"Do Angioplasty Heart Stent Procedures Work?"
The large national cardiology conferences may attract the majority
of cardiologists in the entire country to one place.
So hey, if you’re going to have a heart attack,
that would seem to be the place to do it.
And indeed, that’s when the American Heart Association president
had his, within hours of his presidential address.
With so many of the nation’s top cardiologists at the conference,
maybe that’s a bad time to go into cardiac arrest, anywhere else, though
you don’t know... until you put it to the test.
To their surprise, they found substantially lower mortality
among those going into cardiac failure or cardiac arrest
during the big national cardiology meetings.
Why is the death rate lower when most of the cardiologists are away?
One potential explanation is that the intensity of care may be lower,
suggesting the harms of such care
may unexpectedly outweigh the benefits.
Their results echo paradoxical findings documented during
a labor strike by Israeli physicians during which mortality rates
evidently dramatically fell. And it wasn’t just one strike.
This has been looked at multiple times, and in all reported cases,
mortality either stayed the same or decreased.
In four of the seven cases, mortality dropped as a result of the strike,
and in three, there was no significant change.
The fact is that many current medical practices have been found
to offer no benefit and, in fact, potential harms.
Even physicians themselves estimate that about one-fifth
of medical care is unnecessary.
A national summit was convened by the joint commission that
accredits hospitals and the American Medical Association to identify
areas of overuse—treatments that provide zero or negligible benefit—
potentially exposing patients to the risk of harm for nothing.
They called out five practices; for example, prescribing antibiotics
for viral upper respiratory tract infections, spending a billion dollars
prescribing drugs that don’t work
(and if anything just make things worse).
But another overused practice they identified was elective percutaneous
coronary intervention, in other words, angioplasty and stents.
Just to get everyone on the same page before we dive in,
coronary artery disease, the #1 killer of men and women, involves
blockages in the blood vessels that supply the heart muscle itself.
Low blood ﬂow can lead to a type of chest pain called angina or,
if severe enough, to a heart attack.
Plant-based diets and lifestyle programs have been shown to reverse
these blockages by treating the cause of why
our arteries are clogging up in the first place.
But, for those unable or unwilling to change their diets,
there are drugs that can help, as well as more invasive treatments,
such as open-heart surgery to try to bypass the blockage
or percutaneous coronary intervention.
That’s when doctors insert small balloons or metal tunnels
called stents up through the large blood vessels
typically in the groin and thread them all the way up into the heart.
That way you can get inside the blocked vessels,
and try to open them up and prop them open.
During a heart attack this can be lifesaving.
But hundreds of thousands of these procedures are done every year
for stable angina, meaning on a non-emergency basis,
which can relieve symptoms but doesn’t actually reduce your risk
of having or dying from a heart attack in the future.
However, not everyone knows that. They mistakenly think
the procedure offers more than just symptom relief.
That’s one of the reasons I’m doing this video series.
As Harvard put it, stents are for pain, not protection.
But then, unbelievably, it was discovered that stents may not
even help with pain, as revealed in this double-blind,
randomized controlled trial... Wait, you can blind people
to the active treatment in drug trials by giving them
a placebo sugar pill, but wouldn’t you kinda notice
if you got surgery or not, whether or not they cut into your groin?
Not if you got sham surgery— placebo surgery—where they cut
into everyone, thread up the catheter, and at the last moment
randomly actually do or do not actually place the actual stent.
And those who got the fake surgery did just as well as those
who got the regular surgery. Wait, there are no benefits
to angioplasty and stents outside of an emergency setting?
Doesn’t prevent heart attacks, doesn’t enable you to live longer,
and doesn’t even help with symptoms?
And since the procedure carries some risks—including death—
maybe stents should be used only by people
who are actively having heart attacks.
But wait, so, hundreds of thousands of people are getting
these operations for nothing? How do the doctors justify it?
Is it just greed? How do they get patients to sign up?
Do they just not tell them the truth? And wait, why doesn’t it work?
You are, after all, opening up a blocked artery.
There are just so many questions, which we’ll start addressing next.