Heart disease may be one of the most studied illnesses, but just 11 percent of treatments approved by conventional cardiologists are actually supported by high quality scientific testing, reveals the Wall Street Journal. Moreover, a study published in the Journal of the American Medical Association (JAMA), has found that about half of all medical recommendations are the subjective viewpoints of physicians who are often not in agreement. Case in point? The debate about using daily aspirin, which is supported by rigorous scientific studies, continues, particularly with regard to side effects and aspirin’s link to internal bleeding. Questions remain about the use of blood thinners to prevent patients who have undergone angioplasty from experiencing a rare, but life-threatening blood clot. And it’s also still unclear when patients suffering from excess bleeding while undergoing a heart procedure should receive a blood transfusion. Yale University School of Medicine Cardiologist Harlan Krumholz says that physicians should let patients know about the strength of evidence behind the treatments they recommend. “Treatment decisions are often made very dogmatically even when the level of evidence isn’t very strong,” he says.
Why doesn’t clearer scientific proof exist? For the most part, drug and device companies have sponsored the large clinical trials that have “dominated cardiovascular research.” According to the JAMA study, the goal of the trials isn’t to guide treatment decisions, but rather to win approval for a treatment or to broaden market use of an already available therapy. Furthermore, guideline writers are chosen because of their expertise in their field. Yet they are often the same people who regularly consult with the drug industry, creating potential conflicts of interest that can introduce bias into the guidelines.
It’s not surprising that doctors and patients face many challenges when trying to determine the best course of treatment. “In most situations that we encounter when we see patients, it isn’t so clear what is the best thing to do,” says Pierluigi Tricoci, a cardiologist at Duke University’s Duke Clinical Research Institute and lead author of the study. And says Sidney Smith, a medical guidelines expert and cardiologist at University of North Carolina, Chapel Hill and senior author of the JAMA paper: “We need those studies with high quality scientific backing to make the kind of changes in healthcare that are being talked about-being sure we get the best possible care for our patients in the most cost-effective manner.”
The JAMA study follows President Obama’s plans to develop a council on Comparative Effectiveness Research (CER), which would be responsible for developing guidelines that specify which treatment options are the most effective and most cost effective. Critics of CER within the integrative medicine community fear that this will lead to a completely government controlled medical system dominated by the big drug companies. However, others believe this could be an opportunity for the integrative medicine community to speak up and make its case that integrative medicine has the potential for successful treatment and significant cost savings.
News Release: The vast majority of recommendations given to heart patients are NOT supported by good science! www.medaus.com April 2009
