Overuse of heart stents and the response of Abbott Labs

“Someone needs to take this writer out and kick his ass.”

The quote leaped out at me from a New York Times article.

Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I am a writer. Maybe I am especially sensitive about threatening to kick someone’s ass for writing about healthcare. To my eyes, the quote stood out as emblematic of the tumor of waste at the heart of healthcare economics.

The quote was from an email, written (according to the NY Times) by Abbott Laboratories executive David C. Pacitti. The owner of the targeted ass was the author of an article in the Baltimore Sun about a Baltimore cardiologist who had become a champion installer of Abbott Labs’ stents, until someone complained that a second opinion showed that the stent was unnecessary. The hospital where the cardiologist had installed these stents put together an independent panel of experts to review the medical records. Looking just at the period of January 2007 to May 2009, this panel found that the cardiologist, a Dr. Mark Midei, had installed 1878 stents in that period. In their group second opinions, they felt that at least 538 stents may have been medically unnecessary.

The NY Times summarized what followed: “When asked to review the cases himself, Dr. Midei found far less blockage than he had initially, according to the Maryland Board of Physicians. The hospital suspended his privileges and eventually sent letters to all 585 patients. Hundreds of lawsuits against Dr. Midei and St. Joseph followed, including from patients treated well before January 2007.”

Abbott Lab’s response to the controversy was to hire him as a consultant. After all, he had long been a celebrated exemplar of all that they found estimable in a doctor. As an Abbott executive put it in an email, “It’s the right thing to do because he helped us so many times over the years.” In August 2008, when Dr. Midei had put in a record 30 stents in one day, Abbott threw a massive barbecue for him to celebrate. They bought a whole roast pig.

A whole roast pig

Out of all the possible imagery that we might associate with healthcare, what could be better a better symbol to call up than a whole roast pig?

That’s right, let’s celebrate the outliers. They are heroes, avatars of the age, benefactors of the suffering. Let’s not refer to sound medical evidence, the gathered and collegial understanding of medical researchers, the peer-reviewed literature, to decide what to do and to defend what has been done. No, let’s use money, lawyers, and PR firms. And threats to kick the ass of anyone who says otherwise.

At a time when the country is drowning in the costs of the largest national industry of any kind in the history of the world, when there is incontrovertible evidence that at least 30 percent and perhaps much more of that cost is simply wasted and useless, when tens of thousands every year die from lack of access to good sound medicine, and tens of thousands more from complications of unnecessary, imprudent, unhelpful procedures, let’s not bend our corporate efforts to making healthcare actually better and cheaper for everyone. Let’s bend every corporate asset necessary to doing more and more of whatever makes the most money – and fighting or silencing anyone who complains.

From the NY Times article:

A landmark 2007 study published in the New England Journal of Medicine showed that many patients given stents would fare just as well without them. … Prosecutors, malpractice lawyers and state medical boards are only now waking up to the issue. The Texas Medical Board last month accused a widely known cardiologist in Austin of inserting unnecessary stents. In September, federal prosecutors accused a cardiologist in Salisbury, Md., of performing unnecessary stent surgeries, and last year a Louisiana doctor was sentenced to 10 years in prison for inserting unneeded stents. “What was going on in Baltimore is going on right now in every city in America,” said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who said he routinely treats patients who have been given multiple unneeded stents. “We’re spending a fortune as a country on procedures that people don’t need.”

Cases are legion

Cases like this are legion, and they are an ongoing and gut-wrenching amazement to me and to anyone who looks at them squarely. Our capacity for surprise seems endless, but we should not be surprised at all. After all, our system of healthcare is mostly financed as “fee for service,” that is, it does not pay clinicians or pharmaceutical companies or device manufacturers to heal, or to keep us healthy. It pays them to do procedures and tests, and to sell products. And people, by and large, do what you pay them to do. And some people will do as much as they physically can.

Now the Senate Finance Committee has looked into the case, and issued a voluminous report that does not seem to have come down on the side of Abbott Labs and Dr. Midei. Committee chair Max Baucus (D-Montana), commented, “Hospital patients expect their care to be based on medical need, not profits. Even more disconcerting is that this could be a sign of a larger national trend of wasteful medical device use.”

The lawsuits are ongoing. I have not been holding my breath for a mea culpa, an apology, a new and bracing accession of humility by Abbott Laboratories or the good doctor, and it has not happened. According to the NY Times, Abbott Labs has only said that its affiliation with Dr. Midei ended early this year: “‘Dr. Midei has been a highly regarded physician in his field, with whom Abbott had consulted in the past,’ said the spokesman, Jonathan Hamilton. ‘We have no further comment at this time.’ Meanwhile, Dr. Midei has apparently decamped to Prince Salman Heart Center in Saudi Arabia, where perhaps he will be less bothered by lawsuits, Senate committees, or questioning peers. Meanwhile, his lawyer, doing what he is paid to do, continues to insist that Dr. Midei will be completely exonerated.”

If Abbott Labs wants to celebrate heroes of medicine, let them celebrate the volunteer doctors and nurses who have been in Haiti facing riots and deprivation and their own health to fight the ghastly and ongoing cholera epidemic. Or the volunteers who staff free clinics for the massive crowd of the uninsured that descend on them across our own blessed land. Or the doctors and nurses by the thousands and scores of thousands who come to work every day to do their best by the patient, with the best medical knowledge available, even when their decisions do not make them the most money possible.

But Abbott Labs, like many parts of this massive, profligate industry, does not seem to celebrate heroes of medicine. It celebrates heroes of selling, champions of installing their products.

Sometimes, in the right light, on the right morning, healthcare in the U.S. looks like the world’s most amazing scientific and humanitarian enterprise, a vast and noble struggle to end suffering. Far too often it looks like an eating contest, with table after table of people face-deep in pies, sausage, chili, poi, pudding, cheeks smeared and dripping, gorging away. Yeah, let’s celebrate that. Buy another whole roasted pig. Tie balloons to the trees.

Joe Flower is a healthcare speaker, writer, and consultant who blogs at Healthcare Futurist: Joe Flower.

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