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 theheart.org (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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