First let me start by reiterating my personal definition of corruption. It is far more expansive than merely an indictable act. Let me quote directly from our book, “Illinois Deserves Better.”
Many people may object to our use of the word “corrupt” in describing something as broad as “Illinois’ political class.” We do not apologize. Corruption takes many forms, and most of them are not “indictable offenses.” As you find out more and more about Illinois government, you will see that it allows many people to engage in things that are “wrong” even if they are not illegal.
We think “corrupt” is a valid term for these acts and actors.
With that definition in mind, let me introduce you to a corrupt business practice of the American Medical Industry.
The study, known as “Courage” and published in the New England Journal of Medicine in 2007, shook the world of cardiology. It found that the most common heart surgery—a $15,000 procedure that unclogs arteries using a small scaffold or stent—usually yields no additional benefit when used with a cocktail of generic drugs in patients suffering from chronic chest pain.
The Courage trial was led by William Boden, a Buffalo, N.Y., cardiologist, and funded largely by the Department of Veterans Affairs. It tracked 2,287 patients for five years and found that trying drugs first, and adding stents only if chest pain persisted, didn’t affect the rate of deaths and heart attacks, although stents did produce quicker pain relief.
Steven Nissen, then chairman of the American College of Cardiology, called the study a “blockbuster.” Shares of leading stent maker Boston Scientific Corp. fell on the day the news broke, as many doctors and investors expected stent usage to fall off.
For a brief while, they were right. U.S. stent implants declined 13% in the month after the study’s release. But as the headlines about Courage faded, stentings soon began to rise again, and are now back at peak levels of about one million a year, according to hospital surveyor Millennium Research Group.
There you have it. A procedure that we can almost certainly do without, and it still lives on. Why?
In 2008, the Courage study faced a key challenge. A Washington state agency called the Health Technology Assessment Program, or HTAP, announced it would consider putting Courage’s findings into practice.
The agency, empowered to change coverage decisions for the state’s Medicaid program and some public-employee health plans, commissioned a review of the evidence backing stents. That process could have led to limiting the procedure’s use in the state’s Medicaid program and health plans for some state employees.
Certain cardiologists, as well as stent manufacturers, rallied to resist the review. In policy papers submitted to the agency, they argued that the Courage study had not included the latest models of stents, which were introduced after the study began, and should not be used to require all patients to attempt drug therapy first.
Other than Leah Hole-Curry, an attorney who heads HTAP, the agency has only one employee. State law requires it to outsource its reviews to private research firms. For the stent review, it hired a Seattle firm, Spectrum Research Inc.
Spectrum decided it needed more medical expertise to tackle the issue, and convened an August 2008 conference call with Ms. Hole-Curry, representatives of stent makers, and a number of interventional cardiologists.
According to an audio recording of the call, Spectrum’s researchers asked for assistance paring down the question of comparing stents to drug therapy, such as what kinds of patients should be considered and how to define different kinds of heart disease.
The industry and doctors declined to help. “We don’t want to end up being our own willing executioners,” said Mitchell Sugarman, the senior director of health economics for Medtronic Inc., a stent maker, on the call. (Rob Clark, a Medtronic spokesman, later said there was “widespread consensus amongst physician and industry groups that the [agency's] questions were off-base and heavily misguided.”)
Greed, corruption, and personal financial interest is destroying our society. If that sounds socialist to you, you’re merely a misguided fool. Capitalism requires information, freedom of choice, transparency, and competition. The corporations, governmental agencies, and doctors involved in this issue are anti-capitalist, and pro-corruption.
That is why they get along so well with the Obama Administration.