Comment from Marginal Revolution by someone who sounds knowledgeable:
"To start with there is a significant problem with the article. Cardiac surgeons don't go to cardiology meetings and don't perform the type of interventions mentioned in the article. Interventional cardiologists are not cardiac surgeons. The recurrent mislabeling of the specialty involved is yet another example of the slipshod treatment and lack of understanding of science and medicine in the lay press which makes for an ill-informed public."
They suggest mortality is lower during meetings because:
"the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits."
Not sure if they accounted for delayed surgeries in the study.
> Not sure if they accounted for delayed surgeries in the study.
That's sort of what I am wondering. Perhaps it just delays the inevitable - the patient is gravely ill is is going to die if they don't perform _potentially_ life-saving surgery. The surgery, is of course risky.
The conference delays the surgery, so the patient's surgery or other high risk procedures are delayed. This gives the patient a few more days of being ill, but doesn't probabilistically change the outcome of actually undergoing the procedure.
> The conference delays the surgery, so the patient’s surgery or other high risk procedures are delayed.
My understanding from listening to the author’s podcast, is that this is the proposed mechanism. There is a percentage of patients who were going to get better on their own anyway. But if they receive urgent care, it may cause harm.
The conclusion seems to be that there is a measurable percentage of patients who got surgery but didn’t need it and thus suffered greater harm than if they had been left alone. Because heart attacks are so critical, medical staff errs on the side of action instead of waiting. This seems reasonable, but may in fact be bad.
They appear to be already accounting for that since they are measuring 30-day mortality for acute conditions. They’re saying it’s possible the reduced mortality is due to the high risk procedures actually being unnecessary.
To understand why, i think you have to know 2 data points
1) The first date (and then-current surgery schedule) at the point when the conference dates where announced.
2) The date (and then-current surgery schedule) at the point, when the doctor booked his/her travel plans.
Both lists and dates will help you understand if changes in information also resulted in the changes of mortality (by rescheduling hard cases to a later date, for example).
This is complete and utter nonsense. The "exceptions" are 99% of medicine. Almost all of medicine is applying strategies we know on average improve outcomes as well as we know how and as well as that clinician is able to within the scope of the time given. If you don't know this is likely that you haven't had much need of medicine. I you had you would know better.
This isn't to say outcomes are always good our knowledge is imperfect, people are imperfect, and not every situation has a good answer.
Not sure if that's a useful definition of 'harm'. It's like pointing out that most substances are poisonous. Can't just ignore the dose or context when it comes to medicine.
I mean, fair enough. Just because you're an immunologist doesn't mean you carry spare adrenaline, antihistamines, inhalers, and steroid infusions in your fanny pack at conventions. All they can do is call an ambulance.
It's a bit like expecting a hacker to hack a network without their laptop.
(bit weird if HE didn't have his epipen on him though ...)
> Just because you're an immunologist doesn't mean you carry spare adrenaline, antihistamines, inhalers, and steroid infusions in your fanny pack at conventions.
Maybe they should.
> It's a bit like expecting a hacker to hack a network without their laptop.
A real hacker can break into a network with some bubblegum, a pen, and a corgi.
I saw some sort of collapse at a medical school. Loads of people went to help. At the time we wondered how that went, with half trained students on the loose.
From my experience, it was more "too many cooks" than the ultimate bystander effect.
I saw someone feel unwell at a party, nothing serious, just a drink too much, but half of the room happened to work in healthcare, and half of the room came to help. As expected it went all over the place, until a relative (also a doctor) came in, ousted the crowd and took proper care of the poor guy.
In that situation you need an anesthesiologist, not an allergologist. Even a random anesthesia tech without medical education would do far better than an allergologist. A paramedic too.
Speaking as someone with a health care worker in the family who just went on strike, I think this makes a lot of sense. When hospital workers go on strike, it often forces the hospital to go on diversion, leading to other hospitals taking on all new patients, who are usually in some form of medical crisis and have a higher chance of dying than stabilized patients already under care. Thus, it makes sense that a hospital which has workers that go on strike have a lower death rate on average.
The article mentions controlling for this in numerous ways. It was looking at elective surgeries, as well as county wide mortality rates and not just a single hospital. That said, in the elective surgery cases it could well be a spin on what you're mentioning and people just deferred their surgeries until after the strike. You'd think surely they also controlled for this, though.
As someone dealing with elder care of multiple family members I also believe mental anguish caused by medical environments, including insurance and billing in the US, and the dismissiveness of hospice care (you’re taking too long to die, speed it up or transition to a lower form of care) doesn’t help the matter.
Modern medicine is a miracle but struggles to evolve beyond many immediate hurdles. In an extreme minority of cases it can be better to avoid traditional intake methods.
Hard to say without more details, though it's certainly plausible.
There's other possibilities though. Like if the timing of other interventions is being delayed until the cardiologist is able to see the patient instead of deferring to a less specialized physician.
Interestingly, there were no differences in the number of procedures performed on meeting and nonmeeting days (it's not the surgeries that are killing people).
The hypothesis that I find most interesting is that the cardiologists who are at the meetings spend less time caring for patients and more time doing research, hence they aren't as good at caring for patients.
I've never been to one of those conferences, so just a second hand anecdote:
A couple of years ago some friends of ours invited us to lunch with a couple of their relatives who were in town for a cardiology conference. They (the relatives) were both stout* people, technicians of some kind rather than doctors, and the husband was super hung over from the previous night.
Anyway, they told us all about how the sessions at these things were pretty dry, but the after party was always a drunken, hours long slurry of alcohol and aorta-clogging food, and it was so ludicrously un-heart-healthy that it was a running gag.
So I'm wondering if the people who opt to go to those things tend to perform differently in their work than the ones who stay home and live quieter lives?
(*I only mention this because a few days after we had lunch, the husband apparently had a heart attack while he was driving, pulled off to the side, and died.)
Could it be that the conferences take place at a time of year where mortality due to cardiac events is higher, e.g. in summer? Maybe I missed it, but I don't think they controlled for time of year.
The author of this study talks about time of year in a later podcast, iirc. They did control for time of year (maybe in a later study) and found no effect.
Readit News
"To start with there is a significant problem with the article. Cardiac surgeons don't go to cardiology meetings and don't perform the type of interventions mentioned in the article. Interventional cardiologists are not cardiac surgeons. The recurrent mislabeling of the specialty involved is yet another example of the slipshod treatment and lack of understanding of science and medicine in the lay press which makes for an ill-informed public."
https://marginalrevolution.com/marginalrevolution/2023/08/86...
"the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits."
Not sure if they accounted for delayed surgeries in the study.
That's sort of what I am wondering. Perhaps it just delays the inevitable - the patient is gravely ill is is going to die if they don't perform _potentially_ life-saving surgery. The surgery, is of course risky.
The conference delays the surgery, so the patient's surgery or other high risk procedures are delayed. This gives the patient a few more days of being ill, but doesn't probabilistically change the outcome of actually undergoing the procedure.
My understanding from listening to the author’s podcast, is that this is the proposed mechanism. There is a percentage of patients who were going to get better on their own anyway. But if they receive urgent care, it may cause harm.
The conclusion seems to be that there is a measurable percentage of patients who got surgery but didn’t need it and thus suffered greater harm than if they had been left alone. Because heart attacks are so critical, medical staff errs on the side of action instead of waiting. This seems reasonable, but may in fact be bad.
it’s a good podcast: https://freakonomics.com/podcast/what-happens-to-patients-wh...
1) The first date (and then-current surgery schedule) at the point when the conference dates where announced.
2) The date (and then-current surgery schedule) at the point, when the doctor booked his/her travel plans.
Both lists and dates will help you understand if changes in information also resulted in the changes of mortality (by rescheduling hard cases to a later date, for example).
Note: I said most, there are obvious exceptions.
This isn't to say outcomes are always good our knowledge is imperfect, people are imperfect, and not every situation has a good answer.
https://www.hopkinsmedicine.org/news/media/releases/study_su...
He said his doctor (an internist) was attending a medical conference for allergists, in the Bahamas. About 500 doctors attended.
This doctor was fearfully allergic to peanuts. Like, anaphylactic allergic.
He had an anaphylactic reaction to something he ate, during the main speaker banquet.
He died.
Surrounded by 500 allergists.
It's a bit like expecting a hacker to hack a network without their laptop.
(bit weird if HE didn't have his epipen on him though ...)
Maybe they should.
> It's a bit like expecting a hacker to hack a network without their laptop.
A real hacker can break into a network with some bubblegum, a pen, and a corgi.
I saw someone feel unwell at a party, nothing serious, just a drink too much, but half of the room happened to work in healthcare, and half of the room came to help. As expected it went all over the place, until a relative (also a doctor) came in, ousted the crowd and took proper care of the poor guy.
Dead Comment
Modern medicine is a miracle but struggles to evolve beyond many immediate hurdles. In an extreme minority of cases it can be better to avoid traditional intake methods.
Does this mean percutaneous coronary intervention [PCI] is over-applied, or something else?
There's other possibilities though. Like if the timing of other interventions is being delayed until the cardiologist is able to see the patient instead of deferring to a less specialized physician.
Interestingly, there were no differences in the number of procedures performed on meeting and nonmeeting days (it's not the surgeries that are killing people).
The hypothesis that I find most interesting is that the cardiologists who are at the meetings spend less time caring for patients and more time doing research, hence they aren't as good at caring for patients.
A couple of years ago some friends of ours invited us to lunch with a couple of their relatives who were in town for a cardiology conference. They (the relatives) were both stout* people, technicians of some kind rather than doctors, and the husband was super hung over from the previous night.
Anyway, they told us all about how the sessions at these things were pretty dry, but the after party was always a drunken, hours long slurry of alcohol and aorta-clogging food, and it was so ludicrously un-heart-healthy that it was a running gag.
So I'm wondering if the people who opt to go to those things tend to perform differently in their work than the ones who stay home and live quieter lives?
(*I only mention this because a few days after we had lunch, the husband apparently had a heart attack while he was driving, pulled off to the side, and died.)
source: https://freakonomics.com/podcast/what-happens-to-patients-wh...
https://en.m.wikipedia.org/wiki/Iatrogenesis