Far too many stents and heart bypass operations

Insertion of stents in blocked arteries during a heart attack or the beginnings of one (unstable angina or unstable patients) saves thousands of lives yearly. But 70 to 90% of stent insertions are done for only narrowing arteries in stable patients.

In spite of the many studies that show that the insertion of stents and heart bypass operations save few lives if any when done on stable patients, we do about a million of the two combined every year. This is at a cost of $60 to $100 billion a year. This estimate has a wide range because there is wide variation in charges for these and in amount of expensive follow up.

Treating symptoms vs correcting root causes

These procedures do not address the underlying causes of heart disease: emotional disharmony including stress, poor diet and lack of physical activity. This explains why there is no proof that they save lives and often have to be repeated. Many have additional stents placed in other arteries or graduate to heart bypass surgery.

Dr. Michael Ozner is a board-certified cardiologist among many other things. He has written an expose and instruction book, “The Great American Heart Hoax”. In it he shows:

  • how overused these procedures are

  • what heart disease is with diagrams

  • why stents and heart bypass operations don’t save lives for stable patients

  • how to get at the root causes of heart disease for prevention and reversal

Dr.Ozner also points out:

“America has 5 percent of the world’s population, yet we perform half of the world’s bypass surgeries and stent placements.”

“For the majority-an estimated 70-90 percent-these procedures are at best unnecessary”

“The mortality rate for bypass surgery ranges from 3 to 5 percent. This may sound insignificant initially, but when you consider that half a million people undergo these procedures every year, 3 to 5% quickly adds up: to 15,000 to 25,000 lives lost a year”

Given the mortality rate for bypass surgery and a lack of proof that they save any lives, it looks like the industry has a NEGATIVE effect on those in stable condition. That is, they kill more than they save if they save any.

These procedures do have an instant effect on Angina pains. Drugs can relieve the pain at a drastically lower cost, but take longer. They can also have side effects. With insurance paying for the cardiac procedures, millions have them without much concern for the cost. We pay the $60-100 billion yearly for these in our insurance premiums or depletion of the Medicare trust fund.

Its not just Dr. Ozner

A randomized controlled trial published in April 2007 in The New England Journal of Medicine found that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients, for 95% of those who receive them.

The Interheart study, published in September 2004 in The Lancet, followed 30,000 men and women on six continents and found changing lifestyle could prevent at least 90% of all heart disease.

Dr. Ozner observes from the Seven Countries Study: “The Average middle-aged Greek man had a 90 percent lower risk of dying from a heart attack than the average middle-aged American”. Diet and lifestyle account for this difference. For that reason, Dr. Ozner advocates a Mediterranean diet and other lifestyle changes in his books.

Dr. Dean Ornish, a world famous cardiologist, works in a similar way with his own program in his book “The Spectrum”.

Collaterals

It’s a no brainer to say that exercise or physical activity are a key ingredient to preventing heart disease. It builds up the heart muscles and burns calories. It also aids in the development of collaterals or detour capillaries that go around narrowing arteries to keep healthy blood flow in the heart in spite of a bad diet. The body senses the loss of blood flow and builds collaterals around the narrowing area in the artery. Angina pains occur when the arterial narrowing exceeds the growth of collaterals.  Change the diet to stop the narrowing and collaterals can make up for it.  A properly changed diet can also reverse the narrowing of arteries as Dr. Ornish and others have proved.  This should be done.

In 2001, I was told to have a stent. The doctor told me I had a “time bomb” in my chest. I read Dr. Ornish and refused the stent. As of this writing, 14 years later, I am still alive with no heart problems other than a heart murmur. My blood numbers are all very good. I exercise moderately and avoid all sweets that are not fruits. I follow close to a Mediterranean diet.  I am one among tens of thousands who have done this. Other cultures do this routinely with their healthy diets, sense of community and physical activity.

In spite of what some believe about “free markets”reducing healthcare costs, they promote wasteful spending in the following ways:

  • If an insurance company wanted to restrict stents and by pass operations, then patients could switch to another insurance that didn’t. So insurances all have to pay for them to remain competitive even if they do little or no good.

  • There is little money in preventing heart disease. Cardiologists like Dr. Ozner and Dr. Ornish make a few bucks writing books, but it is a pittance compared to what cardiologists make inserting large numbers of stents with follow up and heart surgeons make with surgery and follow up. Hospitals and other facilities often owned by doctors make the lions share of money for these. So the advertising and promotion go on in what really is no “free market”.

We need laws to reduce the overuse of stents and heart bypass operations. Some possibilities are:

  • Mandatory informing of patients that lifestyle factors will probably reduce and eliminate Angina pains. Anything else is only a patch up and likely to get worse. Risk factors must also be presented with informing that there is no proof that stents and heart bypass operations save lives for stable patients. Point out that drugs have known and unknown side effects (especially mixing with other drugs).   Doctors must also state beforehand what they will be charging for the procedure and whether they have any ownership in the facility where the procedure will be done.  Patient and doctor must sign that these were presented and discussed.

  • There must be at least a general definition of what “stable” and “unstable” heart conditions are and other conditions that might justify stents and heart bypass operations.

  • Mandatory approval from a review board not involved directly or indirectly with making money from the procedures.

  • Alarms from insurance on excessive high volume doctors and facilities.  Criminal liability for cardiologists and heart surgeons who do an excessive amount of these without proof of need.

If we could reduce the overuse of stents and heart bypass operations by 50%, we could save $30-50 billion a year. Those inspired to use lifestyle changes like not smoking, emotional well being, diet and physical activity would be healthier than they ever were.

Disclaimer: This article is not medical advice. It is information to help with informed decisions and trimming our healthcare spending.

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  • Pepper1311

    Let use not forget our over use of cholesterol lowering drugs, why so much type 2 diabetes? See long term effects of your statin drugs.