the United Kingdom and other western European nations, and ten times the number compared to eastern Europe. Yet the survival rate of patients with CAD in such countries is just as good, if not better than in the USA. Even in the States, there may be as much as a tenfold variation in the number of procedures performed per 100,000 patients beteen such states as Wyoming and California.
What is so frustrating to noninvasive cardiologists, is the mountain of evidence that has accumulated over the past 25 years that documents the failure of surgery to increase survival benefits to the vast majority of people undergoing surgery. [Note I said noninvasive. It only has been in the past couple of years that cardiologists began identifying themselves ast noninvasive or interventional. It is good that they finally identify themselves. Truth in advertising.] Oh, an occassional patient may benefit from a bypass and sometimes you may win big in Vegas. Unfortunately, there is no reliable way to tell in advance who those few individuals may be. That might be acceptable if the treatment were harmless, like giving an antibiotic for a week. But the complications frequently encountered often make the treatment far worse than the disease. Besides, we know now there are over a dozen good reasons to explain why patients may have symptom relief and even lived longer after bypass surgery. However, those reasons have nothing to do with the surgical procedure itself.
If the cardiologist or cardio-thoracic surgeon told the absolute truth to the patient with CAD, this is what he'd say, "Look Mr. Patient, you have a heart problem. We might be able to help you, but we might make it worse. If you have surgery, you may die, have the very heart attack we are trying to prevent, have brain damage with loss of memory or reasoning, or have a strke and become a lifelong cripple. We can't predict what will happen or whether we can even save your life. The cumulative survival benefit for patients undergoing surgery is no better and is often worse than it is for medical treatment. Nor do we know who will and who will not improve. Eighty percent will have some relief of their symptoms, but those symptoms will return in 50% of the patients within 3 to 5 years. For the rest, surgery will be of no benefit. On the other hand, you can be treated with medication. It might be very successful and save your life, or it might fail and you would die. If you have surgery, you burn your brdiges behind you. If medication fails, you can still undergo bypass surgery. Finally, even surgery will not eliminate the need for you to take medication for the rest of your life."
But that's not what is said. Seeing a cardiologist is not like going to a store and selecting the merchandise you want. You may want it very much, but if the price is too high, you have the freedom to reject it. But in the physician's office or the emergency room, you don't have that freedom. He tells you what you need and often threatens imminent death unless surgery is performed immediately. You are swept along with the tide. You don't have a chance. After all, how can you argue with all that technology and all those impressive pictures of your clogged coronary arteries.
Take charge of your own body and health. When your cardiologist says "cut," you say, "I want a second opinion." When he scares you with imminent death, understand he is speaking out of his own self-interest. You represent a Mercedes or house payment. Always get a second opinion from a noninvasive cardiologist.