Trials, temptations, disappointmentsall are helps instead of hindrances

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While 19 th Century writer James Buckham may have an idealistic perspective about adversity, some legislators attempting to reform healthcare and cardiovascular researchers attempting to seek out better outcomes may find it difficult to maintain this optimism when confronted by such disappointments.

Senator Max Baucus waited to unveil the Senate Finance Committee version of healthcare reform until mid September, months after the Senate HELP Committee and the House bills had endured months of debate, and a week after President Obama presented his vision of reform through his Sept. 9 speech.

Even though Baucus’ bill does not contain the highly contentious public option, after two failed attempts at inclusion last week, there is some speculation that this legislation will not pass through the Senate. However, one bright spot for these lawmakers is Wednesday’s preliminary analysis from the Congressional Budget Office found that this bill could potentially reduce the federal deficit over the next 10 years, even with its current mark-ups.

Likewise, cardiovascular researchers are not getting the results they expect. The IRIS trial, published today in the New England Journal of Medicine, found that ICDs implanted after a heart attack do not reduce overall mortality among patients with acute MI, especially for deaths unrelated to sudden cardiac death—results that surprised the researchers.

Yet, the fight goes on. The highly anticipated DAPT trial, which is seeking to assess the appropriate duration of dual-antiplatelet therapy following drug-eluting stent implantations, officially began enrolling patients. The four-year public health study is powered to evaluate the benefits of 12 versus 30 months of dual-antiplatelet therapy.

Also, the NIH has awarded a $4 million grant to the American College of Cardiology (ACC) and the Society of Thoracic Surgeons (STS) to study the comparative effectiveness of PCI compared with coronary artery bypass graft (CABG) surgery. Though surgeons and interventionalists have long debated the benefits of each treatment method for patients with coronary artery disease, this trial will ideally help provide more convincing evidence for the patient population—much like Buckham suggests about trials.

The completion of Buckham’s quote is that these complications can become helpful, “if one uses them rightly. They not only test the fiber of a character, but strengthen it.” As these trials play out in the halls of Congress and clinical research labs, the legislators and physician champions could become more emboldened about the proper direction through their learned disappointments.

On these topics or any others, feel free to contact me.

Justine Cadet