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Here's an alternate and more informative headline for anyone who wants a bit more detail rather than clicking through and trying to skim for the needle in a dig

Here's an alternate and more informative headline for anyone who wants a bit more detail rather than clicking through and trying to skim for the needle in a digital haystack: >>> "At 88, doctor pursues clot-busting medication combination to aid in treatment of heart attacks and strokes"

downrightmike 9y ago
This is a much better title. Considering that the now favored course of action is surgery, a potent drug combo would be my choice. Once you start cutting, Docs often want to keep cutting.
- projektfu 9y ago
  The favored course of action is interventional radiology and those guys like to get done and move onto the next patient to rake in the dough.
  - neuro_imager 9y ago
    Actually, its interventional cardiology for heart attacks and neurointerventional surgery/interventional neuroradiology(NIR) for strokes. (Not IR which cover non-neurological and non-cardiological interventional procedures). I'm a NIR and most of us are not paid per surgery/intervention. Also these interventions tend to be loss leaders in terms of hospital reimbursements. Funding for stroke centres can be profitable but that's a very long discussion. In addition, at least 7 randomized clinical trials have shown the benefit of thrombectomy in acute stroke (actually something of a modern medical technological miracle).
    - projektfu 9y ago
      I find that surprising. What's the typical compensation model? Salary or hourly?
      - neuro_imager 9y ago
        Salary (unless you're moonlighting - which is less common, and overall less attractive). Why do you presume that our intentions are nefarious when you have no idea what you're talking about?
        projektfu 9y ago
        I don't at all presume nefarious intentions. As if physicians don't try to make money. My original comment was a tongue in cheek defense of the status quo because I took offense at the comment that surgeons just like to keep cutting. Sure, I'm "just" a veterinarian, but I like to cut as little as possible. I do know that doctors like to keep it moving. Surgeons like to start early and finish early. Nobody wants to get bogged down in a specific procedure. As far as profitability (or cost recovery, whatever euphemism) is concerned, doing several short procedures beats one longer procedure, even when surgery time is billed by the minute. You ignore the fact that many doctors leave the strict employ of the hospital for a private practice that still bills through the hospital. While they are still salaried, they also get a profit share, usually divvied out on productivity. There is no one model. But you're right, I have no idea how it's typically done in IR, NIR, IC etc.
        neuro_imager 9y ago
        For the sake of completeness, I'll expand: It's rarely up to the interventionalist if and when they will treat a stroke. There are clear guidelines on treating these patients (which mostly take place at comprehensive stroke centres), mostly defined by the neurology service, which functions somewhat independently. These guidelines have been expanding as newer evidence has shown a role in wider time windows but this point remains the same. There is very little opportunity for an individual interventionalist to increase his patient volume independently (at least for ischemic stroke). I agree in principle with most of the points you make, although I think perverse incentives are largely a function of the US healthcare system in general rather than the domain of any particular specialty. In specific relation to the original article, I'm extremely doubtful that combing two anti-thrombotic agents would be a miraculous therapeutic regime for treating stroke but I'd be happy to be proved wrong by a legitimate trial. However, I'd worry that we'd be sacrificing patients that could otherwise be treated if we assigned them to an arm of a trial that precludes established therapy.
kbenson 9y ago
Considering a large part of the story is about how he's not been able to get people interested or informed for decades, I think you dropped a useful bit of information.
- arkades 9y ago
  In fairness, that was the lens the narrative played up. The other side is, “doctor pursues combination of two apparently shitty drugs for decades without anything but armchair hypothesis for support despite massively accumulating evidence that they suck independently, fails to garner attention/interest.” He might be right, but I’d hesitate to lean too hard on the lone genius angle.
IncRnd 9y ago
That is 26 characters too long to work at HN.

downrightmike 9y ago

This is a much better title. Considering that the now favored course of action is surgery, a potent drug combo would be my choice. Once you start cutting, Docs often want to keep cutting.

projektfu 9y ago
The favored course of action is interventional radiology and those guys like to get done and move onto the next patient to rake in the dough.
- neuro_imager 9y ago
  Actually, its interventional cardiology for heart attacks and neurointerventional surgery/interventional neuroradiology(NIR) for strokes. (Not IR which cover non-neurological and non-cardiological interventional procedures). I'm a NIR and most of us are not paid per surgery/intervention. Also these interventions tend to be loss leaders in terms of hospital reimbursements. Funding for stroke centres can be profitable but that's a very long discussion. In addition, at least 7 randomized clinical trials have shown the benefit of thrombectomy in acute stroke (actually something of a modern medical technological miracle).
  - projektfu 9y ago
    I find that surprising. What's the typical compensation model? Salary or hourly?
    - neuro_imager 9y ago
      Salary (unless you're moonlighting - which is less common, and overall less attractive). Why do you presume that our intentions are nefarious when you have no idea what you're talking about?
      - projektfu 9y ago
        I don't at all presume nefarious intentions. As if physicians don't try to make money. My original comment was a tongue in cheek defense of the status quo because I took offense at the comment that surgeons just like to keep cutting. Sure, I'm "just" a veterinarian, but I like to cut as little as possible. I do know that doctors like to keep it moving. Surgeons like to start early and finish early. Nobody wants to get bogged down in a specific procedure. As far as profitability (or cost recovery, whatever euphemism) is concerned, doing several short procedures beats one longer procedure, even when surgery time is billed by the minute. You ignore the fact that many doctors leave the strict employ of the hospital for a private practice that still bills through the hospital. While they are still salaried, they also get a profit share, usually divvied out on productivity. There is no one model. But you're right, I have no idea how it's typically done in IR, NIR, IC etc.
        neuro_imager 9y ago
        For the sake of completeness, I'll expand: It's rarely up to the interventionalist if and when they will treat a stroke. There are clear guidelines on treating these patients (which mostly take place at comprehensive stroke centres), mostly defined by the neurology service, which functions somewhat independently. These guidelines have been expanding as newer evidence has shown a role in wider time windows but this point remains the same. There is very little opportunity for an individual interventionalist to increase his patient volume independently (at least for ischemic stroke). I agree in principle with most of the points you make, although I think perverse incentives are largely a function of the US healthcare system in general rather than the domain of any particular specialty. In specific relation to the original article, I'm extremely doubtful that combing two anti-thrombotic agents would be a miraculous therapeutic regime for treating stroke but I'd be happy to be proved wrong by a legitimate trial. However, I'd worry that we'd be sacrificing patients that could otherwise be treated if we assigned them to an arm of a trial that precludes established therapy.

kbenson 9y ago

Considering a large part of the story is about how he's not been able to get people interested or informed for decades, I think you dropped a useful bit of information.

arkades 9y ago
In fairness, that was the lens the narrative played up. The other side is, “doctor pursues combination of two apparently shitty drugs for decades without anything but armchair hypothesis for support despite massively accumulating evidence that they suck independently, fails to garner attention/interest.” He might be right, but I’d hesitate to lean too hard on the lone genius angle.

IncRnd 9y ago

That is 26 characters too long to work at HN.