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New Business June 9, 2009, 4:36PM EST

Giving Patients the Data They Need

A growing effort by doctors, insurers, and politicians helps people make better-informed medical decisions

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Each year, more than 1.3 million Americans undergo angioplasty Eduardo Contreras/San Diego Union Tribune/ZUMA Press

By John Carey

Editor's note: For related stories on CBS Evening News, done in collaboration with BusinessWeek, click here, or go to CBS Evening News and search for angioplasty.

Whenever researchers compare drugs or treatments to see which works best, somebody's ox gets gored. Such "comparative effectiveness" studies have already cast doubt on expensive new blood pressure and schizophrenia drugs, as well as spinal fusions and other surgeries. And the latest case involves a very expensive ox: a heart procedure known as angioplasty.

Each year, more than 1.3 million Americans have their clogged arteries widened with a tiny balloon and then kept open with slender mesh tubes called stents, made by companies like Johnson & Johnson (JNJ) and Boston Scientific (BSX). The total bill for these angioplasties is more than $21 billion a year. But while many patients and doctors firmly believe that angioplasties prevent heart attacks, the data say otherwise. A series of studies—the newest published in the June 11 issue of The New England Journal of Medicine—finds that stable patients with chronic heart disease who have the procedure get little benefit compared with similar patients treated just with drugs, such as Pfizer's (PFE) cholesterol-lowering Lipitor and other statins, and aspirin. "There are still many patients who undergo angioplasty without really understanding that it will not reduce chances of heart attacks or death—though it will reduce symptoms," says Dr. Judith S. Hochman, director of the Cardiovascular Clinical Research Center at the New York University School of Medicine.

That's why there's a growing effort, led by physicians, health insurers, and even state legislatures, to make sure patients truly understand the medical evidence about angioplasty and other treatments and procedures. Once informed, the patients are encouraged to make their own choices. This idea goes by the somewhat clunky name of shared, or informed, decision-making. Instead of being routinely whisked in for a prostate screening PSA test, for instance, men would first be told that major studies have failed to show the test saves lives. What's more, the test increases the chances a patient will undergo surgery or treatments that cause incontinence, impotence, and other problems. "The fact that PSA screening is more likely to cause mischief than save a life is not intuitive to patients or even physicians," says Dr. Paul J. Wallace, medical director for health and productivity management programs at health-care provider Kaiser Permanente, which is testing this approach.

savings potential

Studies show this process, using comprehensive videos and other materials prepared by groups such as the nonprofit Foundation for Informed Medical Decision Making (FIMDM), leads patients to choose conservative options more often. It reduces rates of angioplasty or prostate surgery, for instance, by 15% to 30%. Put into widespread use, the approach has the potential to trim hundreds of billions of dollars from the nation's $2.4 trillion health-care bill. Yet patients do as well or better than if they had opted for the procedures. Surveys done after the decision also show patients to be more satisfied, no matter which choice they made. "That's the kind of win that doesn't fall into your lap very often," says Washington State Senator Cheryl Pflug, a Republican.

A nurse and health-reform advocate, Pflug two years ago pushed through the nation's first law encouraging the use of informed decision-making. One prod to action was seeing the wide variation in the rates of procedures in the state of Washington, suggesting that some patients were being overtreated. Another was a sobering medical experience in the family of one of Pflug's staffers. The staffer's 90-year-old mother could no longer use her right arm after a stroke, though she was still able to live independently. Then a lump was discovered in her breast. Her doctor wanted to do a radical mastectomy, saying it could add 20 years to her life. And, on top of that dubious assessment, he failed to inform the mother that surgery might cost her the use of her remaining arm. After the staffer dug up this information, her mother said no to the surgery.

In today's health-care system, such sharing of evidence is rare—and financial incentives are heavily skewed toward doing more surgeries and other procedures, not fewer. Doctors and hospitals get hefty paychecks for interventions but not for spending the time needed to discuss the full evidence with patients. "The payment system is upside down. To get paid more for doing more is not the right answer," says Dr. James N. Weinstein, chair of orthopedic surgery at the Dartmouth-Hitchcock Medical Center.

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