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Archive for December, 2010

“Low risk” nurse with normal cholesterol but self-destructive lifestyle ends up with heart transplant after CCTA

Posted by Colin Rose on December 20, 2010

Here in a nutshell is a demonstration of the problem with expecting technology to substitute for good clinical medicine and save us from our self-destructive addictions. If anyone is puzzled about the dichotomy between the exorbitant cost of the US medical system and its relative lack of effect on any measure of health here is the reason.

Below is a story from theheart.org followed by the actual paper in the Archives of Internal Medicine minus the references.

In the absence of any symptoms attributable to coronary artery disease there was no reason to do any more testing but the temptation to use high tech tools without good indication is irresistible to many doctors. CCTA is the latest expensive test to detect coronary atherosclerosis. Patients think that they will never have a heart attack and live longer if the disease is detected and some surgical procedure, like an angioplasty or bypass is done and doctors making $millions from doing them are not about to discourage them and point out the total lack of evidence for any significant benefit from angiography or the surgical procedures in patients with chronic coronary disease.

The authors have labelled this patient “low risk” because her “cholesterol” was normal but clearly she was at high risk based on her obesity and hypertension, both indices generally of  junk food addiction, in spite of her being a nurse.  When she started new exercises she probably got muscle pain from weight lifting. With an obvious self-destructive lifestyle, she should not have been “simply reassured” as recommended by the editors. But instead of encouraging her to make meaningful lifestyle change her doctors ordered tests with no clinical indication.

Framingham scores, lipid profiles and CRPs can be very deceptive because they do not assess LDL modification in the arterial wall, essential to the formation of atherosclerotic plaque. In spite of having “normal” numbers for all the usual “risk factors” she had advanced atherosclerosis in her coronary arteries. Apparently no dietary history was taken and no attempt was made to encourage her to change her lifestyle, an example of gross diagnostic and therapeutic incompetence, all too common in an era of absolute faith in the power of technology to protect us from our self-destructive addictions. Doctors abdicate professionalism by ordering tests instead of dealing with the real problems, like junk food addiction, which take much time for which they are not compensated and risk alienating patients who demand a high-tech fix or reassurance so that they can continue their risky behaviour.

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Case study shows how “just-in-case” CCTA in a low-risk patient may spectacularly backfire

DECEMBER 17, 2010 | Reed Miller

San Francisco, CA – Coronary computed tomographic angiography (CCTA) in patients with a low pretest risk of coronary disease wastes resources and can even lead to horrendous outcomes, a case study published December 13, 2010 in the Archives of Internal Medicine shows. The report tells the story of a 52-year-old white female who initially presented with chest pain and had a CCTA; this was followed by an unfortunate chain of events in which she suffered an aortic dissection during cardiac catheterization and that culminated in her having a heart transplant.

Part of its ongoing “Less is More” series begun last April, the latest case, reviewed by Dr Matthew Becker (St Vincent’s Heart and Vascular Institute, Erie, PA), Dr John Galla (Providence Hospital, Mobile, AL), and Dr Steven Nissen (Cleveland Clinic, OH), describes how the well-meaning attempt to reassure a patient with a low risk of coronary disease backfired spectacularly.

“Perhaps the most important point to be learned from the case described by Becker and colleagues is that there are safer ways to reassure patients,” say journal editors Drs Rita RedbergMitchell Katz, and Deborah Grady (University of California, San Francisco) in an accompanying editorial. “Patients value our advice. Talking with our patients should be our first choice for reassurance.” They add that “applying the ‘less-is-more’ principles prospectively could have avoided this unfortunate case.”

From diagnostic uncertainty to disaster
The 52-year-old nurse had hypertension and mild obesity and had recently begun an exercise and diet regimen to control her weight and blood pressure. She presented to her primary physician with chest pain, but no other symptoms: she had a normal ECG with a normal lipid profile and normal C-reactive-protein level. Her doctor attributed the chest pain to a musculoskeletal cause but performed a CCTA to reassure her that she was not at risk for a coronary event.

The CCTA showed discrete, noncalcified, nonobstructive plaque in the mid and distal segments of the left circumflex and dominant right coronary arteries and diffuse, complex calcification in the proximal left anterior descending (LAD) coronary artery. Because that calcification was difficult to quantify, the physician recommended that she undergo cardiac catheterization to get a clearer look at the LAD.

This exam, performed at the local community hospital, revealed only a mild irregularity in the LAD, but during the procedure, the patient complained of chest pressure, which prompted an aortogram that revealed an aortic root dissection that was compromising the left main coronary artery.

So the patient underwent urgent coronary artery bypass graft (CABG) surgery and stayed in the hospital for two weeks with a residual left ventricular ejection fraction of 35%. The bypass graft soon failed and was treated with multiple drug-eluting stents, but despite her compliance with dual antiplatelet medical therapy, a stent in the vein graft supplying the circumflex artery developed a thrombosis, causing an ST-segment-elevation MI complicated by cardiogenic shock. The thrombosis was successfully treated, but the patient remained in refractory cardiogenic shock and ultimately underwent orthotopic heart transplantation.

Unnecessary testing happening every day
“With few cardiac risk factors and an atypical chest pain presentation, this patient had a low pretest probability for coronary artery disease and should have been reassured and not undergone any further risk stratification,” say the authors. “Lacking randomized data suggesting improvement in clinical outcomes and with clear risks, including contrast load, radiation exposure, and suboptimal diagnostic specificity, CCTA should have a very limited role in the evaluation of patients who present with chest pain.”

They acknowledge the risk of complications associated with cardiac catheterization is low, but catastrophic events are always a possibility. They believe the physicians in this case overestimated the stenosis in this patient’s coronaries because they did not fully appreciate the CCTA’s potential for false-positive findings. Complete visualization of all segments of the coronary tree with CCTA is often hindered by cardiac motion, which can lead to the appearance of “blooming artifacts” of coronary calcification that may cause the observer to overestimate the extent of stenosis.

Becker et al point out that previous studies comparing CCTA with conventional coronary angiography in diverse patient populations show CCTA’s sensitivity is between 79% and 100% for the detection of obstructive coronary disease, but its specificity is only 64% to 85%, corresponding to “an unacceptably high false-positive rate” of up to 81% in some populations.

As reported by heartwire, the recently released professional guidelines on Appropriate Use Criteria for Cardiac Computed Tomography list CCTA as “inappropriate” for detection of CAD patients with a low risk of heart disease, ability to exercise, nonacute symptoms that may be an “ischemic equivalent,” and an interpretable ECG.

Patient could have been simply reassured
“If a test is not sufficiently accurate to change clinical management in a particular setting, it should not be done,” but according to Redberg et al, often these tests are done anyway—sometimes even before the patient sees a physician—because nobody has assessed the patient’s pretest probability of the disease or properly considered how the test result will change the clinical management of the patient.

“There are cases where [the test presents] more risks than benefits, and you really need to consider the risks and benefits and not [assume that] just because you can do the test, you should do the test. And this case highlights that,” Redberg told heartwire.

Cases like this where an inappropriate test leads to many complications and near catastrophe are rare, “but to have a CT or another test that was just done for reassurance, when you could have just told the patient ‘You’re fine,’—I think that’s done every day lots of times.

“You don’t know which [tests] are going to lead to that kind of problem, but you do know which of those is not going to give you any benefit, so if there is no benefit, it’s better not to be taking any risk, even a small one.”

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Left Main Trunk Coronary Artery Dissection as a Consequence of Inaccurate Coronary Computed Tomographic Angiography

Matthew C. Becker, MD; John M. Galla, MD; Steven E. Nissen, MD

Arch Intern Med. Published online December 13, 2010. doi:10.1001/archinternmed.2010.464

ABSTRACT


A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations. Her physicians subsequently performed coronary angiography, which was complicated by dissection of the left main coronary artery, requiring emergency coronary artery bypass graft surgery. Her subsequent clinical course was complicated, but eventually she required orthotropic heart transplantation for refractory heart failure. This case illustrates the hazards of the inappropriate use of cardiac computed tomography angiography in low-risk patients and emphasizes the need for restraint in applying this new technology to the evaluation of patients with atypical chest pain.

REPORT OF A CASE

A 52-year-old white female nurse with a medical history that was notable for hypertension and mild obesity presented to her local primary care physician with the recent onset of chest pain. Further investigation revealed that in an effort to lose weight and assist in the control of her hypertension, she had adopted a new diet and exercise program several weeks earlier. At her initial presentation, she described 48 hours of nonexertional, sharp chest pain that was aggravated by elevation of her right arm and deep inspiration. She denied associated symptoms of shortness of breath, nausea, vomiting, or diaphoresis, and her office electrocardiogram showed no abnormalities.Other than mild hypertension (blood pressure, 142/85 mm Hg), the results of her physical examination were unremarkable except that elevation of her right arm and palpation of the right chest wall reproduced the symptoms with which she presented. With a normal lipid profile and an ultrasensitive C-reactive protein level, she was diagnosed as having atypical chest pain most likely of musculoskeletal origin. Hydrochlorothiazide was used to treat her hypertension, and cardiac computed tomography angiography (CCTA) was performed to exclude the possibility of coronary artery stenosis and to reassure her. Interpretation of the CCTA findings suggested that both the left circumflex and the dominant right coronary arteries had discrete areas of mild, noncalcified, nonobstructive plaque in their mid and distal segments. The large-caliber left anterior descending coronary artery (LAD) was reported to have diffuse and complex calcification of the proximal segment, which made accurate quantification of the luminal stenosis challenging.

Subsequently, the patient’s physician recommended cardiac catheterization to enable more precise assessment of the LAD luminal stenosis. Selective coronary angiography was performed at the local community hospital and revealed only a mild luminal irregularity of the LAD. Shortly after the second injection of contrast, the patient complained of intense chest pressure and was noted to be hypotensive and tachycardic (blood pressure, 78/45 mm Hg; heart rate, 110/min). Mild “staining” of contrast was noted in the left coronary cusp of the aorta, and an ascending aortogram revealed a dissection of the aortic root extending into, and resulting in compromise of, the left main coronary artery. An intra-aortic balloon pump was placed, and the patient underwent urgent coronary arterybypass with saphenous vein grafting of both the LAD and the left circumflex coronary artery.

Following a prolonged, 14-day hospital course and a residual left ventricular ejection fraction of 35%, the patient was discharged home with intensive cardiac rehabilitation. Unfortunately, within 6 months of the bypass, she presented again with escalating chest pain and was noted have premature graft failure that was treated with percutaneous coronary intervention with multiple drug-eluting coronary stents. Despite her compliance with dual antiplatelet medical therapy (aspirin and clopidogrel daily), she presented 8 weeks later with an ST-segment elevation myocardial infarction complicated by cardiogenic shock. Emergent catheterization revealed thrombosis of the stent in the vein graft supplying the circumflex artery that was successfully treated with a catheter-based intervention. However, the patient remained in refractory cardiogenic shock and ultimately required urgent orthotopic heart transplantation.

COMMENT


Emergency department visits for chest pain syndromes represent a large and growing health care burden. Because patients with chest pain require urgent triage and timely management, there are great incentives for developing a new generation of novel, complementary diagnostic strategies. A recent addition to the diagnostic armamentarium, multidetector CCTA, can noninvasively generate reconstructed images of the coronary circulation. However, the brisk expansion and rapid adoption of CCTA over the past decade has outpaced supportive clinical data and has led to the referral of a much larger, and often lower-risk, segment of the population for coronary artery catheterization. We believe that in this case the unwarranted use of advanced diagnostic imaging (false-positive CCTA findings) directly contributed to unnecessary cardiac catheterization that resulted in a tragic complication and significant morbidity.Advanced diagnostic imaging technologies or the latest biomarker cannot, and should not, replace a thorough history and physical examination with subsequent decision making guided by the bestevidence-based practice. The need for testing in patients with chest pain is based on the clinician’s estimation of the pretest probability of coronary disease. In a patient with a low pretest probability (<10%) of having significant coronary disease, the preferred course is to reassure the individual and to focus the treatment plan on primary or secondary prevention strategies. Additional diagnostic testing rarely garners useful information and exposes the patient to unnecessary risk—both from the diagnostic test itself and from subsequent invasive testing because of false-positive results. While the risk of complications associated with cardiac catheterization is low, catastrophic events can occur. As opposed to CCTA, in appropriately selected patients coronary angiography allows the presence, location, and, most importantly, the functional significance (eg, fractional flow reserve, intravascular ultrasonography) of lesions to be determined. Because there is often discordance between luminal stenosis and the physiologic significance of lesions, functional testing has assumed critical importance in the assessment of patients with a moderate pretest probability (10%-90%) of coronary disease.

Therefore, given the possible adverse consequences of the overuse of diagnostic imaging in a broad and uncensored population of patients with chest pain, recent joint professional guidelines emphasize that ” . . . an appropriate imaging study is one in which the expected incremental information, combined with clinical judgment, exceeds the expected negative consequences by a sufficiently wide margin for a specific indication that the procedure is generally considered acceptable care and a reasonable approach for the indication. . . . “Furthermore, because of differences in body habitus, coronary physiology, exercise physiology, symptom presentation, and disease prevalence, the diagnostic accuracy of stress testing may be affected by the female sex. In addition to having a markedly different ST-segment response to exercise from a young age, data suggest that ST-segment depression tends to be less sensitive and specific for coronary artery disease in women. With normal electrocardiographic findings, negative cardiac biomarkers, and a classically atypical presentation, our patient had an age-specific risk level that was below average. She had a low pretest probability of coronary disease (<10% risk of myocardial infarction or death per 10 year interval), making further testing inappropriate and the chance of false-positive study results unacceptably high. However, in an era of rapid advancement in diagnostic imaging strategies, the savvy clinician must not forget the basic tenets of data-driven medicine, patient selection, and risk tolerance and ultimately realize when less may be more. Such is precisely the case with CCTA.

Because CCTA is rapid and noninvasive and has wide availability, it has increasingly been used to detect coronary atherosclerosis in a broad array of patient populations. However, the lack of randomized data suggesting clinical benefit, as well as technical and anatomical limitations, restricts its application in many patients. Studies comparing CCTA with conventional coronary angiography in diverse patient populations suggest that CCTA is highly sensitive (79%-100%) for the detection of obstructive coronary disease, with a positive predictive value ranging from 86% to 91%. However, these same studies report suboptimal specificity (64%-85%) and negative predictive values of 83% to 90% that correspond to an unacceptably high false-positive rate of up to 81% in selected subpopulations. Further limiting the diagnostic accuracy of CCTA is the fact that complete visualization of all segments of the coronary tree is hindered by cardiac motion (heart rate, >70/min), smaller vessel caliber (<2 mm), and tortuousity that may result in portions of a vessel moving in and out of an imaging plane. Furthermore, given its high attenuation coefficient, the presence of coronary calcification commonly produces a “blooming artifact” that makes accurate assessment of adjacent arterial luminal challenging and may result in overestimation of the degree of luminal stenosis, which is likely the case in the patient described herein. Therefore, CCTA often overestimates the presence and severity of coronary atherosclerosis to a degree that is dependent on the study population, the equipment used, and the experience of the interpreting physician, which may lead to unnecessary, higher-risk, and costly invasive procedures.

Nevertheless, the use of CCTA has increased dramatically over the past decade, with some estimates suggesting up to 26% per year. In an era in which comparative efficacy of therapies has assumed critical importance, the unchecked growth of CCTA seems not only unfounded but also irresponsible and unsustainable. Aside from its cost implications, CCTA also exposes the patient to substantial amounts of ionizing radiation. It is estimated that the collective dose received from medical radiation increased by more than 700% between 1980 and 2006, with increases in computed tomography accounting for more than 50%. Furthermore, 64-slice CCTA (without tube current modulation) exposes the patient to an average effective dose of 15 mSv of radiation compared with only 7 mSv for diagnostic coronary angiography. With recent data suggesting that 1.5% to 2.0% of all reported cancers in the United States may be linked to ionizing radiation from computed tomography, there is reason for pause.

In conclusion, our patient suffered a rare but devastating complication from an cardiac catheterization that was the direct result of unnecessary CCTA and false-positive findings. With few cardiac risk factors and an atypical chest pain presentation, this patient had a low pretest probability for coronary artery disease and should have been reassured and not undergone any further risk stratification. Lacking randomized data suggesting improvement in clinical outcomes and with clear risks including contrast load, radiation exposure, and suboptimal diagnostic specificity, CCTA should have a very limited role in the evaluation of patients who present with chest pain.

Posted in atherosclerosis, cardiology, CCTA, cholesterol, coronary artery disease, coronary computed tomographic angiography, diet, ethics, heart transplant, junk food, lifestyle, obesity, professionalism, surgery, technology, waist circumference | 1 Comment »

Zamboni is incapable of doing or unwilling to do legitimate research into his own “CCSVI” and “liberation” fantasy

Posted by Colin Rose on December 19, 2010

Dr. Alain Beaudet is President of the Canadian Institutes of Health Research and has been trying to navigate between the incessant demands of politicians pressured by desperate MS patients to authorize “liberation” on demand while doing “trials” and the scientific evidence to date showing that “CCSVI” doesn’t even exist.

Apart from exposing more of this political pressure in the Committee hearings, the testimony of  Dr. Beaudet revealed the true nature of Zamboni’s mentality. It is very interesting that Zamboni has effectively dissociated himself from large controlled studies of “CCSVI” diagnosis in Italy by demanding that only he can interpret the images and that he hasn’t received ethical approval or funding for a controlled trial of “liberation”. If Zamboni can’t get ethical approval for “liberation” now, why did the University of Ferrara approve the ethics of Zamboni’s initial testing of “liberation”, even on his wife?  It seems that Zamboni is incapable of writing a successful grant application and that even the Italians are getting a little suspicious of his hypothesis and techniques. I doubt that Zamboni himself will ever do a controlled trial of “liberation”. Why should he? He has gained transient fame and probably fortune by generating world wide hysteria with the tantalizing mirage of an instantaneous surgical cure for MS supported only by YouTube videos of anecdotal miracles. He was very fortunate that his only clinical publication on his hypothesis, an unscientific  concoction of hallucinations, was published, albeit in an obscure journal. He has indirectly compelled real scientists, like Dr. Beaudet and many other legitimate researchers to divert their time and money into dealing with the scientific absurdity of “CCSVI”. So why should Zamboni risk proving himself to be a fraud? When he is proven to be so he will be liable for compensation for the hundreds of millions of dollars wasted on his scam by patients, doctors and granting organizations. Zamboni will eventually  join the ranks of the great medical con men of history in the company of the likes of Dr. Walter Freeman, the ice pick lobotomist.

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Subcommittee on Neurological Disease – Evidence from Alain Beaudet – December 7, 2010

Dr. Alain Beaudet:

I think this is an important point. First of all, Dr. Zamboni was originally part of the very large association studies that involved I think around 20 sites in Italy, and he withdrew from the study. The scientific director of the Italian MS Society told us that he withdrew because he asked that all the images from all the sites be vetted by his own laboratory, which obviously the committee didn’t feel was appropriate. Dr. Zamboni, however, is also applying for a therapeutic trial, a trial this time to investigate the treatment. As far as I know, the study doesn’t have all the funds necessary to be fully carried out. He did receive a bit of money from the province where his lab is, but I don’t know about the status of the ethical approval of this study. He was supposed to receive ethical approval at the beginning of December. I don’t know whether he did receive it.

Do you know? We don’t know.

The last time we spoke to Dr. Battaglia, the scientific director of the Italian MS Society, Dr. Zamboni still hadn’t received the ethical approval for his studies. It was pending, and we were told the beginning of December. What we know, however, is that right now the funding from the province that he’s receiving for that study is not sufficient to carry out the type of study that would be necessary to prove or disprove the efficacy of the treatment.

Posted in alain beaudet, ccsvi, ethics, junk science, liberation, multiple sclerosis, professionalism, randomized trial, Zamboni | Tagged: | 7 Comments »

Therapeutic knee arthroscopy and vertebroplasty; surgical scams for which we all pay

Posted by Colin Rose on December 18, 2010

These are just more examples of surgical impunity. There are many others such as “bariatric” surgery and coronary angioplasty for chronic coronary disease.

If one wishes to market a drug the FDA and Health Canada demand proof of effectiveness and safety requiring many years and many millions of dollars worth of research and clinical trials. But any surgeon can concoct some superficially attractive operation and he and his colleagues can make millions of dollars selling it before anyone gets around to doing a controlled trial of the procedure out of curiosity, not because surgeons are required to do so. Why do surgeons enjoy impunity from scientific proof demanded of drug makers?

Even if there is hard scientific proof that a procedure is totally useless, surgeons are still free to perform them and get paid for doing them by insurance companies and medicare. There are good trials of therapeutic knee arthroscopy for osteoarthritis and vertebroplasty with sham operated controls showing the total absence of benefit of these procedures and yet they are still done. See below for excerpts from these reports. These trials also show the necessity for SHAM OPERATED CONTROLS in testing any surgical procedure for chronic diseases. Sham operation are perfectly ethical when a procedure is not proven to have benefit and has risks associated with it.

Dr. Yee says, “… there’s a bit of a lag in catching up with the evidence. That’s normal.” What’s “normal” about the lag? Surgeons are illiterate? Surgeons are destitute? If a procedure is shown to be useless, just stop doing it. Why aren’t these procedures delisted immediately? Some surgeons might miss the payments on their Jags? They might decide to go to the US?  If they are doing useless operations who needs them anyway? If a drug, approved on the basis of small clinic trials, is found to have unexpected serious side effects when sold to the general population, it is delicensed and instantly removed from the pharmacist shelves. Why is should surgical procedures not be instantly halted if proven to be useless?

With this rampant dereliction of professionalism by some surgeons one can hardly blame patients with MS for also demanding that medicare support a more recent unproven, scientifically absurd surgical scam, Zamboni’s “liberation” treatment for “CCSVI”, his fantasy for the cause of MS.

A toilet money award goes to all surgeons performing therapeutic knee arthroscopy for osteoarthritis and vertebroplasty

 

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Common back and knee surgeries fail to ease pain: study

ANDRÉ PICARD,

PUBLIC HEALTH REPORTER— From Friday’s Globe and Mail
Published Thursday, Dec. 16, 2010 6:48PM EST
Last updated Friday, Dec. 17, 2010 7:12AM EST

There are thousands of unnecessary surgeries being done on the knees and backs of Canadians, particularly patients with osteoarthritis, a new report concludes.

There were 3,600 therapeutic knee arthroscopies and 1,050 vertebroplastiescarried out in Canadian hospitals in the fiscal year 2008-09, according to new data from the Canadian Institute for Health Information.

In both cases, there is mounting evidence that the procedures are largely ineffective to combat certain ailments, and those are but two examples cited in the report that more needs to be done to align care with evidence that it actually helps patients, said John Wright, the president and CEO of CIHI. “Evidence and appropriateness of care are a significant issue in Canada’s health-care debate,” he said.

Mr. Wright said improving efficiency is one of the keys to getting health spending under control.

Knee arthroscopy, a minimally invasive surgery, was once used to diagnosis and treat a host of minor knee problems. But it has fallen out of favour as studies showed it did little to reduce pain and that a large number of patients went on to have knee replacements within one year.

Vertebroplasty is a spinal surgery in which bone cement is infused into fractured vertebrae through a small incision. Recent research has shown that people with compression fractures (a common problem in those with osteoporosis) are not any better that those who undergo a placebo (or fake) procedure. Yet the number of vertebroplasties done in Canada has doubled over the past three years.

Albert Yee, an orthopedic surgeon at Sunnybrook Health Sciences Centre in Toronto, said that the new data are useful but they should not be interpreted as meaning that surgeons are ignoring evidence. With most innovative technologies and surgical techniques, he said, “over time, there are scientific studies that refine the appropriate indications and there’s a bit of a lag in catching up with the evidence. That’s normal.”

Dr. Yee said he hopes policy-makers will not use this data as an excuse to delist procedures like arthroplasty and vertebroplasty (meaning they would no longer be paid by medicare): “I think we need to be careful. These procedures work for some patients; we just need to use them for the proper indications.”

The CIHI report also underscored, once again, the large variations in the number of cesarean sections and hysterectomies performed in various parts of Canada. For example, 23 per cent of birthing women in Newfoundland and Labrador had a c-section, compared to just 14 per cent in Manitoba.

With hysterectomies – the surgical removal of the uterus and sometimes the fallopian tubes and ovaries as well – rates range from a low of 311 per 100,000 population in B.C. to a high of 512 per 100,000 population in PEI.

“When we see these kinds of variations, it is a cue to start asking questions about whether the care being provided is appropriate,” said Jeremy Veillard, vice-president of research and analysis at CIHI. “Reducing unnecessary surgical procedures is beneficial to the patient but there are cost implications for the system as well.”

Mr. Veillard noted that cesarean deliveries cost about twice as much as vaginal births – an average $4,930 versus $2,265. Nationally, hospital costs related to cesareans total about $292-million a year. If nationwide c-section rates were lowered to Manitoba’s level of 14 per cent, there would be 16,200 fewer surgeries annually and an estimated $36-million in savings. Flattening out the regional variations in hysterectomies would deliver similar savings.

According to CIHI, hospitalizations for hysterectomies cost $192-million a year. If the national rate was reduced to B.C.’s current level, 3,700 fewer women a year would undergo the procedure and that would generate savings of $19-million.

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Posted in angioplasty, bariatric surgery, ccsvi, multiple sclerosis, professionalism, randomized trial, sham operation, surgery, therapeutic knee arthroscopy, vertebroplasty, Zamboni | Tagged: | 4 Comments »

Majority of Canadians believe Zamboni’s “CCSVI” and “liberation” scam; science education is pitiful

Posted by Colin Rose on December 15, 2010

There is no better example of why the general population should have a good grounding in the basic principles of scientific investigation than this poll. It is a given that when the politicians digest these results and realize the thousands of votes they could gain by appeasing the majority, they will start throwing  hundreds of millions of dollars at Zamboni’s scam regardless of the junk science upon which it is based. Why would they care? They are already throwing money at bariatric surgery, an equally scientifically absurd scam. What’s a few more hundred million to keep the population happy in their world of surgical fantasies. So, prepare to see more of your tax dollars flushed down the toilet of surgical scams.

A Toilet Money Award to all Canadians who think "liberation" treatment for MS is beneficial.

Clearly our primary and high school science courses are failing the population if they readily accept an obviously suspicious, instantaneous cure for a chronic degenerative disease and can’t ask the right questions about Zamboni’s hypothesis and the reason for the  improvement in subjective symptoms in the YouTube videos of some of the MS patients who have been “liberated.”

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Canadians support liberation treatment trials: survey

CTV.ca News Staff

Date: Wednesday Dec. 15, 2010 6:48 PM ET

A vast majority of Canadians believe the federal government should support clinical trials of the controversial “liberation treatment” for multiple sclerosis, and say it should be available in Canadian hospitals for patients who request it, according to a new survey.

In an online poll of 2,011 Canadian adults conducted Dec. 13 to Dec. 15, polling firm Angus Reid found that three quarters of respondents support government-funded clinical trials, while 82 per cent support making the treatment available to Canadian patients.

The poll found that 37 per cent of respondents had seen, read or heard something about the procedure, while another 13 per cent said they were well-informed about the treatment.

Half of respondents had never heard of the procedure.

The so-called liberation treatment has sparked a great deal of controversy over its founder’s claims that MS is not an autoimmune disorder, as most experts believe, but rather a vascular problem that can be treated with balloon angioplasty.

The theory and treatment were developed by Italian vascular surgeon Dr. Paolo Zamboni, whose research suggests that the majority of MS patients have blockages in veins in their necks that prevent blood from draining from the brain. According to Zamboni, these blockages cause toxic levels of iron to build up in the brain, which triggers MS symptoms such as fatigue and paralysis.

Zamboni called the condition cerebrospinal venous insufficiency, or CCSVI, and began treating it with balloon angioplasty to open blocked veins.

Despite Zamboni’s research, and successful follow-up studies conducted at the University of Buffalo, experts have remained skeptical of the treatment based on other research that has failed to prove the liberation treatment’s benefits.

Earlier this year, the Canadian and U.S. MS Societies announced that they will offer $2.4 million in research grants for studies on Zamboni’s theory. But the federal government has said it will abstain from funding clinical trials until further research is completed.

Meanwhile, patients buoyed by Zamboni’s findings are travelling to foreign countries to have the liberation treatment, at great personal expense (and at great personal risk). Some patients have reported complications since returning home. One patient died in October after developing a blood clot around a stent that was put in during a procedure in Costa Rica.

The Quebec College of Physicians has warned patients that further research must be done on the treatment to prove its effectiveness and advised them not to seek treatment at overseas clinics.

But many Canadian patients have returned from outside Canada reporting a vast improvement in their symptoms. And the Angus Reid survey found that many Canadians believe the patients over the experts.

When asked which side of the debate over the liberation procedure they agreed with most, 61 per cent said they side with MS sufferers who have had the treatment and claim it has provided relief. Twelve per cent support the doctors who claim the treatment is unproven and risky, while 27 per cent said they weren’t sure.

The survey was conducted online between Dec. 13 and Dec. 15 and has a margin of error +/- 2.2 per cent, 19 times out of 20.

Posted in ccsvi, liberation, multiple sclerosis, Zamboni | 6 Comments »

University of Maryland solicits donations from desperate MS patients to support Zamboni’s “CCSVI” and “liberation” scam

Posted by Colin Rose on December 5, 2010

A Toilet Money Award to the University of Maryland

The temptation was too great. American and Canadian professional fund raisers and catheter-wielding interventional radiologists around the world have been drooling over the ability of foreign clinics in places like India, Poland, Mexicao, Costa Rica, Bulgaria and Egypt to rake in hundreds of thousands of dollars per week flogging the Zamboni “CCSVI” and “liberation” scam for “treating” MS patients. So fund raisers at the University of Maryland, following the example of those at the University of British Columbia, convinced or, more likely, were convinced by Dr. Ziv Haskal, an interventional radiologist who stands to make many millions of dollars doing “liberation”, to ride Zamboni’s “CCSVI” hysteria to fatten the endowment of the University while giving legitimacy to the scam. UBC is using the scam to raise funds for a new MRI machine that will probably be used for other purposes than trying to diagnose “CCSVI”. But U of M is using the bait of implying that Haskal will actually be doing “liberation”. If so, this will be the first university-sanctioned use of “liberation” other than Zamboni’s University of Ferrara. Neither university is in the top 100 of the world’s universities. Ferrara isn’t even in the top 500.

Perhaps we should not be too surprised. After all, only 40% of the US population accepts the theory of evolution as the explanation for the variety of life on the planet, the most important scientific concept in history; presumably, the majority, 60%, believe in some form of creation or “intelligent design”. If one can believe the latter, one should have no reservations about accepting that internal jugular veins can cause damage to the brain without raising intracranial pressure and even if it did raise intracranial pressure could cause damage selectively to the  slowly-metabolizing, myelin-producing cell of the white matter BEFORE damaging the much more sensitive rapidly-metabolizing cells of the grey matter of the brain. Interventional radiology, while requiring a certain degree of manual dexterity, certainly doesn’t require more than a superficial knowledge of physiology and metabolism and doesn’t preclude a belief in creation.

“CCSVI” is junk science and its “treatment” by “liberation”, dilating presumably blocked neck veins to “cure” MS, is one of the greatest surgical hoaxes in medical history. Performing any medical procedure with no scientific evidence of benefit but with potential risk is grossly unprofessional and contrary to the Hippocratic Oath.

“CCSVI” is the crack cocaine of surgical scams. It has been estimated that at least three BILLION dollars will be spent next year by MS patients pursuing the Zamboni’s mirage, dwarfing other recent surgical scams like “bariatric” surgery.

 

Posted in ccsvi, ethics, liberation, multiple sclerosis, professionalism, surgery, Zamboni | Tagged: | 35 Comments »