Business Week's got an interesting article doubting the benefits of coronary heart surgery. Apparently, bypass operations and angioplasty, save in the most severe of cases, do shockingly little in the way of risk reduction. Patients who undergo the operations are no less likely to have or die from a heart attack than those who don't. There may be some benefits in symptom reduction, but even that's questionable.
The reason seems to be a reevaluation of how heart attacks work. While the old conception held that ever-increasing plaque buildup eventually narrowed arteries to the point that no blood got through, it now looks like the plaque actually breaks off into clots, and the clots block arteries causing attacks. That's why so many heart attacks strike unexpectedly and why there's so little evidence linking narrowed arteries to heart attacks. Seen that way, widening the arteries won't do much: it's lifestyle changes and certain medications that reduce plaque and tamp down on bad cholesterol that'll be most effective.
So why am I starting your morning off with a discussion on heart attacks? Treatments, particularly expensive, invasive ones, have become quasi-routine in the health care system, but they've not proven themselves in better health outcomes. And that's one reason liberals shouldn't be quick to dismiss the principle behind HSA's. Currently, so much power resides in the hands of the doctor that anything she utters is assumed to be of great, even miraculous wisdom. Patients know nothing. MD's are infallible. And so must be their suggestions, otherwise, why would yours be putting you under the knife? But the doctor, who doesn't want her patients scared and has no interest in undermining the psychological power of her treatments, doesn't cop to the uncertainty of the surgeries. What happens when she does?
Some scientists argue that the rational solution is to let patients decide for themselves. But that requires providing detailed information about the risks and benefits of medical procedures, such as coronary surgery -- including the unknowns. In trials where one group gets the information and the other group receives no special attention, the well-informed patients opt for more invasive, aggressive approaches 23% less often, on average, than the other group. Without this full information, "patients typically don't understand that they have options, and even if they do, they often wildly exaggerate the benefits of surgery and wildly minimize the chances of harm," says Annette M. Cormier O'Connor, clinical epidemiologist at Ottawa Health Research Institute and a leader in this field of so-called decision aids.
Spread out over society, that's a staggering reduction in health costs without a corresponding decrease in outcomes. We need to encourage more of it. That doesn't mean a Gingrich-esque attempt to invalidate surgery through a relentless focus on its unknowns, but it does mean making patients more a part of the process. Maybe it can be part of the Democrats' Ownership Society: Not only do we give you, rather than your employer, the keys to your health care, but you even get to help steer once in awhile.