Doctors, Pharmaceuticals, and Statisticians
By Arnold Kling
The study, called the Courage Trial, enrolled 2,287 patients at 15 VA medical centers and another 35 hospitals in the United States and Canada. It was sponsored primarily by the VA and the Canadian Institutes of Health Research. Most of the researchers involved have received consulting and lecture fees from major drug companies.
All the patients had at least a 70% blockage of their coronary artery and had chest pains several times per week. Most also had high cholesterol and high blood pressure and many had diabetes.
…All of the patients were placed on multiple medications, including beta-blockers, ACE inhibitors and diuretics to lower blood pressure, statins to decrease cholesterol and blood thinners to prevent clots. They were also counseled about lifestyle programs for smoking cessation, increased exercise and a better diet.
Half the patients also underwent angioplasty and most of them received a stent — a wire-mesh tube inserted into the artery to hold it open after the balloon is withdrawn.
After an average of 4.6 years of monitoring, there were 211 deaths, heart attacks or strokes in the group receiving angioplasty and 202 in the group receiving only drug therapy.
The conclusion is that the angioplasty on average provides no benefit in terms of longevity. The thinking of the researchers is that the other therapies, particularly the medications, take care of the artery problems.
Doctors think that they add value by giving advice on issues such as angioplasty. But the advice of statisticians may be better.
Doctors also think that drug companies earn too much money. But it may be the doctors who earn too much money.
I predict a collision between doctors and statisticians somewhere down the road.