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I was breezing through a prominent cardiology journal the other day and found an article evaluating whether a patient needs to have a catheterization sooner or later after they have had clot busting medicine (thrombolytic therapy) for their heart attack. Thrombolytic therapy is indeed an expensive treatment for heart attack, but not as expensive as the heart catheterization and stent placement.
Years ago the use of the clot busters was tested head to head with coronary stent placement. There was an improvement in overall mortality with the stent such that if you got the stent you would have a mortality rate of about 6.7% and with the clot busters your chances of dying was about 7.5%. Thus the stent became preferred treatment. Most people would not think much of this difference and certainly some would just as soon forgo the procedure for the wee bit of benefit it seems to provide. Nonetheless the cardiology community (who makes a fortune doing this procedure) consider it the treatment of choice.
Yet some patients show up at hospitals where the procedure is not available and they are treated with the clot busting medicines. It has been common practice to transfer patients from community hospitals to referral hospitals with a cath lab after getting the clot busters in the field with the idea that if things go wrong a stent may be placed.
The American College of Cardiology looked into the care of patients who had clot busters and decided that it was not a good idea to routinely do heart catheterization afterwards. They felt that only under specific circumstances could this be justified.
The article mentioned above completely ignores this recommendation and moves past the question of whether it is justified and moves onto when it should be done.
Some people are just simply addicted to doing procedures on patients. Actually they have become adept at doing the procedure and then spent time looking for new classes of people on whom the procedure can be done. Patients who have been adequately treated with the clot busting medicine do not benefit from the additional procedure and may be harmed. The expense is also difficult to justify. But this kind of experimentation is common. To the man with the hammer everything looks like a nail.
The tendency for physicians to design procedures and look for new indications for them has been a major factor in the expensification of health care in our country. Many times procedures become common and may be on the verge of becoming standard without really being beneficial. At the same time hundreds of thousands of patients may be subjected to these procedures in the course of running a clinical trial to see if the procedure is beneficial. The doctors have no problem charging for these procedures that are not yet documented to be beneficial and the insurance companies age glad to pay for them. This adds substantially to the dollar care of health care in this country.