In 2007, when the results were published from the COURAGE trial, all the experts agreed that this study would fundamentally change the way cardiologists managed patients with stable coronary artery disease (CAD).*
*”Stable” CAD simply means that a patient with CAD is not suffering from one of the acute coronary syndromes – ACS, an acute heart attack or unstable angina. At any given time, the large majority of patients with CAD are in a stable condition.
But a new study tells us that hasn’t happened. The COURAGE trial has barely budged the way cardiologists treat patients with stable CAD.
Lots of people want to know why. As usual, DrRich is here to help.
The COURAGE trial compared the use of stents vs. drug therapy in patients with stable CAD. Over twenty-two hundred patients were randomized to receive either optimal drug therapy, or optimal drug therapy plus the insertion of stents. Patients were then followed for up to 7 years. Much to the surprise (and consternation) of the world’s cardiologists, there was no significant difference in the incidence of subsequent heart attack or death between the two groups. The addition of stents to optimal drug therapy made no difference in outcomes.
This, decidedly, was a result which was at variance with the Standard Operating Procedure of your average American cardiologist, whose scholarly analysis of the proper treatment of CAD has always distilled down to: “Blockage? Stent!”
But after spending some time trying unsuccessfully to explain away these results, even cardiologists finally had to admit that the COURAGE trial was legitimate, and that it was a game changer. (And to drive the point home, the results of COURAGE have since been reproduced in the BARI-2D trial.) Like it or not, drug therapy ought to be the default treatment for patients with stable CAD, and stents should be used only when drug therapy fails to adequately control symptoms.
When the COURAGE results were initially published they made a huge splash among not only cardiologists, but also the public in general. So cardiologists did not have the luxury of hiding behind (as doctors so often do when a study comes out the “wrong” way) the usual, relative obscurity of most clinical trials. Given the widespread publicity the study generated, it seemed inconceivable that the cardiology community could ignore these results and get away with it.
But a new study, published just last month in JAMA, reveals that ignore COURAGE they have. Read more »
Guest post submitted by MD Anderson Cancer Center*
When you raise your glass at this year’s holiday toast, choose your beverage wisely. Research shows that drinking even a small amount of alcohol increases your chances of developing cancer, including oral cancer, breast cancer and liver cancer.
Dr. Otis Brawley has taken the gloves off on prostate cancer screening.
Brawley, chief medical officer of the American Cancer Society (ACS), makes some powerful statements about controversies in prostate cancer screening in a new YouTube video that is billed as the first of a series that the ACS will post on discussions with its officials.
Key nuggets from this video — not surprising to anyone who has followed this debate or Brawley’s past comments — include these quotes:
“I’m very concerned. There’s a lot of publicity out there – some of it by people who want to make money by recruiting patients – that oversimplifies this – that says that ‘prostate cancer screening clearly saves lives.’ That is a lie. We don’t know that for sure…
…We’re very concerned about a number of clinics that are offering mass screening where informed decision making – where a man gets told the truth about screening and is allowed without pressure to make a decision – that’s not happening. Many of these free screening things, by the way, are designed more to get patients for hospitals and clinics and doctors than they are to benefit the patients. That’s a huge ethical issue that needs to be addressed.
We’re not against prostate cancer screening. We’re against a man being duped and deceived into getting prostate cancer screening.”
Cancer is the world’s costliest disease, sapping the equivalent of 1.5 percent of the global gross domestic product through disability and loss of life, according to the American Cancer Society (ACS). Cancer cost $895 billion in 2008, and that’s before factoring in the cost of treating cancer.
Cancer and other chronic diseases cost more than infectious diseases and even AIDS, according to a report the ACS [presented last] week. While chronic diseases are 60 percent of all deaths globally, they receive only 3 percent of private and public research funding. The organization is calling for a new look at priorities by the United Nations and the World Health Organization. (Associated Press)
Recently Paul Goldberg of The Cancer Letterreported on an investigation into Duke cancer researcher Anil Potti, M.D., and claims made that he was a Rhodes Scholar in Australia. The misrepresentation was made on grant applications to National Institutes of Health (NIH) and the American Cancer Society (ACS).
News & Observer higher education reporter Eric Ferreri has a nice overview of the situation. Potti has been placed on administrative leave by Duke, and the ACS has suspended payments on his grant and initiated their own investigation. Read more »
It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…
I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…
When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…
I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…
I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…