Heart Surgeons Get Wake-Up Call On Common Procedure

On May 15th, 2007, the Commonwealth Fund issued a report entitled, “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care.”

The results were not good. In fact, here’s what the first sentence of the report had to say: “Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. Are you Shocked?  You shouldn’t be.  Why?  This is because this is nothing new at all.

According to the report: “Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care.”

Overall, Germany and the UK topped the list, with Canada and the United States bringing up the rear. Also worth noting here is that America spends close to three times as much for its mediocre approach to health per capita ($6,102) annually than does New Zealand ($2,083), and almost twice as much as Canada ($3,165). Even worse, American doctors are the slowest to change when it comes to technology, again, with the lowest numbers in relation to using electronic medical records or keeping up with the latest treatments via the Internet.

Now here is something that you will probably find interesting, even puzzling.  According to the report, “the area where the U.S. health care system performs best is preventive care, an area that has been monitored closely for over a decade by managed care plans.”

It’s always been abundantly clear that an ounce of prevention is worth a pound of cure. For example, the May 9th edition of the Journal of the American Medical Association (JAMA) had an article entitled: “Cardiologists Get Wake-up Call on Stents.” According to the article, “Patients with stable coronary artery disease treated with stents and optimal medical therapy fare no better than those who receive optimal medical therapy alone, according to new findings from a large clinical trial.”

For many cardiologists, the results serve as a wake-up call that they need to reevaluate how frequently they offer stenting (which has slight risks associated with the intervention itself, as well as stent-associated thrombotic events) as a first option for relief of stable angina. The data comes from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial, reported here in March at the annual conference of the American College of Cardiology.

It seems like research is simply confirming what many thought to be true all along.  Prevention is far superior to invasive “crisis” procedures after years and years of neglect.  It is abundantly clear you cannot abuse or neglect your body and health and have the wonders of modern medicine save you.

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