While recent lawsuits and research studies have raised questions about why some stent-happy cardiologists are implanting the tiny metal devices into the hearts of those who don’t need them, the group representing the doctors who implant those stents relies heavily on income from the very folks who make them. So say the Pulitzer Prize-winning investigative journalists over at ProPublica.
For example, the Society for Cardiac Angiography and Interventions (SCAI) received 57% of its total 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 in fact 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 also reported that the Heart Rhythm Society, which in 2010 got nearly half its $16 million in revenues from makers of drugs, catheters and defibrillators used to control abnormal heart rhythms, had sometimes left out or downplayed information about the risks and limitations of cardiac devices and procedures.
In January, for example, a study in the Journal of the American Medical Association found that more than one in five patients who received cardiac defibrillators did not meet science-based criteria for getting them.
Weeks later, the Heart Rhythm Society disclosed it was assisting a U.S. Justice Department investigation of the issue.
Two of the society’s biggest funders — Boston Scientific and St. Jude Medical — have paid millions since 2009 to settle federal allegations that they improperly paid kickbacks to unidentified physicians for using their cardiac devices on patients.
Industry not only provides financial support to Heart Rhythm, says ProPublica, but also paid many of its board members: 12 of 18 directors are paid speakers or consultants for the companies, one holds stock, and the outgoing president disclosed research ties, according to the society’s website.
For the American College of Cardiology as a whole, nearly 32% of its total consolidated revenue last year came from industry.
Meanwhile, SCAI’s immediate past president, Dr. Larry Dean, told ProPublica that industry funding has no influence on the group’s medical positions or treatment guidelines, and that it supports proper use of stents. One wonders then what Dean and other cardiologists in SCAI are doing to help implement the findings of the COURAGE trial, which found that 5-year outcomes for both patients with implanted stents and those who were put on medications alone turned out to be essentially the same.
Asked about doctors accused of implanting unnecessary stents in patients, Dean also said his group is not a “policing agency”, but takes the issue seriously and would expel any doctor found guilty of inappropriately implanting them. He also told ProPublica:
“I don’t think industry is driving the delivery of health care. The companies that make stents don’t drive it, either.”
Critics say these stent manufacturers are not spending millions solely for altruistic reasons. Dr. Gordon Guyatt, a health policy expert at McMaster University in Hamilton, Ontario, told ProPublica investigators:
“If it weren’t influencing the doctors, they wouldn’t be doing it.”
There are now fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.
Drug and device companies are required to report all payments they make to physicians by 2013, but payments to medical societies and other advocacy groups are not included.
And as the New York Times has reported, stents are big business, with powerful stent manufacturers like Johnson & Johnson, Abbott, Medtronic and Boston Scientific selling over $3 billion worth of stents last year alone. They have invested heavily in expanding the use of these stents; stent implants have become more popular as rates for the more invasive open heart bypass surgery have dropped. According to the Times:
“The specialists who are most likely to diagnose coronary artery disease are in many cases also the doctors who implant stents. Cardiac surgeons who do open heart coronary bypass procedures have seen their annual incomes dwindle to an average $425,000, down from $1.02 million in 1990 after adjusting for inflation. Meanwhile, the average income of an interventional cardiologist, as a stent specialist is known, has risen to $550,000 from an inflation-adjusted $392,000 in 1990.”
Read the rest of the ProPublica report.
- Cardiologists Accused of Implanting Coronary Stents That Weren’t Needed
- Say What? Do Patients Really Hear What Doctors Are Actually Telling Them? published on my other site, Heart Sisters
- Stent-happy Docs on Notice in Maryland Health Care Fraud Debate
- “You Can Lead a Cardiologist to Water, But, Apparently, You Cannot Make Him Drink”