12 Seconds of Placebo – An Outsider’s View of ORBITA

By, SAURABH JHA MD   The reactions of physicians to ORBITA, a blinded, randomized controlled trial (RCT) from Britain, with a sham arm, comparing percutaneous coronary intervention (PCI) to placebo, in patients with stable angina, are as fascinating as the cardiac cycle. There were murmurs, kicks, and pulsating jugulars. Though many claimed to be surprised, and many unsurprised, by the null results of the trial, the responses were predictably predictable. Some basked in playful schadenfreude, and some became defensive and bisferious. No shame in sham The coverage of the trial in the NY Times was predictably jejune and hyperbolic. Predictably, the most nuanced and divergent viewpoints were curated by Larry Husten. Predictably, medical Twitter was set alight. The trial vindicated Vinay Prasad and Adam Cifu who predicted that PCI for stable angina will get placeboed, in their popular book, Ending Medical Reversal. Prasad and Cifu are tireless advocates for using sham control trials to judge the true efficacy of procedures, such as PCI, in relieving symptoms, and reject the notion that invasive placebos are unethical. There’s no shame in sham, they say. They were right. The Objective Randomized Blinded Investigation With Optimal Medical Therapy in Stable Angina (ORBITA) is an impressive trial, which enrolled 230 patients with stable angina and single vessel stenosis greater than 70 %. The vast majority had class 2 (59 %) and class 3 (39 %) angina. Majority of the patients,...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs