[HN Gopher] Heart doctors 'held back stent death data'
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       Heart doctors 'held back stent death data'
        
       Author : olvy0
       Score  : 54 points
       Date   : 2020-02-18 20:53 UTC (2 hours ago)
        
 (HTM) web link (www.bbc.com)
 (TXT) w3m dump (www.bbc.com)
        
       | mgarfias wrote:
       | 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.
        
       | scrozier wrote:
       | 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."
        
         | satya71 wrote:
         | Exactly, the last two year survival of control group may be
         | artificially enhanced because the ones that were going to die
         | were already dead in the first three.
        
           | James_Henry wrote:
           | Why would they compare the death rate in just the fourth year
           | between the two groups instead of doing a normal survival
           | analysis?
        
         | mohammad_ali85 wrote:
         | 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 wrote:
           | 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.
        
       | dontdoitpls wrote:
       | Physicians claim they should be the only ones with the power to
       | give antibiotics, but then they created the opioid epidemic.
       | 
       | The physician cartel in the US is awful.
       | 
       | I only see them being more powerful in the future. They've
       | bribed/lobbied $400,000,000 in my lifetime.
        
       | pcj-github wrote:
       | 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").
        
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       (page generated 2020-02-18 23:00 UTC)