There's nothing like a famous public figure to illustrate a medical lesson, as our friends over at Celebrity Diagnosis well know. But a new post on HealthNewsReview.org — a widely respected health journalism watchdog site — brings that art to new heights. You may not normally be interested in inside-baseball medical battles about how widely used blood thinners like Coumadin should be prescribed, but does this get your attention?
"...if Clinton takes a VKA [Vitamin K antagonist like Coumadin] or other oral anticoagulant continuously over the next 11 ¼ years (i.e., throughout 2 more Presidential election terms should she win in 2016 and 2020), her cumulative risk of fatal bleeding, would be about 55% (1 – 0.994^135 months). Even if she had only the all ages risk of major and fatal bleeding over the next 11 ¼ years (major bleeding: 0.29%/patient-month and fatal bleeding: 0.09%/patient-month), her risk of catastrophic bleeding before 2025 would be considerable (major bleeding: 32% (1 – 0.9971^135 months) and fatal bleeding: 12% (1 – 0.9991^135 months).
The post's author, Dr. David K. Cundiff, argues that the current guidelines for prescribing Coumadin and other anticoagulants are skewed too heavily in favor of prescribing the drugs, despite the harms they may cause. He writes that the guidelines' evidence base is weak, and possibly biased by financial conflicts of interest, and that we need to improve the process for setting such hugely influential guidelines.
Read the full post here for his cogent policy points, but I must confess that what stuck in my mind was his take on Hillary Clinton's public medical record and how it could affect the next presidential campaign:
In the International Study of Cerebral Venous Thrombosis (ISCVT), the largest study of CVT patients ever completed (n=624), a thrombophilia (type of hypercoagulability) was noted in 34% of patients. If Clinton has a thrombophilia diagnosed after two venous thromboses, she is likely to be recommended lifetime Coumadin under the AHA/ACC guidelines, which now guide common clinical practice. At some point in the run up to the Presidential primaries, she will probably have to disclose whether she has a thrombophilia. Consequently, the clinical practice guidelines recommending anticoagulants for CVT could potentially be a factor in selecting our next president. This highlights the importance of the evidence basis of anticoagulant treatment for Clinton or any CVT patient.
Note: Health News Review's funding recently ran out and its future is uncertain. In our opinion, it would be a real loss to American health journalism.
This program aired on December 2, 2013. The audio for this program is not available.