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Cardiac Society Draws Bulk of Funding From Stent Makers

The Society for Cardiac Angiography and Interventions got more than half its income in 2009 from medical device and pharmaceutical makers. This week, a study in JAMA questioned why more patients who received angioplasty and stents didn’t first receive recommended medications.

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A poster for the Boston Scientific drug-coated stent at a conference in 2006. Boston Scientific is one of the biggest funders of the Society for Cardiac Angiography and Interventions. (Thomas S. England/Bloomberg via Getty Images)

A Pittsburgh hospital informed 141 patients earlier this year that they may have received unneeded angioplasties and stents, the tiny mesh tubes inserted to keep arteries open.

A Towson, Md., cardiologist faces a hearing on the fate of his medical license after being accused of implanting stents unnecessarily in more than 500 patients.

And this week, a new study found that more than half of patients with stable heart disease who received angioplasty and stents didn't first receive medications, as scientific guidelines recommend.

While a host of lawsuits and research studies has raised questions about the overuse of stents, the group that represents cardiologists who implant them relies heavily on income from the makers of these devices.

The Society for Cardiac Angiography and Interventions (SCAI) received 57 percent of its revenues in 2009 from medical device and pharmaceutical makers, according to financial information on the group's website.

Industry contributions to the society's budget covered $4.7 million of the $8.2 million it received that year.

The group's biggest funders are the companies with the biggest share of the stent market: Cordis Corp. (a subsidiary of Johnson & Johnson), Boston Scientific, Abbott Laboratories and Medtronic.

Researchers who study conflicts of interest in medicine say medical societies that receive a lot of industry support are susceptible to taking positions that either promote their sponsors' products or downplay their risks.

ProPublica reported last week that the Heart Rhythm Society, which gets nearly half its revenues from drug and device makers, had sometimes left out or downplayed information about the risks and limitations of cardiac devices and procedures.

SCAI's immediate past president, Dr. Larry Dean, said industry funding has no influence on the group's medical positions or treatment guidelines and that it supports proper use of stents.

Asked about doctors accused of implanting unnecessary stents in patients, Dean said his group is not a "policing agency" but takes the issue seriously and would expel any doctor found guilty of inappropriately implanting them.

Stents are big business.

From fiscal 2004 to 2009, Medicare paid about $25.7 billion for inpatient hospital stays in which a patient received a cardiac stent. From calendar years 2005 to 2009, Medicare paid doctors approximately $1.3 billion for 248,116 procedures, government records show.

This week's study about stent use in the Journal of the American Medical Association did not look at the role SCAI or other medical societies played in treatment decisions. One of the authors, however, said such groups need to play a role in ensuring that doctors practice medicine in line with the best scientific evidence.

"Our study should be viewed as ... an important stimulus to societies, providers, physicians and health care organizations to try to optimize medical therapy," said Dr. Alvin Mushlin, chairman of the public health department at New York Presbyterian/Weill Cornell Medical Center. "I think there are plenty of opportunities to do more."

Dean said the study doesn't demonstrate the influence of industry on practice but rather "how difficult it is to educate the masses of cardiologists out there in practice." Other studies, he said, have shown that the vast majority of stents have been implanted properly, particularly for patients with acute heart problems.

"I don't think industry is driving the delivery of health care," Dean said. "The companies that make stents don't drive it either."

A report released last year by the U.S. Senate Finance Committee suggests that the field of interventional cardiology has done little to discourage overtreatment.

The committee's report cited an internal document from Abbott Laboratories describing a medical advisory board meeting in October 2007. Among the topics mentioned was a large clinical trial that recommended patients with stable heart disease be given drugs before receiving angioplasty and stents.

One of the "key takeaways" of the board meeting was that panelists "revealed candidly that they're [sic] profession has done a better job promoting PCI [percutaneous coronary intervention] than policing it and that some of these practices have alienated their fellow cardiologists," the senate report quoted the Abbott document as saying.

SCAI receives a significantly higher proportion of industry funds than the American College of Cardiology, which last year took in less than a third of its revenues from drug and device makers.

Dean said his group would like to have a similar ratio of industry funding. But without raising dues or registration fees, he said, that could be tough.

About 20 percent of SCAI's industry money is passed along to hospitals that run training programs for interventional cardiologists. Other funds are used to provide educational programs for doctors and raise awareness of heart disease among the public, he said.

Industry funding "has allowed us to do a lot of things that we would not have been able to do otherwise," Dean said.

Membership societies, representing every specialty of medicine, play a critical role because they help set treatment guidelines used by physicians across the country, lobby for Medicare coverage and research funding, and provide information about diseases and treatments to the public.

Experts said that while many societies are eager to discuss the latest advances in their fields and ways in which drugs and devices may be underused, they spend less time talking about possible overuse.

In 2008 and 2009, Sens. Charles Grassley, R-Iowa, and Herb Kohl, D-Wis., targeted another cardiac group, the Cardiovascular Research Foundation, which holds annual gatherings to show off advances in stents and heart catheters.

The senators accused the research group's leaders of failing to disclose millions of dollars they received from industry to Columbia University, with which the foundation is affiliated.

Columbia told the senators that the doctors received some of the money before they became employees and therefore did not have to disclose it. The university adopted a new policy on financial conflicts of interest in research in 2009.

Sharon Schuster

May 13, 2011, 4:17 p.m.

Three years ago a stress echocardiogram registered a 3 on a 5 pt. scale in a single area.  All other areas showed nothing.  Two cardiologists in the same practice (I’d asked for a second opinion) wanted to do an angiogram and, if indicated,put in stent(s).  I basically said hold off, I want to try medication first.  I went on Coreg and Benicar and two subsequent nuclear imaging stress tests and another stress echocardiogram came out normal. Their recommendations has left me somewhat anxious that I might have made the wrong decision and should have had accepted their angiogram/stent recommendations.  But rationally, I think, the subsequent tests showed my caution justified….I hope!  Your article makes me feel better about my decision. Thanks!

“Membership societies, representing every specialty of medicine, play a critical role because they help set treatment guidelines used by physicians across the country, lobby for Medicare coverage and research funding, and provide information about diseases and treatments to the public.”

The Infectious Disease Society of America (IDSA) is the perfect example of how industry infects all aspects of these so called medical societies’ decision making processes. As a matter of record the CT AG had to threaten the IDSA with an investigation of antitrust violations in order to get Lyme literate doctors on the panel that makes treatment recommendations.  Millions are suffering from Lyme disease and can’t get treatment because the industry-funded societies like the IDSA are biased in favor of industry guidelines.  Doctors that dared to treat patients of Lyme disease with long-term antibiotic were targeting by the insurance industry and some were suspended or had to go out of business.  People’s lives are ruined and many are getting over treated with expensive products that are repeatedly shown to have fatal flaws that were ignored.  The stent is no different and once it is in you cannot take it out while you are still alive.  And at the very least some have allergic reactions to the metal they use.  Oops, too late.

In addition the cardiologists are likely to use proven-to-be toxic contrasting agents that at times results in death.  So if the medical device doesn’t kill you hope for the best in that you don’t wind up with an allergic reaction to the metal or being screened to death with gadolinium based contrasting agents used for MRIs and MRAs.

I spent over 20 years as a “detail man” and another 20 defending doctors in malpractice suits.  As public money for research has been reduced or redirected, teaching institutions and medical organizations have become more and more dependent on industry money.  I was around in the early 1960’s when the rules regulating the way drugs/devices were promoted were tightened and I watched them all unravel, particularly after the Reagan Revolution.  It wasn’t just in the financial arena that this kind of laxity was allowed to spread.
I worry that the established credentialing peer review boards (as opposed to some of these “societies”) may also become infected with more industry money sufficient to influence their ethics.

Brian Stevens

May 17, 2011, 9:13 a.m.

If we don’t allow industry to be involved in funding research, development, and medical education then it will have to come from the government, ie US.  That means higher taxes and/or more debt.  I believe the majority of doctors are not influenced by industry even if they do get research money from them.  How many people do you hear saying “Go to my doctor, he is crooked and the worst”.  My doctor showed me what some of these guidelines look like that are referred to in this article.  They are hundreds of pages long and filled with discussion on the research that the guidelines are based on.  They are not just straight ‘do and don’t’ statements that are followed blindly. 

As far as the comment on the stents and medicines issue, my cardiologist (who I will disclose happens to be my neighbor) says it’s much more complex than just saying they are equal.  However, he also said the underlying problem is the way physicians are paid.  Their pay continues to decline on a yearly basis based on cuts….they have data saying that medications or stents are pretty much equal, yet they get paid to put in a stent and not to prescribe a medicine.  So of course there is incentive to put in a stent.  They aren’t working for free for all of us. 

It’s always impressive to put up big Medicare dollar numbers for stents or anything else, but since half of us die from heart disease, maybe we should be spending a lot on cardiology and healthcare.

The underlying problem is our healthcare system as a whole, not the fact that industry is helping to fund medical societies instead of our tax dollars.

Classic “straw man” approach, Brian, arguing with something nobody said.  I never suggested private industry should not be allowed to be involved in research and nobody suggested that all doctors are crooked. Maybe you can read my post and the article again and address the real issues.

vonbargen

May 17, 2011, Noon

Oh, and show me a doctor who can’t be bothered to read hundreds of pages of instructions and guidelines and I’ll show you a doctor who is still prescribing slippery elm bark and castor oil.

This article is part of an ongoing investigation:
Dollars for Doctors

Dollars for Doctors: How Industry Money Reaches Physicians

ProPublica is tracking the financial ties between doctors and medical companies.

The Story So Far

ProPublica is investigating the financial ties between the medical community and the drug and device industry. In October 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors.

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