Good News Also Deserves Attention

The current model of attention has downsides

I wrote this week, on Sensible Medicine, a summary of the DanGer-Shock trial of a mechanical assist device in patients with cardiogenic shock due to acute myocardial infarction (heart attack).

The trial was positive. It showed that the device lowers death rates over standard of care.

Yet my summary post did terrible. Few comments, likes and the traffic was low.

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I’ve spent the last few years being skeptical about the microaxial flow pump, brand-named, Impella. Why? Because it is costly. Because no trial to date had shown it to be effective. Because FDA approved it without proper data. Because doctors and hospital are compensated well for its use—which may be a reason why it became a popular device.

But.

DanGer-Shock was a proper trial. Danish investigators took 11 years to enroll the patients they felt most likely to benefit. And the device worked.

For patients who had the worst kind of myocardial infarction, use of the device reduced the chance of dying by 26% in relative terms. The absolute risk reduction was a whopping 12.7%. The number needed to save a life was amazingly small at 8. Most cardiac therapy trials have NNTs of 50-100.

Yet the column did terrible.

This is not how medical writing should go. The company that makes the device is a strong marketer. Doctors are paid well to use the device. Everyone makes money.

But now we have strong evidence that if the support device is used in the correct patient, it can save a life. That is darn good news.

If you or your loved one has cardiogenic shock due to a heart attack, and you are similar to the 360 patients enrolled in this trial, your odds of survival are higher if the doctor uses this expensive device.

It is sad that contrarian articles get more attention. There is plenty wrong with profit-driven healthcare. The incentives sometimes make for bad behavior.

Sometimes though the incentives benefit people. I will keep telling you about that.