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Stroke Prevention Surgeries Unnecessary?

Over the past four months, one of the more popular articles we've posted on our site has been the multi-part Modern Health Care System is the Leading Cause of Death, itself a sequel of sorts to our 2000 story, Doctors Are The Third Leading Cause of Death in the US.

I feel even more strongly than ever that the entire modern health care system -- no specific disease or physician -- is to blame for allowing, even promoting, so many unnecessary procedures, drugs and mishaps.

That's why I was attracted to a recent study led by a University of Alberta researcher that found a significant proportion of stroke prevention surgeries performed each year are unnecessary.

Scientists reviewed 3,167 carotid endarterectomies performed in Western Canada over a two-year span. The surgery involves cutting open the carotid artery in the neck to scrape the plaque inside. Plaque build-up causes the artery to narrow and can ultimately block the blood flow to the brain or cause a blood clot to form, causing stroke in both cases.

Four to 5 percent of these surgeries result in complications including death or stroke. But those who don't suffer complications experience an average hospital stay of two days and minimal pain. The study results indicated that 52 percent of procedures were considered appropriate, 10 percent were unnecessary and the remainder of the cases was uncertain.


The lead researcher believes to ensure inappropriate stroke-prevention surgeries don't continue to needlessly put patients at risk and tie up resources, what he calls "cockpit management" could do the trick. Just as a pilot must go through a checklist before take-off, a surgeon could be required to complete a checklist before a procedure.

The problem: Well-intentioned doctors struggle to keep track of cutting-edge research. This researcher points out that it's hard for the average practitioner to be aware of all the evidence and to be up to date completely. A checklist might be seen by doctors as a bureaucratic exercise, but it would also prevent them from bowing to pressure from patients to have procedures they don't need.

Studies like these illustrate precisely why our present health care system is so desperately in need of change, and why facilitating this change is, and will continue to be, a substantial portion of my vision.

Science Daily September 17, 2004

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