Guest Post: Industry editorial makes outlandish claim about impact of medical devices 2

Editor’s Note: The following guest post by Gary Schwitzer is reprinted with permission from HealthNewsReview blog, an indispensable resource for tracking the best and worst of healthcare journalism.

Industry editorial makes outlandish claim about impact of medical devices

by Gary Schwitzer

Minnesota is the home of several medical device makers.  So there’s been a lot of editorializing about the medical device tax in the Affordable Care Act. There has been some criticism of Minnesota politicians over whose interests they represent on the issue.

Today’s Star Tribune carries a commentary from an industry spokesman – Dale Wahlstrom, president and CEO of LifeScience Alley. He retired from Medtronic in 2006 after 24 years.  His commentary includes this claim:

Medical devices save and improve lives. Between 1980 and 2000, medical device technology slashed the death rate from heart disease by a stunning 50 percent and cut the death rate from stroke by 30 percent. As a result, life expectancy was extended by more than three years.

Please note: I’ve written to a contact at LifeScience Alley asking for the source of that data.  In fairness, he hasn’t had much time to respond but I don’t expect an answer on the data source because I don’t think there is one. I’ll be happy to post an amendment/addendum if/when an answer is forthcoming. That editorial has been published for hours already and I think it’s important to publish even this quick analysis as quickly as I can.

This quote attributes ALL cardiovascular health improvements to devices rather than siphoning off the mere fraction that might be attributable to devices versus drug therapies versus lifestyle changes.

One analysis published in the New England Journal of Medicine concluded:

Approximately 47% of this decrease (in coronary disease death rate) was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively).

So a little less than half is attributable to changes in risk factors.  A little more than half to ALL treatments – including drugs, surgery, etc.

The largest reductions in deaths came from the use of secondary-prevention medications or rehabilitation after acute myocardial infarction or after revascularization (a total reduction of approximately 35,800 deaths) and from the use of initial treatments for acute myocardial infarction or unstable angina (approximately 35,145 deaths), followed by treatments for heart failure and hypertension, statin therapy for primary prevention, and treatments for chronic angina.

The editorial is more than a matter of playing loose with the numbers; it is a vast overstatement and a distortion of the evidence. There’s no question that medical devices have contributed to the decline.  It is disingenous to attribute ALL of the benefit to devices.

I’m not going to comment on the medical device tax.  For now, I’ll leave that to the politicians and special interests.

But on this site, we address and try to correct any misleading claims about medical interventions whenever we see them – whatever the source.  And this editorial made a whopper!

I only hope that such whopping misleading claims aren’t misleading politicians into positions they wouldn’t take if they evaluated the claims.

Advertisements

2 comments

  1. I agree this was an extreme claim, but the NEJM paper does not seem to shed that much light on the situation either, as the reduction in events does not seem to have been attributed to orthogonal input variables. For example, of a total of 310K deaths prevented or delayed, 69,000 are attributed to lower bp and 83,000 are attributed to reduced cholesterol (almost half in total). But elsewhere, statin treatment is given credit for preventing only about 21,000 deaths, blood pressure medications are given credit for about another 25,000 deaths prevented, decreased smoking 40,000, increased physical activity 17,000, and increased BMI -25,000 deaths.

    Question: If decreased cholesterol and blood pressure did not arise from increased exercise, decreased smoking, reduced BMI, statins, or blood pressure medications, what caused them?

    So I cannot follow the author’s argument that this paper tells us anything about the relative roles of lifestyle and medical technology in reducing cardiovascular death.

What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s