Angioplasty and Stents Are Ineffective in Treatment of Some Heart Symptoms

Another Window Into the World’s Most Inefficient Health Care Delivery System

When a person has a heart attack, one procedure is to use angioplasty to insert a stent into the heart artery.  A study published in the Journal of the American Medical Association found that this is appropriate treatment nearly all the time.

When a person may have symptoms indicating a potential heart attack might happen, the same study found that this procedurewas ineffective and inappropriate at least 12% of the time and maybe as much as 50% of the time.  Here are some parts of the article in the WSJ that reported on the JAMA study.

About 600,000 angioplasty procedures, which almost always involve placement of a tiny metal tube called a stent, are done in the U.S. each year. Roughly 70% of these procedures are performed on patients suffering symptoms of a heart attack and aren't medically controversial. But the remainder are done on stable patients who are suffering mild symptoms or no symptoms at all. Of those, 50% are deemed appropriate, 38% uncertain and 12% inappropriate, the report says.

And

One big warning sign that stents were likely being implanted unnecessarily in some patients came in 2007 when the New England Journal of Medicine published a study known as "Courage" by a Buffalo, N.Y. cardiologist named William Boden. The Courage study, which tracked 2,287 patients for five years, showed stents weren't any better than a cocktail of medicines to treat patients suffering from chronic but stable chest pain.

Why might the medical profession do a procedure that is not appropriate or effective.  Here’s a clue.  The procedure costs $20,000. 

 Need more evidence?

Last December, the Senate Finance Committee released a report on a Maryland cardiologist, Mark Midei, who allegedly performed unnecessary angioplasties on hundreds of patients. Dr. Midei was suspended by his hospital, St. Joseph Medical Center in Towson, Md., and charged with unprofessional conduct by the Maryland State Board of Physicians.

The Senate report revealed that Abbott Laboratories, one of the biggest makers of stents, hired Dr. Midei as a sales consultant after St. Joseph's barred him from operating on patients. Abbott also feted Dr. Midei in 2008 with a $1,407 pig roast when he implanted 30 stents in a single day, setting what may have been a company record.

Let’s see, 30 stents in one day at $20,000, how much would that be?  Well if The Dismal Political Economist can do the math, and he can as he was a star econometrics student, the number is $600,000! And don’t forget the pig roast.

And in case anyone thinks this is an isolated case, we have this from the same article.

Last week, The Spine Journal, the official publication of the North American Spine Society, published a study revealing that surgeons who collectively received tens of millions of dollars from medical-device giant Medtronic Inc. failed to report serious complications in a dozen research papers they wrote about a Medtronic bone-growth protein.

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So, U. S. you have two choices.  You can reform the health care delivery system away from the fee-for-service model, or you can continue to have stories like this, rising costs and ultimately pricing many people out of needed health care.  Doesn’t sound like a tough decision, does it?