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The Takeaway: Surgery to Stop Strokes Doesn't Work; Appeals Court Upholds Health Care Mandate

preventive stroke surgery proved unsuccessful- a portrait of Dr. William Powers
Stroke-Prevention Surgery A Bust: Doctors had high hopes for an operation designed to prevent strokes, but a $20 million federal study on the procedure was cut short when it became apparent that it didn't work, the New York Times reports. The surgery-intended to improve blood flow to the brain in people with blocked carotid, or neck, arteries-was not helping, researchers reported in The Journal of the American Medical Association. Patients who had the surgery and followed a strict regimen of drugs to lower their risk of stroke fared no better than those who took the drugs alone. But brain surgeon David Langer told the  New York Times that despite the results, the study was important.

"Surgeons don't want to be doing bad operations," Dr. Langer said. "Whenever you have a paper like this, we're all disappointed, because we like to operate. But in the end it's a good thing."

This is the second stroke prevention method that's fallen short of expectations recently-in September, researchers reported that stents used to prop open blocked arteries in the brain were actually causing strokes.

In an editorial accompanying the study results, neurologist Joseph P. Broderick said the failure highlights the peril of assuming improvements like better blood flow or a wider artery will translate into less strokes. He also cautioned that other stroke treatments, such as devices that remove clots, were still being used without sufficient study.

+1 For the Individual Mandate: A conservative-leaning federal appeals court yesterday ruled Barack Obama's health care law-including the individual mandate, the core requirement that Americans buy health insurance or pay a penalty-is constitutional.

That a direct requirement for most Americans to purchase any product or service seems an intrusive exercise of legislative power surely explains why Congress has not used this authority before - but that seems to us a political judgment rather than a recognition of constitutional limitations," Judge Laurence Silberman, who was appointed by President Ronald Reagan, wrote in U.S. Court of Appeals for the District of Columbia's opinion.

This latest ruling makes two appellate court rulings upholding the individual mandate and the health care law at large; one striking down the individual mandate (but not the whole law); and an appeals court in Virginia ruling that it was premature to decide the law's constitutionality. "Careful reasoning by judges has led to different conclusions in the courts, which suggests that the Supreme Court has its work cut out for it," said Kevin Walsh, an assistant professor at the University of Richmond School of Law who has been tracking the challenges.

The U.S. Supreme Court is meeting in private tomorrow to decide whether to take on the issue. "The stakes are huge going into the case," Stanford University law professor Pamela Karlan told USA Today. "The case will determine how much power the federal government has to deal with life in the 21st century, health care being among the most important issues."

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Photo: Sid Hastings/New York Times/Redux

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