The New Health Dialogue

Larry Husten, a medical reporter who specializes in cardiology, wrote a post over the weekend responding to my piece on the blog last week about a donation from the Parsemus Foundation to the "Less is More" series in the Archives of Internal Medicine. The Parsemus Foundation, in Husten's view, is biased against angioplasty and stents, and the grant to the Archives represents a conflict of interest. Husten goes on to suggest that the Archives didn't want to disclose the fifty grand it got from Parsemus Foundation, which he calls, "medical Luddites who stand against one of the most important advances in modern medicine."

Wow. "Medical Luddites." We're talking about a family foundation with nothing to gain financially from a decline in the use of angioplasty and stents. When we talk about conflict of interest in medicine, the topic is usually the billions of dollars spent by the drug and device industries to influence physicians, systematically bias medical science, and pack medical journals with studies that amount to what psychiatrist and medical critic Barney Carroll calls "experimercials." Richard Horton, editor of the British medical journal, The Lancet, went further in an essay in The New York Review of Books:

"Indeed, medical journals have become an important but underrecognized obstacle to scientific truth-telling. Journals have devolved into information-laundering operations for the pharmaceutical industry."

The Parsemus Foundation hardly seems to be in the same league in terms of its power to sway medical opinion, but maybe there's a deeper issue here with regard to the Less is More series. In an editorial launching the series in 2010, Archives editors wrote that it was intended to "highlight situations in which the overuse of medical care may result in harm, and in which less care is likely to result in better health." The fact is, Less is More represents a tiny dissenting voice in a medical literature that for the last 50 years has been saying, in effect, More is More. It's hard to imagine this little series could possibly feel like a threat to physicians and the other powers that be in medicine. Then again, here's what a cardiologist just wrote me in an otherwise thoughtful email: 

"It is generally accepted that the "spin" of the Archives series has been against angioplasty and interventional medicine. When this is presented in a one-sided way, this undermines the perceived benefits that a procedure can provide. So rather than proposing a "less is more" message, I think it's far more constructive to promote a "Use when indicated" message with point/counterpoints on overuse/appropriate use. "

You can only view the Less is More series as one-sided spin if you ignore the mountain of papers published over the last three decades extolling the benefits of cardiac procedures, and the fawningly positive stories in the popular press. I don't mean to diminish the sound and careful research that cardiologists have conducted in recent years in an effort to improve patient outcomes. There's more good science being done in cardiology than most other fields of medicine. Even so, Less is More represents a much needed antidote to a medical culture that is steeped in the opposite message.