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    Experts Find Dangers in Emphysema Surgery


    One surgical team found only 4% of the patients died within six months after the surgery. The death rate among patients getting traditional treatment with medicine was 17%. And the benefits seemed to last for years after the procedure. Again, treatment was focusing around patients with severe emphysema.

    But this week, other researchers have said that initial optimism probably went too far.

    "There has been a prevailing view -- that I think unfortunately surgeons have contributed to -- that this operation may be a temporary cure for your disease, and it's clear that it's not for this subset of patients," said one of the researchers, Steven Piantadosi, MD, PhD, of Johns Hopkins University.

    A pioneer in the surgery, Joel Cooper, MD, downplayed the findings. He said they were predictable because patients reported in the latest findings suffered from disease that was widely spread around their lungs. He said they were bad candidates for the surgery in the first place.

    Cooper said his team dropped out of the five-year study in 1997 over this and other disagreements, including a condition that all participating surgeons stop doing the surgery outside the study.

    He also said administrators at the federal Medicare program for the elderly, which is funding the study, are seeking justification to limit, delay, or deny coverage for the surgery, which typically costs from $25,000 to $40,000.

    "Medicare has used the trial for its own purposes," said Cooper, a lung surgeon at Washington University in St. Louis.

    An official at the Centers for Medicare and Medicaid Services said the agency didn't interfere with the scientific decision making. The official spoke on condition of anonymity, which is agency policy.

    Gail Weinmann, MD, project officer for the study at the National Institutes of Health's Heart, Lung and Blood Institute, said surgeons agreed to forgo surgery outside the study because they saw a need for systematic research.

    "There was a concern about the spread of the procedure so quickly, and that it could be doing harm," she said.

    The surgery was first tried more than 30 years ago with disastrous results. Improvements in anesthesia, surgical methods and postoperative care revived it in the 1990s. It is based on the idea that smaller, but healthier lungs can work better after the operation.

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