BMJ  2008;336:59 (12 January), doi:10.1136/bmj.39450.691169.3A

Letters

Financial ties that might bind

Consider palliative coronary intervention

The first 150 words of the full text of this article appear below.

The recommendation by Yank et al, that pharma sponsored drug trials should be interpreted with caution, is well made.1 Most percutaneous coronary intervention (PCI) procedures entail the implantation of a coronary stent. Most stent studies are funded by equipment manufacturers and are designed and conducted by researchers who believe in coronary intervention despite the lack of hard evidence of cost effectiveness or clinical superiority over optimal medical therapy.2 3

Therapists’ irrational faith in intuitive based practice adds an extra dimension to the "positive spin" effect described in the paper. Given the paucity of independently funded coronary stent studies and the total lack of a placebo controlled study of this palliative therapy, healthcare commissioners have a hard time unravelling spin, especially when professional bodies weigh in with their spin on the evidence.

The RITA-2 study showed that, although palliative PCI was associated with a small and transient improvement in symptoms, it increased . . . [Full text of this article]

Michael R Chester, director

1 National Refractory Angina Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L14 3PE

chester@angina.org


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