Former President G.W. Bush Gets Scammed Into Undergoing a Stent Operation
Wasn’t it just a couple of months ago that George Bush, fit and buff at 66, led a group of Wounded Warriors one hundred kilometers across the deserts of West Texas for the Bush Institute’s annual spring mountain bike ride? According to press accounts, “The former President stayed in the lead throughout the race, yelling encouragement and jokes to his fellow cyclists.” Not exactly the picture of a man suffering from critical coronary artery narrowing.
But suddenly, and without warning signs, he’s getting a stent to prop open a blocked artery. What happened?
If it were anywhere else in the developed world—Japan, Germany, Scandinavia, England—or if he were not a “high-value” celebrity, nothing of the sort would have happened. In those countries, heart patients have similar outcomes, with far fewer operations. And extensive scientific evidence substantiates the equivalence, even superiority, of a more conservative, low-tech approach.
We know the scenario. Every year, Bush, ever the one to heed “expert advice” but not renowned as an out-of-the box thinker, dutifully reports for his annual “million dollar workup.” That workup probably includes a “routine” PSA (now discouraged as a general screening test), a “routine” chest X-ray (not necessary), a “routine” EKG (also discouraged), and possibly a “routine” stress test (also discouraged in healthy individuals without heart symptoms).
Precisely the main reason NOT to have these tests is that they might show something!
PSAs have been shown to lead to unnecessary biopsies which reveal indolent cancer that elicits life-impairing treatments that study after study show DO NOT extend life.
Stress tests may reveal glitches that lead to the next work station on the conveyor belt to a heart procedure: the angiogram (or cardiac catheterization).
In that procedure, a small catheter is threaded through an artery in the groin and into the heart, where dye is released, tracing heart function and blood flow.
The procedure is generally safe, but complications like bleeding and cardiac arrhythmias can ensue. Rarely, deaths can occur. What is sometimes overlooked by patients who undergo routine nuclear stress tests is that they get a whopping dose of radiation each time, adding to their lifetime cumulative radiation exposure which can increase the risk of cancer significantly.
Angiograms have been criticized because they equate anatomy with function. That is, a subjective call that a heart blood vessel is “blocked” logically calls for it to be opened with a small metal stent. If it works for the Roto-Rooter man and toilets, why not for interventional cardiologists working on actual people?
You might think that no one has dared to pose the question, “Are the million plus stents we do on Americans each year really worth it?” But they did. And we’ve had the answer since 2007.
In 2007, the New England Journal of Medicine published the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial. I’ll let the study conclusion speak for itself:
“As an initial management strategy in patients with stable coronary artery disease, PCI [stents] did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy.”
Yet the rush to unnecessary stents has continued unabated. Some blame risk-averse, liability-fearing doctors. Indeed, if patients die, at least they’ll die with a “full-metal jacket” as patients with lots of stents in their coronary arteries are sometimes cynically referred to in certain medical precincts.
Others highlight the profit motive. And indeed, some “star” interventional cardiologists and some hospitals have suspiciously high rates of stent-placement. There might be a three or four-fold geographic variation in the likelihood of getting a stent depending on what state you’re in. Do patients in Florida really need stents that much more than comparable patients in Minnesota? In some cases, medical audits have shown trumped up test findings leading to totally unjustified stents, and doctors have been fired or disciplined for avarice.
But I think something else is at work. It’s just very hard, when you have technological firepower at the ready, to just stand there and “do nothing.” Heroic intervention is at the heart of modern medicine. And patients demand “the best care” regardless of whether it’s in their long-term interest.
We see countless examples of this; we invent elaborate “fixes” for problems that don’t deserve them.
Unless we’re extraordinarily disciplined, and demand better, smarter care from our medical system, this trend will continue to rage unabated, to the ruination of our economy and to the detriment of our collective well-being.
George Bush has become the latest victim of great medical care. Maybe you’ll be luckier.