The four operations discussed on the following pages are overperformed for a variety of reasons: Some are moneymakers for hospitals and doctors, others are expedient, and still others seem to work, at least in the short term. But evidence shows that all have questionable long-term outcomes for treating certain conditions, and some may even cause harm. Here's what to do if your doctor recommends one of them.
1. Stents for Stable Angina
Stents are tiny mesh tubes that surgeons use to prop open arteries carrying blood to the heart. If a patient is having a heart attack, a stent can be a lifesaver. But for heart disease patients with stable angina — chest pain brought on by exertion or stress — a stent is not better at preventing a heart attack or prolonging survival than lifestyle changes such as exercising and taking statins to lower cholesterol, according to a landmark 2007 Department of Veterans Affairs study.
Despite stents' ineffectiveness, close to 500,000 are implanted each year for stable chest pain, says Sanjay Kaul, M.D., a cardiologist at Cedars-Sinai Heart Institute in Los Angeles. Surgeons frequently insert the stents during heart-catheterization procedures to evaluate patients' blood vessels, says Lee Lucas, Ph.D., an epidemiologist at Maine Medical Center Research Institute, who argues that the catheterization should be done first as a diagnostic test, and stenting done later, if necessary. "This should be a two-stage procedure, but patients never get to leave the cath lab to think about it," says Lucas.
Alternatives to Surgery
If your doctor orders a heart catheterization, ask that he or she wait to perform any treatment such as stenting in a separate procedure. Even before submitting to a heart cath, make sure you've explored other alternatives. Have you had a stress test? Do you adhere to a strict diet, exercise, or take medications to manage your cholesterol? "The reality is that 20 percent of patients who undergo this [catheterization with stents] do not have any symptoms, 30 to 50 percent have not had a stress test, and 30 percent are not treated with medical therapy first," says Kaul. If plaque is forming in your arteries, this is a systemic disease; a stent won't keep even a full inch of your arteries clear. You'll still need aggressive medical therapy to prevent future problems.