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    Sunday, October 16, 2005

    Conventional Wisdom II: A reader sends this reflection on medicine and technology:

    For those who believe that advances in medical technology equal advances in health care, that because we can do something we should do something, the case of the Swan-Ganz catheter is instructive. Last week's JAMA contains 2 studies, one a randomized controlled trial, the other a meta-analysis, showing lack of efficacy of the Swan-Ganz in managing various diseases. It took us more than 40 years to determine that something as simple and intuitively useful as a pulmonary artery catheter is, in most cases, useless, and in some cases, harmful. What's next for the scrap heap of medical history?


    For almost thirty years, the Swan-Ganz catheter, or pulmonary artery catheter, a catheter that is threaded through the right side of the heart and floated into the pulmonary artery, has been used to measure the cardiac and pulmonary status of very sick patients. For most of those years, it was assumed that it was the best standard of care. If we can measure something, then we should measure it. Its measures were used to guide therapy to insure the best outcomes.

    Except that no one knew for sure if it actually made those outcomes better. Everyone just assumed it. Then, about ten years ago, studies began to suggest that perhaps patients did worse when they had pulmonary artery catheters. The procedure, after all, isn't without risk. Anytime you place a foreign body in the heart, you're courting complications. But still, there was little evidence - pro or con - for the procedure.

    But now, it appears, the pulmonary catheter doesn't add much to the therapy of heart failure beyond what can be achieved with non-invasive clinical observation, and it confer much in the way of benefits for other critical illnesses, either.

    As in so many other areas of medicine, it is sometimes better to just stand there than to do something.
     

    posted by sydney on 10/16/2005 01:58:00 PM 0 comments

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