Does this bode well for the future of cards?
http://www.newyorker.com/online/blog...-medicine.html
This is from the New Yorker after several articles were written against stents (Businessweek)
http://www.bloomberg.com/news/2013-0...ruse-seen.html
- I hate the NYTimes
They have an exceedingly powerful lens on the medical establishment. Mostly against doctors- as if we're a cabal of dangerous people (I'm just a med student)
Excerpted from the New Yorker:
The study found that those treated with medications lived just as long as those with stents. COURAGE is a super-star trial, the best of its kind. So why cant we say, once and for all, that its inappropriate to use stents for patients with stable coronary disease?
The answer is that its because such a statement is a colossal oversimplification. The fundamental challenge of translating data into practice is what we call generalizability: Can we extrapolate the findings from a trial to real life? If you are a doctor who is trying to practice evidence-based care, the first thing you want to ask yourself is, Would my patient have been enrolled in the trial? Sun Kim would not have been eligible for the COURAGE trial, which excluded all patients with high-risk featuresor nine out of ten otherwise eligible patients.
....
(If anyone can link to the study below much appreciated- cant find online)
Excerpted from New Yorker:
Last month, a study was published in the New England Journal of Medicine which will likely change clinical practice, as well as the constantly updated guidelines that define appropriateness. The study looked at patients, like Sun Kim, who at the time of a heart attack are also found to have chronic blockages. Half of the patients were managed conservatively, as I had managed Sun Kim. Half received stents for both their acute and chronic disease. The results were a surprise: stenting both the acute and chronic disease led to fewer deaths and fewer heart attacks. In fact, the benefit was so pronounced that the trial was stopped early. I have yet to read about this trial in the news.
http://www.newyorker.com/online/blog...-medicine.html
This is from the New Yorker after several articles were written against stents (Businessweek)
http://www.bloomberg.com/news/2013-0...ruse-seen.html
- I hate the NYTimes
They have an exceedingly powerful lens on the medical establishment. Mostly against doctors- as if we're a cabal of dangerous people (I'm just a med student)
Excerpted from the New Yorker:
The study found that those treated with medications lived just as long as those with stents. COURAGE is a super-star trial, the best of its kind. So why cant we say, once and for all, that its inappropriate to use stents for patients with stable coronary disease?
The answer is that its because such a statement is a colossal oversimplification. The fundamental challenge of translating data into practice is what we call generalizability: Can we extrapolate the findings from a trial to real life? If you are a doctor who is trying to practice evidence-based care, the first thing you want to ask yourself is, Would my patient have been enrolled in the trial? Sun Kim would not have been eligible for the COURAGE trial, which excluded all patients with high-risk featuresor nine out of ten otherwise eligible patients.
....
(If anyone can link to the study below much appreciated- cant find online)
Excerpted from New Yorker:
Last month, a study was published in the New England Journal of Medicine which will likely change clinical practice, as well as the constantly updated guidelines that define appropriateness. The study looked at patients, like Sun Kim, who at the time of a heart attack are also found to have chronic blockages. Half of the patients were managed conservatively, as I had managed Sun Kim. Half received stents for both their acute and chronic disease. The results were a surprise: stenting both the acute and chronic disease led to fewer deaths and fewer heart attacks. In fact, the benefit was so pronounced that the trial was stopped early. I have yet to read about this trial in the news.