Watson Institute for International and Public Affairs

How Do Physicians, Policymakers Respond When a Procedure Proves No Better Than a Placebo?

October 12, 2018

In May 2018, Public Policy program director Eric Patashnik co-convened a workshop at Yale University in the aftermath of the ORBITA study finding. The following posts are part of the Health Affairs Blog series titled “ORBITA: Lessons from a Landmark Trial.”

Last November, the Lancet published a study called ORBITA, the first blinded, placebo-controlled trial of percutaneous coronary intervention (PCI), an invasive procedure in which a stent is inserted to treat stable angina, or chest pain. The study was shocking to the cardiology world, finding that PCI did not increase exercise tolerance, the primary endpoint, by more than the effect of a placebo procedure, in patients who were medically diagnosed with angina and severe coronary stenosis (arterial narrowing). The study brings up a slew of questions, including: How is the use of medical evidence shaped by the regulatory and policy environment? And why have few elected officials become advocates for reforms to strengthen the medical evidence base and correct failures of the medical profession’s self-regulation?

In hopes of addressing these questions, Professor Eric Patashnik and Yale University Professor Alan Gerber hosted a workshop with Yale’s Institute for Social and Policy Studies (ISPS), that brought together cardiologists, health policy experts, and former policymakers. The result was a number of essays that examine the broader significance of the study for ongoing efforts to improve the scientific foundation, quality, and cost-effectiveness of medical care.

To read more of Patashnik and Gerber’s introduction to the blog series, click here.

What It Means for Coronary Stenting in Stable Coronary Artery Disease – Darrel P. Francis

The Scientific Arc Bends Towards Truth – David L. Brown

Will ORBITA Change Clinical Practice? – William E. Boden

The Real Lesson of ORBITA: The Remarkable Power of Medical Therapy – Vikas Saini

Getting Physicians to Stop Delivering Low-Value Services – Shannon Brownlee

The Implications of ORBITA for Regulatory Review and Coverage Processes – Rita F. Redberg

A Policymakers’ Perspective on Comparative Effectiveness Research: History and Prospects – Tom Allen