Why Doctors Still Offer Treatments That May Not Help - The New York Times

When your doctor gives you health advice, and your insurer pays for the recommended treatment, you probably presume it's based on solid evidence. But a great deal of clinical practice that's covered by private insurers and public programs isn't.

The British Medical Journal sifted through the evidence for thousands of medical treatments to assess which are beneficial and which aren't. According to the analysis, there is evidence of some benefit for just over 40 percent of them. Only 3 percent are ineffective or harmful; a further 6 percent are unlikely to be helpful. But a whopping 50 percent are of unknown effectiveness. We haven't done the studies.

Sometimes uncertain and experimental treatments are warranted; patients may even welcome them. When there is no known cure for a fatal or severely debilitating health condition, trying something uncertain — as evidence is gathered — is a reasonable approach, provided the patient is informed and consents.

"We have lots of effective treatments, many of which were originally experimental," said Dr. Jason H. Wasfy, an assistant professor of medicine at Harvard Medical School and a cardiologist at Massachusetts General Hospital. "But not every experimental treatment ends up effective, and many aren't better than existing alternatives. It's important to collect and analyze the evidence so we can stop doing things that don't work to minimize patient harm."

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https://www.nytimes.com/2019/08/26/upshot/why-doctors-still-offer-treatments-that-may-not-help.html?

This Daily Pill Cut Heart Attacks by Half. Why Isn’t Everyone Getting It? - The New York Times

Giving people an inexpensive pill containing generic drugs that prevent heart attacks — an idea first proposed 20 years ago but rarely tested — worked quite well in a new study, slashing the rate of heart attacks by more than half among those who regularly took the pills.

If other studies now underway find similar results, such multidrug cocktails — sometimes called "polypills" — given to vast numbers of older people could radically change the way cardiologists fight the soaring rates of heart disease and strokes in poor and middle-income countries

Even if the concept is ultimately adopted, there will be battles over the ingredients. The pill in the study, which involved the participation of 6,800 rural villagers aged 50 to 75 in Iran, contained a cholesterol-lowering statin, two blood-pressure drugs and a low-dose aspirin.

But the study, called PolyIran and published Thursday by The Lancet, was designed 14 years ago. More recent research in wealthy countries has questioned the wisdom of giving some drugs — particularly aspirin — to older people with no history of disease.

The stakes are high. As more residents of poor countries survive childhood into middle age and beyond — and as rising incomes contribute to their adoption of cigarette smoking and diets high in sugar and fat — a polypill offers a way to help millions lead longer, healthier lives.

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https://www.nytimes.com/2019/08/22/health/heart-disease-iran-study.html