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Commentary

Cut Off at the Bypass For Most People, Stents and Drugs Are Usually Safer, Better
Washington Post, 9-28-04

For all of the national angst about rising health care costs, there is real good news to be had from improved health care, for instance angioplasty and drug treatment replacing the riskier, and ultimately more expensive forms of open-heart bypass surgery.

While Bill Clinton's open-heart surgery for a triple-bypass may have made news, this author points out that bypass is actually the riskier procedure compared to new techniques where stents, or drug coated stents, are threaded into a patientís veins to clear obstructions. Consequently, "the bypass operation, which involves sawing open the chest, is a 40 year old procedure that is usually unnecessary." Today, doctors are increasingly coming to the opinion that the least invasive treatments are often the preferred method. "Over the past year, in fact, New York State has seen three times more stent procedures than coronary bypass operations." The new "conventional wisdom", is that doctors should use a "combination of limited intervention and medication, an improved understanding of the disease process, aggressive risk factor modification, and intensive medical therapy." Today, that means that many Americans at risk of heart disease (15 to 20 million) take statins, cholesterol lowering drugs and "retard the development of coronary blockages to the point" where patients may not need any physical interventions at all. In many ways, President Clinton's case was an exception to the new rules of medicine, rules that are saving more lives and expense than the procedures they replace.



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