Abuse of coronary artery stent by cardiologists.

NEW YORK, NY ” An article in yesterday’s financial press surveys recent high-profile cases of alleged coronary-stenting overuse, described by a sources as “just the tip of the iceberg,” and alternates them with stories from some of the patients involved[1]. Although there are a few comments from leaders in the cardiology community that try to put the cases in perspective, the 3500-word story ultimately portrays a subspecialty too often abused by practitioners bending or ignoring the guidelines in pursuit of procedure-based profits.

“When stents are used to restore blood flow in heart-attack patients, few dispute they are beneficial,” notes the story from reporters Peter Waldman, David Armstrong, and Sydney P Freedberg published yesterday in Bloomberg BusinessWeek . But heart attacks account for only about half of stenting procedures, it notes.

“Among the other half —elective-surgery patients in stable condition—overuse, death, injury, and fraud have accompanied the devices’ use as a go-to treatment,” the article says, citing “thousands of pages of court documents and regulatory filings, interviews with 37 cardiologists and 33 heart patients or their survivors, and more than a dozen medical studies.”

Coronary stenting “belongs to one of the bleakest chapters in the history of Western medicine,” the article quotes Dr Nortin Hadler (University of North Carolina, Chapel Hill).

Most of the story’s words are devoted to the cases of alleged overuse, many of which have been settled and have been covered previously by news organizations. They include the case of Dr Samuel DeMaio , who is said to have implanted 21 coronary stents in one patient over an eight-month period. The patient’s later death was related to the placement of “unneeded stents,” according to the Texas Medical Board.

There is also the case of Dr John McLean of Salisbury, MD, a cardiologist convicted of billing for unwarranted stenting, who “argued in a federal appeal last year that inappropriate usage is widespread, and [he] was prosecuted for behavior that’s the industry norm.”

Also described is the broader story of Baltimore cardiologist Dr Mark Midei, whose “license was revoked in 2011 when the Maryland Board of Physicians found he falsified records to justify unwarranted stents.”

A hospital at which Midei worked, St Joseph Medical Center in Towson, MD, “paid the government $22 million without admitting liability” after “at least five hospitals” settled with the Justice Department “over allegations that they paid illegal kickbacks to doctors for patient referrals to their cath labs.”

Those are only a few of the abuse cases covered by article. Considerably less space is devoted to potentially balancing observations from cardiologists or others in the field. Overall, “Doctors are using fewer stents and choosing more appropriate patients than they were a few years ago, according to Dr John Harold [David Geffen School of Medicine at University of California, Los Angeles and the Cedars-Sinai Heart Institute, Los Angeles, CA], president of the American College of Cardiology.” Harold contends that “cardiologists who’ve been accused of fraud or are serving prison time are ‘outliers’ who don’t represent the overwhelming majority.

References:Coronary-Stenting Abuse Cases Highlighted in Bloomberg Story