information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
physician before making any lifestyle or medication changes, or if you
have any other concerns regarding your health.
CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY
great deal of attention is being directed at reducing preventable
and deaths following surgery. Because
much clinical data is available for coronary artery bypass graft (CABG)
it has long been used a model for studying risk reduction following
an important aside, increasing pressure is being exerted upon surgeons
hospitals to achieve high levels of compliance with specific “quality
parameters that have been put into place by Medicare and other large
these criteria have already
become etched in stone, many of them of have been implemented despite a
any high level research evidence showing a direct correlation between
benchmarks and clinical outcomes.
are already some very strong feelings among many physicians and
administrators regarding the imposition of these new “quality
guidelines in the absence of compelling research data to support them. A new research paper in
the journal Circulation adds more
fuel to the fires
burning over this very controversial topic.
CABG operations, and for several other complex, high-risk operations,
cumulative death rates following surgery have long been used as a
measure of overall quality of care.
Indeed, mortality rates for CABG surgery at individual
increasingly, be found published on websites sponsored by the
insurance industry and other groups.
this study from Ontario, Canada,
a retrospective analysis of
347 randomly selected in-hospital deaths following CABG surgery at 9
hospitals was performed. Two
consultant heart surgeons reviewed summaries of the charts from these
while being blinded to patient identification as well as both the
surgeons and the hospitals involved in the care of these patients. In those cases where the 2
were not in complete agreement, a third cardiac surgery consultant was
all 9 hospitals, the overall risk of death associated with CABG surgery
very impressive 1.3 to 3.1%. However,
when the cardiac surgeon consultants completed their analysis of these
perioperative deaths, they determined that 111 of them, or 32%, were
preventable (in 86% of these deaths, problems in the operating room
to have contributed to the death of patients, while 61% of the deaths
to have also involved problems in the intensive care unit following
primary reviewers jointly
agreed that 32% of the patient deaths appeared to involved deviations
established perioperative care guidelines, while 42% of the deaths were
considered by at least 1 reviewer to have involved significant
established care guidelines.
find the results of this study to be simultaneously stunning and
to what I—and many other surgeons—intuitively believe.
While all of us strongly desire to drive
complication and death rates after surgery to the lowest possible
numbers, many of the current indicators of “quality of care” that have
implemented thus far are probably not valid tools for monitoring the
events that they were designed to detect.
Regarding preventable perioperative deaths following CABG
this provocative study found absolutely no correlation between the
mortality statistics at 9 different hospitals and the presence of a
percentage of apparently preventable deaths, and despite the current
use of overall mortality rates as the primary benchmark of “quality of
findings of this study are important, and suggest that we need to find
indicators of preventable complications and deaths other than the
standard of overall mortality. With
enormous pressures facing all aspects of healthcare in the United States
today, we simply cannot afford to base critically important healthcare
and performance-improvement decisions upon faulty and inaccurate
statistical benchmarks. The
results of this study should serve as a
wake-up call to both the healthcare insurance industry administrators
imposed these faulty standards upon all of us; as well as physicians
administrators, the vast majority of whom genuinely desire to deliver
highest possible quality of care to their patients.
written about the potential anti-cancer effects of green tea, including
many research studies that I have reviewed in this column (please see
archives, below). A
new research study,
just published in the journal Gastroenterology,
adds additional important information to our understanding about the
green tea, and its active ingredients, on the development and
several interesting experiments using epigallocatechin-3-gallate, the
active compound in green tea. This
extract of green tea was first applied to human colorectal cancer cells
in a culture dish. A
series of complex
laboratory tests determined that the green tea extract significantly
the presence of the protein basic fibroblast growth factor, which has
implicated, along with several other proteins, in tumor cell growth and
part of this study, mice with a genetic defect that results in a 100%
colorectal cancer had their diet supplemented with the green tea
a control group of similar mice did not receive this supplement). Once again, the
researchers found that the
mice treated with the green tea extract had decreased levels of basic
fibroblast growth factor in their colorectal tumor cells. Moreover, supplementation
with green tea
extract resulted in considerably fewer colorectal tumors when compared
mice that did not receive the extract.
this study provide intriguing insight into the potential caner
effects of green tea, and at the molecular level.
Several human clinical trials are already
underway, looking at the effects of green tea on cancer prevention and
treatment. As we
have seen with other
areas of clinical research, what works in Petri dishes and laboratory
doesn’t always translate well to humans.
It will be interesting to see what the long-term results
human green tea clinical trials will tell us about the potential
and therapeutic effects of green tea.
DISORDER (ADHD) & ST. JOHN’S
children with ADHD are, understandably, reluctant to see their children
the powerful stimulant drugs that are most commonly prescribed for this
condition. As with
many other illnesses,
people often turn to herbal supplements and other “natural remedies” as
alternative to prescription medicines.
John’s Wort, also
known by its scientific name, Hypericum
perforatum, is a
plant with worldwide distribution, and has been touted as a remedy for
variety of ailments, including ADHD.
A new prospective,
study, just published in the Journal of the American Medical
reports on the effects of St. John’s
Wort supplements on children and adolescents with ADHD.
The design of this research study conformed
to the highest achievable level of clinical research in that neither
patients nor the researchers knew who was receiving St. John’s
Wort and who was receiving a
placebo (sugar) pill of identical appearance until after the study was
from the following
institutions participated in this study: the School
of Naturopathic Medicine
at Bastyr University
in Washington, the
General Hospital, and Harvard University.
In this study, 54
children and adolescents with ADHD were randomly assigned to receive
John’s Wort or a
placebo pill 3 times per day, for 8 weeks.
No other ADHD medications were permitted during the course
clinical research study. At
the end of
the study, all patients underwent reevaluation of their ADHD. One of the patients
withdrew from the study
due to side effects from the pills, leaving 53 patients who completed
there was no discernible difference between the two groups of children
of inattentiveness and hyperactivity.
fact, there was no significant difference in overall ADHD scoring
between the group
of children who received St. John’s
Wort and those who received the inactive placebo pills.
this study are, unfortunately, consistent with an increasing number of
recent high-quality clinical research trials that have looked at St. John’s
other herbal or “natural” remedies, for the prevention or treatment of
these kinds of clinical
research trials were performed, the largely unregulated sales and
promotion of dietary
supplements allowed manufacturers to make almost any health claims they
as long as they included the necessary disclaimer indicating that the
not assessed the validity of any such claims.
Even today, the multi-billion dollar supplements industry
completely unregulated, except with regards to industrial hygiene at
world is taking a greater interest in evaluating many of these
this kind of research will not
only debunk the often absurd claims made for the beneficial effects of
supplements by their manufacturers but, perhaps, will also validate the
potential health benefits of at least some of the hundreds of different
supplements currently being produced and sold.
this particular study, although rather small, was well-designed and
and it did not find any apparent benefit associated with St. John’s
Wort in children and teenagers
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.