Lack Of Evidence A Problem For Policymakers, Doctors And Patients
One category of medical mysteries that stumps expert doctors and policymakers alike falls under the heading: What works? News reports on two new studies and one that was never completed offer insight into that issue.
It turns out that "one of the first things you do at a doctor's visit" may not do much to improve your health, the Chicago Tribune reports. The value of collecting family medical histories turns out not to be supported by evidence, according to a review of 137 studies conducted during the past 14 years. The review was sponsored by the U.S. Agency for Healthcare Research and Quality and published in the Annals of Internal Medicine. "Overall, there was not even enough evidence to say how history collection affects patient outcomes. [P]atients tend to report the absence of disease in relatives better than the presence of disease" (Roan, 11/4).
Separately, a recent innovation in bypass surgery turns out to be worse than the method it has begun to replace, The New York Times reports. Surgeons traditionally stopped patients' hearts, letting machines called "pumps" do the work, while operating, but some worried the pump caused strokes, memory loss and personality changes. So-called off-pump surgery on still-beating hearts gained popularity during the past seven years, and now around 20 percent more than 225,000 operations are done off pump. But, a "rigorous" study of 2,203 patients finds that the off-pump procedures have poorer outcomes in terms of repeat surgeries, deaths, strokes and heart attacks. The study was sponsored by the Department of Veterans Affairs and appeared in the New England Journal of Medicine (Kolata, 11/4).
Meanwhile, a planned study to determine which patients actually need heart defibrillators could not be completed when the device industry ceased paying for the research, which it had funded as part of a deal with the Medicare program, The New York Times reports in a second story. In 2004, Medicare expanded eligibility for the devices to almost twice as many patients, on the condition that device makers pay for the study to create evidence that would justify or refute the policy change. "Five years later, Medicare underwrites more than half of the $4 billion the nation now spends annually on defibrillators, but the agency is no closer to knowing how many lives that big investment is saving. That is because the device companies did not finance the study beyond their initial $4 million commitment, and Medicare did not pick up the slack. As a result, researchers still cannot gather data that would identify the types of patients who would most benefit from a defibrillator." That's only one example of how consumers and doctors have "little if any comparative data when choosing a device" (Meier, 11/4).