DJ is a good guy and you are as well. Have you spoken to him privately? I think it would be helpful to let him reply on this page. I am retired as you know and took your advice for my own family after we spoke. I am sending 2-3 people a week to physicians as an advocate in Austin as access is problematic. The lack of trust in our profession since Covid remains a serious concern. I get that basically billions are being spent on a procedure that some view is not helpful or even harmful for most. (If my chest was open and they could sew it closed from the outside I might consider). As far as conflict of interest when Congress felt that physicians should not own hospitals and that administrators should employ, pay, hire and fire docs (while looking at procedure volume every hour), the single greatest conflict was created. (Thank you to the Affordable Care Act- the health systems agreed to support the legislation ONLY if physicians could not own hospitals).
John, you could be even more effective in your criticism by simply listing, without editorial comment, the conflicts of interest disclosed by Dr Lakkireddy and the authors of this unhelpful study for all to see.
I think you might want to take a look st the cheerleading around Lecanemab and its dangerous consquences that affect a rush to judgment about Alzherimers diagnosis
Thoughtful article with good analysis. The answer as to why marginal studies are promoted so aggressively is the same as the answer to why low value and harmful care persist in healthcare despite evidence confirming lack of efficacy - economics. It’s also the same reason why new evidence-based treatments and interventions that are profitable spread faster than those that are unprofitable. Economics determine much of what we do.
Dr. Mandrola is voice of reason and moderation in a crowded space where hospital-employed interventional cardiologists on RVUs are pushing patients to undergo marginally useful "simple procedures" with considerable risk, and worse patients wanting these procedures based on aggressive TV advertising, without comprehending the downside risk.. Medscape-Cardiology needs to be heard by patients, not just physicians.
I also am not a fan of LAA occlusion devices and concur with you that there should have been some kind of control group. However, these devices are traditionally meant to be used in patients who have relative contraindications to anticogulation, the most common of which is a prior history of bleeding. In contrast, patients with a prior bleeding history are typically excluded from anticoagulant trials. So comparison of bleeding rates between LAA device trials and anticoagulant trials is problematic. These are usually patients with a history of bleeding and so are at higher risk of future bleeding. In any case, an incoming HRS president should not be endorsing specific products, particularly if they have a conflict of interest unless it is some kind of dramatic breakthrough or new technology which this clearly is not. What it is, is a blatant marketing campaign and a poor reflection on the HRS.
It speaks a lot to how poor LAA occlusion performs in the RCT data that academic cheerleaders want to promote such poor non-randomized studies.
I totally agree with
"On the matter of cheerleading…why would one of the lead investigators in the field be so publicly enthusiastic about such a limited study? It is especially curious given his and the many financial conflicts of interest listed in the paper. These include the fact that Abbott funded the study; an Abbott employee is a coauthor; and Abbott staff did the statistics and the medical writing. "
DJ is a good guy and you are as well. Have you spoken to him privately? I think it would be helpful to let him reply on this page. I am retired as you know and took your advice for my own family after we spoke. I am sending 2-3 people a week to physicians as an advocate in Austin as access is problematic. The lack of trust in our profession since Covid remains a serious concern. I get that basically billions are being spent on a procedure that some view is not helpful or even harmful for most. (If my chest was open and they could sew it closed from the outside I might consider). As far as conflict of interest when Congress felt that physicians should not own hospitals and that administrators should employ, pay, hire and fire docs (while looking at procedure volume every hour), the single greatest conflict was created. (Thank you to the Affordable Care Act- the health systems agreed to support the legislation ONLY if physicians could not own hospitals).
A great piece.
John, you could be even more effective in your criticism by simply listing, without editorial comment, the conflicts of interest disclosed by Dr Lakkireddy and the authors of this unhelpful study for all to see.
Sunshine is the best disinfectant.
I think you might want to take a look st the cheerleading around Lecanemab and its dangerous consquences that affect a rush to judgment about Alzherimers diagnosis
Thoughtful article with good analysis. The answer as to why marginal studies are promoted so aggressively is the same as the answer to why low value and harmful care persist in healthcare despite evidence confirming lack of efficacy - economics. It’s also the same reason why new evidence-based treatments and interventions that are profitable spread faster than those that are unprofitable. Economics determine much of what we do.
Dr. Mandrola is voice of reason and moderation in a crowded space where hospital-employed interventional cardiologists on RVUs are pushing patients to undergo marginally useful "simple procedures" with considerable risk, and worse patients wanting these procedures based on aggressive TV advertising, without comprehending the downside risk.. Medscape-Cardiology needs to be heard by patients, not just physicians.
I also am not a fan of LAA occlusion devices and concur with you that there should have been some kind of control group. However, these devices are traditionally meant to be used in patients who have relative contraindications to anticogulation, the most common of which is a prior history of bleeding. In contrast, patients with a prior bleeding history are typically excluded from anticoagulant trials. So comparison of bleeding rates between LAA device trials and anticoagulant trials is problematic. These are usually patients with a history of bleeding and so are at higher risk of future bleeding. In any case, an incoming HRS president should not be endorsing specific products, particularly if they have a conflict of interest unless it is some kind of dramatic breakthrough or new technology which this clearly is not. What it is, is a blatant marketing campaign and a poor reflection on the HRS.
It speaks a lot to how poor LAA occlusion performs in the RCT data that academic cheerleaders want to promote such poor non-randomized studies.
I totally agree with
"On the matter of cheerleading…why would one of the lead investigators in the field be so publicly enthusiastic about such a limited study? It is especially curious given his and the many financial conflicts of interest listed in the paper. These include the fact that Abbott funded the study; an Abbott employee is a coauthor; and Abbott staff did the statistics and the medical writing. "