The American College of Cardiology is holding its annual convention this week in New Orleans. A big deal at the convention is Innovation in Intervention “an annual meeting for practicing cardiovascular interventionists” co-sponsored by the Society for Cardiovascular Angiography and Interventions. “Intervention” is the key word here.
A lot of attention is being paid to stents. Stents are small mesh tubes made from metal that are inserted into arteries that feed your heart. They’re inserted to repair an obstruction and prevent the obstruction from returning. Often, these things get inserted when someone is wheeled into the emergency room and the doctors find an artery that’s partially blocked. They’re also put in heart patients outside the emergency room if their doctor finds a blocked artery.
The interventionists at the cardiology convention in New Orleans are talking about what kind of stent works best and what drugs should be used with them. One of the things they’re talking about is whether plain metal stents are as good as the new, improved stents impregnated with drugs to prevent complications. But what made it into the headlines today was a study that found no difference in survivability between stents plus drugs and drugs alone. In the business section, stent manufacturers were not alarmed by this news: they expect sales to continue at a brick pace because the interventionists like stents so much.
The logic for putting a stent in your arteries is simple. A heart attack is caused by a blocked coronary artery. A stent mechanically unblocks the artery and keeps it unblocked.
Stents are not without their problems. For one, it’s a foreign object in your body. Your body doesn’t want it. So it will grow scar tissue around the stent. This causes the artery to get stiff and even clog up. That’s where the drug-impregnated stents come in. A pharmacist friend told me the drugs are basically chemotherapy drugs that kill the scar tissue.
Another problem is that stents can cause blood clots. Those clots could block the artery or they could break loose and block some other artery, such as one in your brain that will cause a stroke. So patients who get stents must take anti-clotting drugs for anywhere from 6 months to 2 years. Another problem arises. Blood clots stop you from bleeding. If you cut yourself or have an internal hemorrhage from a fall, anti-clotting drugs will make it more difficult for your body to stop the bleeding.
The most widely used anti-clotting drug for stents is Plavix. Made by Bristol-Meyers Squibb, Plavix is the second-best selling drug in the world. In 2005, it raked in $5.9 billion. But I digress.
The major problem with stents is that people don’t need them. First, it looks like adding a stent to conventional drug therapy doesn’t improve your chances. Second, the late Dr. Howard Wayne describes why stents don’t work in his book Do You Really Need Bypass Surgery? When an artery narrows it is a gradual process. In response, your body grows blood vessels around the blockage to feed the tissue that’s been cut off.
Let’s return to the logic of stents. As Dr. Wayne points out, and as many people we’ve had on the show have pointed out, blocked arteries don’t cause heart attacks. So this whole stent enterprise is based on a false premise. I’m sure you remember what that means: false premise, false conclusion. Stents are a solution to something that’s not a problem. Although lucrative, stents are technically useless. And the research presented at the cardiologists’ convention is showing it. The interventionists just don’t know what they’re looking at.
But you won’t have control over that logic once you’re wheeled into the emergency room with chest pains. Fear and institutional inertia and the hallowed place of stents in cardiac interventions will take over. And you will loss of control.
You can take control by resisting the fog of fear. You can resist the interventionists and not let them take control from you. But most importantly you can take control by taking care of your heart and your blood vessels so you won’t get wheeled into the emergency room in the first place.
