The heart wars — drugs vs. devices
In the economic battle to determine heart disease treatment, Americans lose out.
DR. MATHEW EDLUND
Contributing Columnist
health@lbknews.com
Heart Disease is the single leading killer in America. The costs of treating it are in the hundreds of billions of dollars. A recent study of stents versus drugs for patients with chronic chest pain produced the “astonishing” conclusion that stents opening arteries did not improve mortality, decrease heart attacks, or over time decrease subjective pain beyond drug treatment alone.
What is, however, truly amazing is that the debate on how to treat the nation’s foremost killer is being carried out by Wall Street for Wall Street, with the nation’s public health not even getting a seat at the table.
The stakes are huge. It is estimated that between 1 million and 1.2 million stents are placed in U.S. coronaries each year, with the average cost running about $38,000 each. Stents are a major part of the business of Boston Scientific, whose problems with stents and other devices have shaved off $40 billion in market capitalization over the last three years.
Other big players in the stent market are Abbott Laboratories and Johnson and Johnson, among the largest medical corporations in the world.
The stent versus drug study was paid for by the VA, the Canadian government, and many of the world’s largest drug companies, whose statin drugs are the world’s most profitable. The stent companies refused to participate. The study patients were suffering on average 10 episodes of chest pain a week, many with recent heart attacks. They should have been the perfect population to show stents worked better than drugs. Except they didn’t.
The reason — what kills and maims most people with heart disease is not severely narrowed heart arteries, but plaque exploding into the vessel wall.
Approximately 50 to 75 percent of heart attacks occur in people who do not have markedly narrowed arteries. Cardiologists have not emphasized that plaque kills Americans, not narrowed arteries. A fair number of American children have fatty streaks in their arteries by age 8. Lifestyle plays a huge part in creating these lesions.
Even with present technology, up to a fifth of people are discovered to have heart disease as the result of sudden death. That’s right — we found out you had heart disease because you’re already dead. You would think figures like that would have companies thinking about lifetime prevention but you would be wrong. Companies make their money on stents and drugs.
One of the spokesmen for the stent companies felt the study was inherently unfair. He noted that many of the study subjects were in VA hospitals, where their access to statin and other heart drugs was assured. In the “real world,” people have trouble getting insurance for these medications.
What was he really saying? Our company has no trouble getting health insurers to pay for a $40,000 procedure, but they won’t pay for drugs, like statins, that work. The truth is that surgery, stents and drugs all have a major place in treating heart disease.
The technologies develop rapidly. What works best for whom will remain a moving target, which requires an honest, independent assessor.
Will that be the FDA? No. The FDA is beholden to the drug companies and device makers for much of its budget. Many of its academic advisors depend on the companies for income and grants, an issue the FDA has belatedly begun to address. So we are left in the dark about cost-effective treatments, relying on one company backed study versus another.
What if perhaps a fifth of the money spent on stents, maybe $6-8 billion dollars per year, was spent educating children about food, activity, and rest? As the longest-lived populations reside in the United States, utilizing simple food, activity, and rest procedures to last longer than 91 years, how many strokes, heart attacks and cancers would we prevent?
Yet even discussing such things is a pipe dream. There are no large advocates for public health on Wall Street, even though medical costs destroy the competitive advantage of many American companies. The large corporations that should focus interest on preventing disease are instead concerned with health care costs for their increasingly mobile workers.
Why pay to protect someone’s future health when they’ll be working for someone else?
Instead, lacking any national health policy, we have a nation whose life expectancy is less than Cuba’s.
Where’s the cost benefit in that?
Dr. Edlund practices sleep medicine and psychiatry in Sarasota. Visit his Web site at www.doctoredlund.com.
Click here for more Staying Alive columns by Dr. Matthew Edlund.
