Tuesday, July 01, 2008

BLOGSCAN - Evidence? We Don't Need No Stinkin' Evidence

The New York Times recently reported on the rush to use advanced CT scans for cardiologic diagnosis, in the absence of much evidence that this expensive technology works. Merrill Goozner on GoozNews, and Matthew Holt on the Health Care Blog offered some pithy comments. My jaw dropped at this quote in the Times article:


It's incumbent on the community to dispense with the need for evidence-based medicine.

As Goozner wrote, when self proclaimed experts (perhaps key opinion leaders) are convinced they are right, they don't need no stinkin' evidence.

ADDENDUM (2 July, 2008): Dr Wes also weighed in, with considerable skepticism. His post is an excellent primer about how the test is actually done, its drawbacks, and the lack of evidence supporting its use except in special circumstances.


8 comments:

Anonymous said...

Hi Roy,

Dr Wes had a post on this also:

http://drwes.blogspot.com/2008/06/revisiting-cardiac-ct-angiograms.html#links

Marilyn

Anonymous said...

I looked at the website for The Society of Cardiovascular Computed Tomography (SCCT), discussed in Merrill's post, and was not surprised to find that they receive funding from companies that make cardiovascular imaging equipment. From their website:

http://www.scct.org/

"Message from Daniel Berman, MD, Chair, Corporate Relations Committee

I am pleased to announce a new Bronze sponsor, Vital Images, Inc, in our SCCT Start-up Funding Campaign.

Our campaign has four levels of funding:
Platinum Sponsor – $100,000
Gold Sponsor – $50,000
Silver Sponsor – $25,000
Bronze Sponsor – $10,000

Our Sponsors include:

Platinum:
Bracco Diagnostics
GE Healthcare
Philips
SIEMENS Medical
Toshiba

Bronze:
TeraRecon
Vital Images

We express our deep appreciation to our Sponsors and look forward to adding additional Sponsors in the near future.

You are invited to click on any of the company logos to the right for further information on a particular company.

[logos for several companies shown]"

SCCT lobbies for the following (from the "Membership Benefits" page, under "Advocacy")

1. Assuring that cardiovascular CT providers obtain adequate reimbursement from all third-party payers, including Medicare

2. Promoting the value of competent and skilled cardiovascular CT physicians, regardless of specialty

3. Advocating for increased funding of clinical and outcomes research in the field of cardiovascular CT

4. Effectively communicating the usefulness of cardiovascular CT in the diagnosis and treatment of CAD to secure access to the technology

5. Support for expanded coverage of the uninsured

6. Actively prevent proposed legislation and/or regulation that dictates the exclusive location (in-hospital vs. outpatient), limits reimbursement or implements guidelines that would prevent the performance of CCT by competent physicians

7. Free subscriptions to advocacy bulletins related to cardiovascular CT as they are introduced by SCCT

The problem is that the members of this organization stand to benefit from increased insurance coverage for cardiovascular CT and the like. They may believe that what they are advocating benefits patients, but they are not unbiased observers.

Marilyn Mann

Merrill said...

And the guy who ran the physicians guild pushing CT scans for heart disease said they were opposed to registries and research. Their contempt for science, not to mention their patients, was simply breathtaking.

Anonymous said...

http://thestatsblog.wordpress.com/2008/06/30/does-the-new-york-times-hate-american-medicine/

Another post on the NYT article, although it focuses mostly on one sentence. I would be interested in hearing people's reaction to this, as it is a topic I don't know much about.

Marilyn

MedInformaticsMD said...

I looked at the website for The Society of Cardiovascular Computed Tomography (SCCT), discussed in Merrill's post, and was not surprised to find that they receive funding from companies that make cardiovascular imaging equipment.

Has this medical society ever been independent? Or is it a shill for the manufacturers, merchants and profit-makers who use this equipment?

Promoting the value of competent and skilled cardiovascular CT physicians, regardless of specialty

In other words, there are no real requirements to be a "cardiovascular CV physician" such as training in cardiology or diagnostic imaging.

Advocating for increased funding of clinical and outcomes research in the field of cardiovascular CT

In other words, this is still an experimental area.

Actively prevent proposed legislation and/or regulation that dictates the exclusive location (in-hospital vs. outpatient), limits reimbursement or implements guidelines that would prevent the performance of CCT by competent physicians

"Competent" by whose standards, exactly?

Free subscriptions to advocacy bulletins related to cardiovascular CT as they are introduced by SCCT

Advocacy is the antithesis of science.

MedInformaticsMD said...

Merrill said... And the guy who ran the physicians guild pushing CT scans for heart disease said they were opposed to registries and research. Their contempt for science, not to mention their patients, was simply breathtaking.

Do you have a reference for that? I would like to take on that attitude directly from the perspective of Medical Informatics.

Anonymous said...

It's in the Times article.

Anonymous said...

Only in medicine could a group of doctors, with the support of device makers, publicly state that the whole purpose of their professional organization was to defraud the patient, insurance companies, and government.

Steve Lucas