Who to trust??

[TXWildflower]

Interesting article and while the claims have not been substantiated, it does make one think about whether you can always trust recommendations from your Dr. You have to consider if there is some underlying reason for their recommendation of one manufacturer's products over another.

I'm betting this goes on all over the country and maybe isn't to the detriment of any patients, but still makes me wonder.

Interventional cardiologist sues hospital under Whistleblower's Act

 

[buncle]

As a business owner there are always perks that go along with buying certain products.Baseball tickets,free product,free lunches,free hotel rooms.It would not surprise me at all if this was true.Money talks and in the medical industry there is alot of it.

 

[river-wear]

It certainly emphasizes the importance of asking questions of your doctor. Yes they are the experts, but there's nothing wrong with asking them to justify their recommendations and explaining the proposed treatment.

The first time I saw a new cardiologist in CA she said she wanted to put me on medication to lower my blood pressure. My old (much-loved and trusted) cardiologist would often share information about new developments and had explained that it's a good idea for many patients because it lowers the pressure across the faulty valve. He went on to say that it wasn't such a good idea for me because my BP tends to run about 102/53 and he was concerned about dizziness and/or fainting.

I suspected her motives and asked for an explanation. She didn't offer much of one and never brought it up again. A couple of years later she took a personal call on her cell phone during my appointment and I never went back.

 

[Lily]

I remember an experience from many years ago, during a time when our insurance changed a couple of times and subsequently did our primary care physicians, when each member of our family was told that not only did we all have [virtually unsymptomatic and previously undiagnosed] allergies but we had always had them and needed to be on a certain new allergy medication for the rest of our lives.

The different doctors each wrote prescriptions for us and filled up small bags with samples for us but we knew better; and when I heard or read later, hearsay though it was, that doctors were getting a trip to Tahiti for a certain quota of these prescriptions they wrote, I wasn't surprised. Disappointed, yes.

(addition - I don't know if my explanation was clear that, within a very brief period of time, a few different doctors came up with the same diagnosis for every member of our family and recommended and prescribed the same new RX for each of us. I'm not sure the ridiculousness of the entire situation would have been as obvious to us had we not had the same reaction from each different new doctor during that insurance shuffle.)

 

[Lynlw]

This is another good reason to get more than one opinion

 

[tobagotwo]

It's extremely common to find that the favored valve of the surgeon is from the company of the salesperson who has best leveraged his or her access and relationships with the cardiologist or surgeon's staff as well as with the doctor himself. Doctors don't have a great deal of time to spend with different salespeople's presentations. Staff sometimes use this to limit who even gets to see the doctor.

Sometimes staff members or hospital management (as in the case above) can have relationships with salespeople (that might or might not be lucrative) that are just as limiting as those that might be made by a not-so-ethical doctor. Hospital administrators sometime interfere because they want to work with one vendor, for simplicity or economic reasons.

One way to tell is by the statements they make. When cardiologists or surgeons are making statements that put them behind the times (such as telling an older person that tissue valves only last 5-10 years at the most), they are often being managed by a salesperson, and have used the same valve for a long time and developed a loyalty. Another is when everyone in their group, hospital, or discussion circle of professional acquaintances uses the same product, and has no interest in telling the patient about any options.

That doesn't mean they're necessarily being paid off or doing anything essentially immoral (in their viewpoint), but it can mean you don't get to "choose your poison." As you are the one who lives with the results and shortcomings of the valve, that choice may be important to you.

There are times when only one type will give the best service for a patient. However, when that happens, the surgeon is completely able to explain why that is for a particular case. That only amounts to a small percentage of cases.

The fact is that cardiologists and surgeons are as fragmented in their approaches and beliefs as the people who visit this website, and quite often more self-righteous and acrimonious in their dismissal of each other's positions as anyone in VR.com has ever gotten. Medicine has lead-butted conservatives who won't try anything new to help their patients and wild-eyed enthusiasts that are ready to plug in anything that looks shiny, regardless of whether it even makes sense. Both serve their patients badly at times. One surgeon is expert at the Ross Procedure, another at St.Jude mechanicals, another at On-X valves, and different ones for cow, pig, and (apparently) horse tissue valves. Some still use only homografts.

But most surgeons and cardiologists are somewhere in the middle, trying to make sense of all the claims.

While it can be said that you should just accept whatever valve your surgeon tells you to use, it's equally accurate to say that if you just go to a different surgeon, he will tell you he uses a different valve.

As far as efficacy, most top brand models offer the same life expectancy, so there's certainly no crime to letting your surgeon or cardiologist choose for you, if you're ambivalent to the ramifications, or just plain too petrified to choose. It's not only your choice as to which valve to use, it's even your choice as to whether to choose.

Best wishes,

 

[ALCapshaw2]

Well Said Bob !

The only thing I would add (which you implied) is that Choosing a Surgeon can be tantamount to choosing a Valve, or at least limiting the patient's choice of valves to those which the Surgeon uses / prefers / is comfortable with / has a bias towards.

As I have advised members many times, if you desire a particular Valve or Procedure, it is wise to find a Surgeon who has Experience (and a good track record) with that Valve or Procedure.

FWIW, I have met several Surgeons. NONE of them offered ALL of the Available Valve / Procedure Options.

'AL C'

 

[Ross]

Old Tobey Cosgrove and company got themselves into some pretty hot water not too long ago over things like this. It even happens at the #1 heart center in the U.S., so it shouldn't surprise anyone.

 

[Bill B]

I second what Bob H wrote. I was on the "darkside" for a couple of decades, part of which time was in sales, part of which was in clinical trials, which are sales motivated. I have mixed feelings about the way the US drug/device industry works. It is the most innovative in the world BY FAR. Capitalism and greed mixed with trying to really help people is a powerful brew. It's true that money buys influence and position, and that when I heard physicians say they weren't influenced by the money as they took it, I knew that we had a conflict of interest on its face that could not be denied like that. I find it hard to talk about. All of us were "good" people who really wanted to help people, but the money lead to a lot of less than honest behavior. How to take the money out or somehow the unethical uses of the money while preserving the productivity of the pharmaceutical/edvice industry is a thorny problem, not unlike the whole area of healthcare reform. And from the way the healthcare reform debate is shaping up, NO ONE has the slightest clue what to do.

 

[Lily]

I just read an interesting and scathing article about statins, written by a retired veterinarian who has been involved with a local (people) hospital board. He quoted some amazing statistics to back his claim that the huge statin push is primarily hype and nearly fraud (paraphrased), related to a $13 billion profit for the pharmaceutical companies.

I may drop some of the highlights from his article into the next statin thread I see here. Look out !

 

[Blanche]

My built-in shock proof crap detector has been going off of late...

My built-in shock proof crap detector has been going off of late...

I have been having some problems with possible breast cancer of late. I chose to investigate possibilities and decided that the information I was getting from local hospitals just did not jibe with the things I was reading on the net.

I chose to get three different opinions from local doctors who were near my residence. Interesting enough, the opinions were very different. When one of the doctors told me, "this is the only way to deal with your issue," I knew I was in trouble.

Since my husband was being treated at the Mayo Clinic in Scottsdale for lung cancer, I thought I might get another opinion there. The bottom line is that I was treated and they gave me a biopsey that showed that I do not have a problem. Mayo Clinic doctors are on salery. The doctor who performed my biopsey took 2-1/2 hours and sought the opinion of a colleague, who spent almost an hour with me.

Getting proper medical care is a real and continuing problem.

Blanche

 

[Gail in Ca]

This is why I like Dr Miller. He mentioned to me which valve he probably would use, but it all depended on what he found when he got in there. I got my paperwork describing my surgery and found out that, although he was going to use a St Judes mechanical valve graft, he ended up constructing his own "back-table" CVG utilizing a carbomedic top-hat within a 30mm graft.That's why you go with the experts. When what they think of using will not work, they can create something that will, while you're on the table!
Oh, just my 2 cents on statins. I finally started taking simvastatin just 6 wks ago. After finally healing from all my health ordeals, my LDL was 186 and that was after I tried to bring it down. My latest blood test showed my LDL is now 93! My total was over 300, now it's below 190! Now, that's results. I am taking 150mg of Co Q 10 daily and so far have had no major achy type side effects, knock on wood. My cardio was very happy with my results. I asked him why this statin and he said, because it's a good drug and it's cheap!