[Updates with mention of AP story.]
Obama isn't the only one with a disastrous healthcare rollout–leading cardiologists have made a mess of their healthcare proposal, too.
And to make things worse, The New York Times is now offering medical advice.
In anticipation of the annual meeting of the American Heart Association in Dallas this week, cardiologists last week issued new guidelines for the treatment and prevention of heart disease–with the imprimatur of both the heart association and the American College of Cardiology. That's as good a pedigree as you can ask for.
Alas, they didn't get it right.
Among other things, the guidelines provide a new risk calculator that doctors can use to determine whether patients should be treated. The calculator, like the healthcare.gov website, immediately came under sharp criticism. In today's paper, Gina Kolata of The New York Times reported, "This week, cardiologists learned that a new online calculator meant to help them determine a patient’s suitability for cholesterol treatment was flawed, doubling the estimated risk of heart attack or stroke for the average patient." Fixing the calculator–like fixing the healthcare.gov insurance website–"would not be easy," she wrote. (And the cardiologists can't blame the complexities of government contracting for their failure.)
Kolata got a comment from Gilbert Welch at Dartmouth that nicely explained the problem. "The model suggests that lowering systolic blood pressure from 130 to 100 is nearly as important as from 180 to 150," he told her. "I doubt there is a cardiologist in the country that believes that."
So far, so good. What amazed me, however, was that the editorial board at the Times decided to go much further and issue its own recommendation for treating heart disease. "Patients in good cardiovascular health would be well advised to stay away for now from following the cholesterol guidelines issued last week by the nation’s two leading heart organizations," its editorial began.
I can't emphasize this enough: The New York Times editorial board flatly advised its readers to ignore treatment guidelines published and certified by the American Heart Association and the American College of Cardiology.
As Kolata's story and others make clear, the guidelines are a mess–but the cardiologists are standing firm in support of them, according to Todd Neale of MedPage Today who, unlike others who wrote this story, was on the scene at the heart association meeting. He attended a press conference that was quickly assembled there to defend the guidelines. David Goff, who was involved in writing the guidelines, said they would result in about 30 million Americans aged 40-75–about one-third of them–meeting the requirements for treatment with statins.
Marilynn Marchione of The Associated Press–who likewise was on the scene, as the AP should be–also reported that the developers of the guidelines are standing by their work. Sidney Smith, a former president of the heart association, told her that "dozens of heart experts spent nearly five years carefully reviewing top-quality studies to develop the guidelines and the formula and let other major medical groups review it" before it was adopted. "We think we've come up with a good risk instrument," he added.
But the cardiologists on the editorial board of The New York Times–if there are any–apparently disagree. That leaves Times readers with an interesting choice: Grapple with the disputed cardiologists' guidelines, or follow the advice of the Times–which expresses no doubts–and stay away from the cardiologists' advice.
Contrast that with the carefully crafted opinion of the editorial board at The Los Angeles Times. It recaps the story, noting the importance of the recommendations and the controversy. But rather than telling its readers to ignore the guidelines, it concludes with this:
These are exactly the kinds of complicated issues that the U.S. Preventive Services Task Force excels in examining. Before the nation embarks on a radical shift that could double the number of people taking statins, this independent, congressionally authorized group should deliver a second opinion.
That's an appropriate and intelligent point at which to let the argument rest.
-Paul Raeburn
[Disclosure: My wife, Elizabeth DeVita-Raeburn, writes for MedPage Today.]
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