George W. Bush got a stent recently. Unfortunately, it doesn't look like he needed it.
Let's backtrack. The former president, by all accounts, was in excellent health, without reported risk factors for heart disease, and recently ran in a competitive race for charity. On a recent physical exam, though he reported no symptoms, he underwent a CT scan which showed a blockage in an artery. At that point, Bush agreed to a stent - despite the reasonably clear evidence showing that stents in people without symptoms don't make them live longer, don't prevent heart attacks, and (since the person starts without symptoms in the first place), don't make anyone feel better. Except, perhaps, those who sell stents.
You can find opinions of those who are careful never to say that this might have been a mistake. Let's not mistake the horse for a zebra, though. It seems very unlikely that this procedure was indicated. But it happened anyway.
We know about the problem of overuse already. This particular instance, like any given instance, might not have taught us any unknown facts, but it does emphasize the same questions:
1. If a former president can accede to a stent he doesn't need, what chance do the rest of us have in avoiding overuse?
2. What were GWB's primary care doctor and cardiologists thinking?
3. Further to number 2. - if we assume that, in fact, there were no extenuating circumstances to this case, and Bush was "overused" just like many Americans are, what is the best way to respond to a given case? Call out the involved physicians?
There must be some way to turn a much-publicized instance of contraindicated care into a turning point in the campaign to reduce overuse.
Let's backtrack. The former president, by all accounts, was in excellent health, without reported risk factors for heart disease, and recently ran in a competitive race for charity. On a recent physical exam, though he reported no symptoms, he underwent a CT scan which showed a blockage in an artery. At that point, Bush agreed to a stent - despite the reasonably clear evidence showing that stents in people without symptoms don't make them live longer, don't prevent heart attacks, and (since the person starts without symptoms in the first place), don't make anyone feel better. Except, perhaps, those who sell stents.
You can find opinions of those who are careful never to say that this might have been a mistake. Let's not mistake the horse for a zebra, though. It seems very unlikely that this procedure was indicated. But it happened anyway.
We know about the problem of overuse already. This particular instance, like any given instance, might not have taught us any unknown facts, but it does emphasize the same questions:
1. If a former president can accede to a stent he doesn't need, what chance do the rest of us have in avoiding overuse?
2. What were GWB's primary care doctor and cardiologists thinking?
3. Further to number 2. - if we assume that, in fact, there were no extenuating circumstances to this case, and Bush was "overused" just like many Americans are, what is the best way to respond to a given case? Call out the involved physicians?
There must be some way to turn a much-publicized instance of contraindicated care into a turning point in the campaign to reduce overuse.
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