Medical hype can be lethal, as ‘minimally invasive’ chest surgery shows

Doctors and hospitals have a right to blow their own horn a bit when they’re onto something good, don’t they? What’s the harm? Plenty, as reported by Healthnewsreview.org, an independent, nonpartisan health information watchdog site.

As part of a series on patient harm from misleading media, Joy Victory, the site’s managing editor, details the tragic results from superficial news stories, typically on smaller media outlets, that deceive patients and their families about the Nuss procedure, a surgery to correct a congenital condition that results in a concave or “funnel” chest (see photo).

This is a serious operation, as I know from my practice. But as Victory points out, this hard, cold fact somehow gets glossed over in glowing reports about the surgery, written by news services and by reporters at smaller papers in South Carolina, Virginia, and Myrtle Beach, Fla., and even in a larger daily in Kansas City, Mo.

In these one-dimensional articles, the surgery is promoted as low-risk and minimally invasive, so much so that stories talk about how young athletes can swiftly to return to playing ball after undergoing it.

But in concrete, practical terms, the Nuss procedure ─  for correction of pectus excavatum, what’s often more of a cosmetic-psychological than a direct health concern ─ requires the surgical installation of a metal bar in a youngster’s chest. It’s kept there for two years or more.

It’s true that the bar, and sometimes two of them, is put in place through small incisions, versus an earlier, more complex surgery in which patients’ chests had to be opened. To be sure, in some patients, the surgery may be required and beneficial for breathing and heart function, not just appearances alone.

One if my firm’s clients had her heart punctured in two places while the surgeon was trying to maneuver the Nuss bar from one side of her chest to the other. With emergency open-heart surgery, she barely survived.  When we pursued a malpractice case against the surgeon, one of the chief defenses, from experts including Dr. Nuss himself, was that this was just an unusual  complication that could have happened to any surgeon. Not something of course, that either my client or her parents had heard from the surgeon pre-op as one of the realistic risks.

There are other risks in the post-operative recovery period, as Helen Haskell, a mother whose 15-year-old son, Lewis Blackman, underwent the surgery, can never forget.

Young Lewis was in such agony that doctors prescribed potent opioid painkillers. Then, they gave him yet another pain medication ─ Toradol, a non-steroidal anti-inflammatory drug that comes with warnings about its risks for perforated ulcers and internal bleeding.

Though doctors and nurses knew the teen’s sunken chest surgery had not gone well ─ it was supposed to take 45 minutes but ran more than 2.5 hours as doctors kept repositioning that metal bar ─ Blackman’s post-op care was mostly left to lesser experienced medical residents. They failed to detect that he had an adverse Toradol reaction, and the drug had created a hole in his intestines.

He bled to death through it over several days, with an autopsy later showing most of the blood in his entire body had pooled in his abdomen. His parents say they frantically demanded more medical attention and assistance for their son, especially as he was wracked with pain.  The nurses and residents, however, never called in more senior doctors or surgeons.

Although the South Carolina children’s hospital where Blackman died settled with his estate for almost the maximum allowed under state law, his mother was unsatisfied and has followed up the steps that led to her family’s tragedy. As she explains what she found in her research to Victory:

The [medical] literature was exactly the opposite of what they were saying–it’s much more invasive, extensive, painful and a longer recovery than the old procedure… I am not saying that the Nuss procedure is a bad procedure. There are undoubtedly people who can benefit from the Nuss procedure. The problem is that it is not a low-risk procedure, and it has been highly promoted to healthy individuals as though it were extremely safe.

Victory points out that medical researchers have raised increasing questions about the Nuss procedure, even as news stories, such as in Kansas City, not only hype it but also report how surgeons want to “open new markets” by performing it on adults. That should require greater vigilance by skeptical journalists and potential patients because grown-ups’ chest walls are much less pliable than those in still-growing young people, Victory argues. Translation: If sticking a metal spacing bar in their chest hurts kids like the dickens, how will that go in adults, exactly?

In my practice, I see not only the significant harms that patients suffer while seeking medical services but also the major damage that can be wreaked on them when doctors fail to provide them informed consent. That’s a fundamental right, critical for all of us: It says that it’s every health care provider’s duty to ensure that you know fully your treatment options, and that you decide what path to take, without your being subjected to strong-arming , scare tactics, or misleading information from anyone, no matter their fancy degrees, medical specializations, or surgical reputations. You can’t be served up medical hype or bunk.

I’ve seen how this occurs with the Nuss procedure, and how fast it can go wrong. Would any young people or their parents choose this surgery over a slightly concaved chest, especially if they knew that it could result in a surgeon puncturing a patient’s heart several times while positioning that metal bar? Would medical marketers describe as “minimally invasive” or “low risk,” the resulting need for extensive, open heart surgery to remedy harms caused in a Nuss procedure?

Doubtful.  It’s yet another reason why patients and their families not only need to inform themselves, to be skeptics (not cynics) about medical services, and to work with medical safety advocates, like Healthnewsreview.org, and as Haskell as become. We all also need to reject and to stamp out medical hype that really can harm us.

 

Photo credit: Joel Cazares, MD

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