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October 13, 2006 -- 2:06pm ET

Note to Reporters: Attribute Your Sources, Especially When They're Me!
They say, "there's no such thing as bad publicity". I would add, "unless it's no publicity".

A month ago, Arlene Weintraub of BusinessWeek requested an interview with me. She was writing an article on the upcoming Transcatheter Cardiovascular Therapeutics (TCT) conference and had read my scintillating commentary from last year's meeting . So naturally she wanted to talk to me.

With great hesitation I agreed, mainly to gain some publicity for our website, Angioplasty.Org. I told myself to be very careful, because, as I have opined in the past, "...the media's thirst for a sexy (or death-y) headline will not go unquenched! "

She went with death-y.

Her article "Medicine In Conflict " appeared online yesterday (co-authored by Amy Barrett) and by the second paragraph, she had already zeroed in on the unfortunate death of a patient two years ago during the TCT. The patient was being given a new aortic valve, percutaneously -- that is, via catheter instead of via open surgery. The valve, BusinessWeek points out, was manufactured by a company co-founded by Dr. Martin Leon, the Director of the TCT. The procedure was televised "live" from Milan, where Dr. Antonio Colombo, one of the pioneers in interventional cardiology, was attempting to perform this very new procedure. The patient developed serious problems and the broadcast was ended. It was later announced that the patient had expired -- the second time this had occurred in over 500 cases done since the TCT began.

The implication in the BW article, of course, was that Dr. Leon was using the TCT to publicize a device he would profit from. The BusinessWeek article states:

Did Leon's financial stake in the experimental device play a role in its being promoted at an important conference where he is the most prominent figure? "Absolutely not," Leon says. The question, he adds, "borders on being offensive."

The question also borders on being uninformed.

The fact is that the 77-year-old patient who died was very sick and frail to begin with. Had the BusinessWeek reporter understood anything about the protocol for performing these types of experimental interventional procedures, she would have realized that this patient had already been rejected for surgery -- his chances of surviving an open surgical procedure were nil. The percutaneous aortic valve was the only alternative to his slowly and painfully wasting away.

Also, had the reporter read the summary of the case published in (September 28, 2004), she would have discovered what the autopsy revealed: that the aortic valve had been placed perfectly, but that the very sick patient died of heart failure -- his heart wouldn't have survived standard surgery and unfortunately it didn't tolerate this minimally invasive procedure either.

Considering the feeble state of the patient, for Dr. Leon to have used this case to promote his device, he would have to be considered a very poor businessman, which he most definitely is not!

As for me, when I was asked during the interview for interesting or out-of-the-ordinary events that I had seen at the TCT, I related the surrealistic atherectomy of the opera singer from La Scala. (I happen to have a rare copy of that broadcast from Milan -- Marty Leon gave it to me for a video I was producing and John Abele, co-founder of Boston Scientific, showed my copy at TedMed as an example of innovative medical communications.) Ms. Weintraub writes:

At the 1997 conference, Italian cardiologist Antonio Colombo (the same doctor whose patient died during the 2004 event) transmitted a live procedure during which he used a tiny motorized device to clear plaque from a professional singer's artery. On camera the patient began singing O Sole Mio to the accompaniment of a guitarist sitting by his side.

It was a bizarrely entertaining moment, fully participated in by physician, patient and accompanist (in scrubs) to the crowd's delight. The only problem is that Ms. Weintraub failed to attribute the story to me (at least in the online version). I spent almost an hour on the phone with the reporter, carefully parsing my words so that my observations about medicine, money and devices would not be misquoted. The good news for me was that I wasn't misquoted; the bad news was that I wasn't quoted at all.

I'm not going to talk here about the TCT and whether or not the large sums of money flying around the Washington Convention Center in less than two weeks have any untoward effect on healthcare and patients. But I can strongly urge readers to view the epilogue of my 1997 documentary, "PTCA: A History" (RealVideo Player required) in which the pioneers of angioplasty specifically discuss the conflicts inherent with marketing and physician-entrepeneurs.

And it's not an either-or issue. Doctors can be inventors. Inventions need capital to be developed. Rights, patents, inventorship, venture capital, speaker fees, stock options all figure into a complex mix which can be abused.

Many of the issues raised by Ms. Weintraub in the BusinessWeek article are very valid and very important -- and they are issues that we have been concerned with for years. Has the field of interventional cardiology been oversold? Are too many procedures being done? Cardiologists have answered this question for themselves. In a recent unscientific poll, 71% said that percutaneous coronary interventions are "grossly overused". On the other hand, in a study by the journal Health Affairs, balloon angioplasty was named the 3rd most important medical innovation since 1975.

So the issues are not as simplistic and certainly not as clandestine as BusinessWeek suggests. If you attend the TCT (or any of the major heart meetings held throughout the world) the scent of capitalism is right out front. The physicians are standing in front of what vascular surgeon Sir Peter R. F. Bell described to me as "a tidal wave of dollars".

I also would direct readers to an article about the TCT that appeared in the New York Times 8 years ago. That piece, entitled "Where Marketing and Medicine Meet" (in contrast to BusinessWeek's "Medicine in Conflict") was written by Gina Kolata and I feel gave a picture of what the TCT meeting is like that is much more accurate.

It would have to be more accurate. The BusinessWeek reporter told me she had never attended a TCT meeting and so was trying to get the flavor of it by talking to people like myself.

So glad to be of service. Next time, tell 'em Burt sent you....

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