There's a pervasive idea that a high-priced invasive procedure has to somehow be better than doing something simple and conservative. I suppose this is human nature. Our ancestors gravitated toward human sacrifice on the instinctive belief that a deity that demanded human life has to be more powerful than one who wanted rice.
And I'm not knocking surgery, or surgeons, or other invasive procedures. In many cases they are critically important and life saving.
But let me tell you some stories.
The cardiologists have a remarkable technology called the stent. It's a tiny piece of metal that can help prop open a closing artery to restore blood flow. It's changed a lot of the way heart care is practiced during my career.
So it's only natural to extrapolate this technology to arteries of the brain. Instead of doing surgery, or using ho-hum medicines, we started putting high-tech stents into arteries supplying the brain, too.
Guess what? A study found boring old pills beat snazzy stents!
Here's another example:
For acute strokes, TPA is the big thing (I'm not going to argue about how effective it really is). But there's all kinds of things we can do beyond just plain old TPA. After all, how exciting is it to slowly drip some liquid into an IV line?
But it can be so much more exciting! What if we give TPA by threading a catheter all the way up to the brain and drip it right onto the clot? COOL! Or we could also use REALLY flashy technology ("technology always implies it MUST be good, doesn't it?). There are tiny gadgets we can thread all the way up to the brain, screw them (gently) into the clot, and pull it out (WOW! Like a cork!). Or another gadget we can use to punch a whole in the clot and restore blood flow.
Sounds all science fiction-y, huh? Well, we DO have the technology to do all those things.
But does it work? (Wait, who DARES ask such a question of advanced technology?!!!)
That's it folks. 2 studies (here and here) found that all this advanced stuff was no better than boringly watching TPA drip into an IV line. Ho-hum.
Now, the companies who make the fancy gadgets, and the doctors who use them, will gladly point out all kinds of flaws in the studies, and some of them may be legitimate. But some complaints, like "we need to select patients better," translate simply as "let's stack the deck in our favor."
In medicine we hear the phrase "Do something!" a lot. But usually we already are doing something. The problem is that many people think that unless it involves a lot of razzle-dazzle and medical voodoo, we aren't.
And in some cases that's quite far from the truth.