
Heart doctors 'held back stent death data' - olvy0
https://www.bbc.com/news/health-51539112
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scrozier
This strikes me as a) not very well written, and b) not presenting all the
relevant information. For example, if the study was designed to gather data
for three years after each procedure, then taking into account data beyond
that period would possibly taint the analysis. (Of course, if people were
dying in year four, there could/should be another study.)

I had to read the article twice to understand the main point. Sentences like
this make me scratch my head: "The data suggested more people fitted with
stents were dying after three years."

~~~
mohammad_ali85
Agreed. It isn’t clear what the issue is here. If the research protocol states
3 years of data collection it’s technically unethical, without submitting an
amendment, to collect data beyond 3 years as the patient hasn’t agreed to
this. Sure, in hindsight the data should have been collected for longer but at
the time of study design 3 years probably seemed appropriate. It’s really
difficult to say how long to follow up - forever? Sure, but would be
financially unfeasible. We do have a yellow carding system in the UK - the
medicine and health regulatory authority (MHRA) run this and it’s for
submission of adverse drug reactions as well device issues. But again, not
sure how helpful it would have been for the instances of participant death
after 3 years. Seems harsh on the doctors who carried out the research, unless
I’m not reading this correctly.

~~~
James_Henry
They were already collecting data past 3 years.

The doctors who carried out this research are, it sounds, blatantly in the
wrong, for they withheld the data that appears to make clear that stents have
worse outcomes past year 3 until after the guidelines were written while they
had already gathered this data before the guidelines were written.

Sure they cannot openly share all their data because it is private, but it is
very suspect that they do not share the external review that found them at
fault

As Prof John Ioannadis points out in the article, there are wide systemic
issues in the trials and guidelines process.

~~~
u801e
> Sure they cannot openly share all their data because it is private

Couldn't they just anonymize the data?

~~~
ska
This depends on jurisdiction of course, but in a lot of cases you can't share
data that wasn't consented for that use originally - anonymized, de-
identified, or otherwise.

Chasing down previous patients for retrospective consent would be difficult to
impossible.

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pcj-github
This is pretty well-known phenomenon to vascular practitioners...

Interventional cardiologists chronically low-ball the dangers of stents and
gloss-over their well-known short-term performance. Who'd a thunk that jamming
a foreign body in a small artery ends up making it worse in the long-term?

Patients with coronary bypass often have a better long-term outlook, but in
many cases the cardiologists simply don't refer to cardiac surgeons to line
their own pockets (and admit "defeat").

~~~
throwawayhhakdl
I’m not a medical expert but your hand waving of stents feels off to me. Yes,
it’s not surprising that stents can be dangerous, but the alternative is open
heart surgery. Which sounds pretty damn risky too.

Is the choice really that simple?

~~~
redis_mlc
I've followed news about stents for decades.

They're about $5,000 each.

A couple times per year there is some news report similar to this story.

I have a feeling that, just like hip replacements took decades to find the
right combination of materials to not disintegrate or be rejected, we're still
researching what to make stents from and when to use them.

The problem is that patients aren't told they're guinea pigs, and stents
aren't that reliable. Oh and doctors get to bill a fortune per operation
regardless.

Regarding this particular story, rather than be outraged, we should have
cardiac experts and statisticians sit down and figure out what's real and what
isn't. There is valuable data in there somewhere.

~~~
raverbashing
> The problem is that patients aren't told they're guinea pigs

Here's the thing. Every patient is a guinea pig in one way or another. Every
medication has side-effects both known and unknown.

But yeah, maybe stents need to be replaced before 3 years or some better
materials need to be found, and maybe they are used in situation where they're
not really needed.

Still better than bypass surgery which is a very invasive surgery.

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mgarfias
Any mention of these things and death is pretty frightening. I've got two of
the damn things in me. However, the article is baffling in the extreme. It
sure appears to be written to alarm, and doesn't provide enough detail. I will
definitely bring it up with the cardiologist in a few weeks and see what he
says.

~~~
mannykannot
If this helps put your mind at rest, I have had a couple of them for twenty-
two years without any problems. They have allowed me to continue an active
lifestyle.

~~~
mgarfias
it does actually. I'm also very eager to get off the #%@#%ing blood thinners
and get back to my normal life.

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mirimir
From what I've read over the years, it's pretty clear that stents are a con
game. And from what I know personally about Abbott, I'm not at all surprised
that they'd bribe researchers to yield the results that they wanted.

In a 2018 article in the New York Times, Marcia Angell wrote:

> Second, there’s good evidence that drug company involvement biases research
> in ways that are not always obvious, often by suppressing negative results.

And as I recall, her 2005 book _The Truth About the Drug Companies_ discussed
research which showed that the geographic distribution of stent usage
correlated with the geographic distribution of capacity to do stents. With
evidence, as I recall, that facilities basically bribed local cardiologists
for referrals.

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agumonkey
I can accept a % of fluff in any industry, but in the medical field,
especially cardiovascular.. it stings a bit. How much more bs is there ?
Should it be investigated ?

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Miniso
It's obvious that it doesn't work every time and some people try to get stents
instead of a open-heart surgery which leads to many devastating things.

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justinclift
The main article picture, from "Getty Images", is of a heart in the exact
middle of a human chest.

WTF? That is _not_ where the human heart is located. :(

~~~
aaron695
I'm not sure that is correct -

[https://biology.stackexchange.com/questions/60718/why-is-
the...](https://biology.stackexchange.com/questions/60718/why-is-the-heart-
not-in-the-middle-of-the-body)

~~~
justinclift
Interesting. I'd learned early on that the heart is on the left side, but it
looks like it's more centrally located than that. eg 2/3 on the left, with 1/3
on the right.

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optimaton
This is terrifying. Does anybody know of any alternative that would work well
in long-term? Asking for a relative who just had a mild heart attack.

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jstanley
See also:
[https://eu.usatoday.com/story/news/nation/2018/03/09/cardiol...](https://eu.usatoday.com/story/news/nation/2018/03/09/cardiologist-
away-then-you-might-more-likely-survive-heart-attack-study-
suggests/407739002/)

Patients are more likely to survive heart attacks while the cardiologists are
all away at a conference, because that means the cardiologists are less able
to interfere.

~~~
bumby
They were still treated by a cardiologist, just not the “preeminent” doctors
as they were all at the conference.

This effect has alternatively been written as an effect arising from the fact
that “lesser” doctors would tend to follow established, standardized
practices, be open to other opinions etc. while the higher status doctors may
be less so

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watertom
Didn’t stents become popular _before_ doing any real clinical trials?

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tibbydudeza
"sponsored by US stent manufacturer" and people are gobsmacked that this
happened.

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justlexi93
Stents do help and are good medical tools but they certainly can cause
problems.

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nottorp
Is this about some specific heart problems?

Because anecdotically I know 2 people with stents that are just fine(tm) after
more than 3 years. I don’t know the specifics of their conditions though.

