Language can be extraordinarily powerful. Words and labels hold hidden meanings that can trigger powerful, emotional reactions. In some cases, once a name has been given to something, it can be nearly impossible to take it back.
This Bloomberg article discusses one example of this phenomenon. A decision made early on in the use of coronary stents later took on all kinds of unintended consequences. The American College of Cardiology (ACC) set up the initial guidelines.
The first stenting guidelines appeared two years after the Courage study spawned arguments about whether stents are ever appropriate for stable patients. The ACC wanted to get ahead of the debate before insurers or the government imposed their own standards, according to Manesh Patel, an interventional cardiologist at Duke University Medical Center who chairs the writing group for the guidelines, officially called the “Appropriate Use Criteria for Coronary Revascularization.”
“We could participate in change, or have change thrust upon us,” said Patel in an interview. The guidelines represented “a first step down the road of self-regulation,” he said.
By using the term appropriate, it appeared to leave stent placements outside of those use cases as "inappropriate." As healthcare costs continue to escalate, that loaded term is now being challenged by regulators and insurers.
“The term ‘inappropriate’ caused such a visceral response,” said Hendel, a cardiologist at the University of Miami. “A lot of regulators and payers were saying, ‘If it’s inappropriate, why should we pay for it, and why should it be done at all?’”
The cardiology group replaced the “Inappropriate” label with “Rarely Appropriate.” Another category -- cases in which there’s medical doubt -- will switch from “Uncertain” to “May be Appropriate.”
The changes reflect the controversy that has enveloped coronary stents, which are threaded through the circulatory system on catheters to prop open blocked arteries. With 700,000 procedures in the U.S. annually -- at an estimated cost of $14 billion -- appropriate use of the devices has become one of the hottest issues in cardiology. Eight studies have found stents are no better than drug-based therapy in preventing heart attacks and death in patients with stable heart disease.
According to Sanjay Kaul, a researcher at Cedars-Sinai, inappropriate uses of stents are estimated at $2.4 billion annually.
Here is the link to the full article: http://www.bloomberg.com/infographics/2013-10-29/when-coronary-stents-are-inappropriate.html
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