We Don’t Just Have an Image Problem – We’ve Got Enemies
My first blog for the Journal of Invasive Cardiology commented on the image problem that cardiologists face in the media and popular culture. Coronary stenting is one of the most commonly performed procedures in the world, so it is understandable that some might look for chinks in the armor, if for no other reason than to contain costs. There has been a concerted effort to go beyond an objective assessment of appropriateness and instead an anti-technology fervor has arisen so that there is no acknowledgment of the value of drug-eluting stents.
For example, the editor of a prestigious internal medicine journal has initiated a feature to “document cases in which less health care results in better health care.” It seems reasonable to explore such experiences, however, it seems there is a not-so-hidden agenda that suggests that this goes beyond exploration and this feature is in fact being used to fortify an anti-technology position in a journal read by physicians with an important role referring patients to interventional cardiologists.
I became aware of her (the editor’s) antipathy to interventional cardiology when she was used as a consultant by the Washington State Health Technology Assessment (even though she is not from Washington State) where she argued that drug-eluting stents should not be afforded reimbursement. In her arguments she refused to acknowledge any value at all to drug-eluting stents. Given that approximately two thirds or more of coronary stent implantation procedures involve drug-eluting stents, her stance is clearly inconsistent with the opinions of the majority of interventional cardiologists, who use these stents and care for these patients. Other evidence of her anti-interventional cardiology leanings may be found in her letter to the editor of The New England Journal of Medicine, regarding the PARTNER study of transcatheter aortic valve implantation. In this letter she referred to balloon aortic valvuloplasty as an “outdated, dangerous procedure” and therefore argued that the benefits seen with transcatheter aortic valve implantation were “unfounded”.
There are other well-known academic individuals who also seem to gain attention in the medical and lay community solely by criticizing the work of others, without any clear body of constructive research to suggest a sense of balance. Interesting as this group of individuals might be, regarding this ethical question of seemingly non-financial conflicts of interest, it is further intriguing to realize that there may be opportunities for financial support for academics who thrive on destructive diatribe. For example, the Parsemus Foundation is an organization with an anti-angioplasty platform and they are providing funding for the anti-technology section ("Less is More") mentioned above. This financial relationship has not been included as a disclosure in the journal. In addition, a new series. “Health Care Reform,” has been launched (which is to address, in part, conflict of interest issues) and still no apparent acknowledgement of these very real, very powerful, conflicts of interest, which are directed at, and damaging to, the interventional cardiology community.
Thus, we, the interventional cardiology community, should probably be aware that we not only have detractors (one might even say enemies). Perhaps our failure to be concerned about less commonly addressed conflicts of interests (that is, those not arising from industry) might have important implications in our ability to care for our patients, to alleviate their suffering. Perhaps we need to be more attentive. I would be interested to know where readers think our community should go from here.
Steven L. Goldberg, MD is the Director of the Cardiac Catheterization Laboratory at the University of Washington Medical Center in Seattle, where he is a Clinical Associate Professor of Medicine. He also serves as the Chief Clinical Officer for Cardiac Dimensions, Inc., a small biotech company in Kirkland, Washington.
