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Coronary Stents: Why The Guidelines Are Not Often Followed

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The Case
In 2009, administrators at St. Joseph Medical Center in Maryland wrote letters to patients of Mark Midei, informing them that its staff cardiologist may have subjected them to a coronary artery stenting procedure inappropriately. That communication prompted an article in a local newspaper, which triggered an investigation by the Senate Finance Committee.

lightening 300x199 Elective Coronary Stenting: A Case in ContextThe Committee subsequently released a report which asserted that Midei performed nearly 600 stenting procedures unnecessarily, and charged Medicare nearly $4m for these procedures. According to the report, all the procedures involved stents made by Abbott Labs. Abbott, in turn, had paid Midei $31,000, added him to its roster of top stent volume cardiologists, and feted him with a pig roast at his home to celebrate a prodigious day in which he implanted 30 stents (apparently a company record). Then, after St. Joseph’s dropped Midei from its roster, Abbott hired him to provide services in Japan and China. In the subsequent year, the number of patients who received stents at the hospital fell to 116 from 350 in the previous year.

Most recently, the Maryland Board of Physicians revoked Midei’s license to practice medicine after concluding that he did implant stents into the coronary arteries of 4 patients inappropriately. The Board also determined that he exaggerated the severity of coronary blockages, and claimed incorrectly that they had unstable angina. Midei has denied the allegations and sued St. Joseph for damaging his career.

The Context Read more »

*This blog post was originally published at Pizaazz*

Research Finds Success In Small, Cheap And Strong Test For HIV And Syphilis

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Researchers from Columbia University have developed a “lab on a chip” HIV and syphilis test, and are now reporting the first results from tests in the field conducted in Rwanda. The mChip, as it is called, is the size of a credit card and replicates all steps of an ELISA test, at a lower total material cost and within 20 minutes. After application of a blood sample, the chip is inserted into a $100 battery-powered handheld analyzer. It needs only 1 μl of unprocessed whole blood and does not require any user interpretation of the signal, providing a clear-cut yes or no result.

Right now, HIV testing in developing countries either relies on expensive laboratory testing taking a long time, or uses cheaper methods based on lateral flow, which, although very rapid, do not provide very reliable results. The mChip combines Read more »

*This blog post was originally published at Medgadget*

A Diet Enriched With Olive Oil Is Associated With A Lower Stroke Risk In One Age Group

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More on the Mediterranean diet shows that olive oil is the key component associated with less stroke risk in seniors, a French study found.

Olive oil by trix0r via Flickr and a Creative Commons licenseThe Mediterranean diet has already been linked to better cardiovascular effects, so researchers poured it on to assess its link to stroke. A study of people 65 and older in the French cities of Bordeaux, Dijon and Montpellier divided 7,625 residents into three categories of olive oil consumption: no use, moderate use for cooking or dressing, or intensive use for both cooking and dressing. Researchers used plasma oleic acid as an indirect biological marker of oleic acid intake from olive oil. (They acknowledged that it could also stem from use of butter and goose or duck fat.) Results appeared in the Aug. 2 issue of Neurology.

In the study, Read more »

*This blog post was originally published at ACP Internist*

Strokes Are Quite Common In Pregnant Women: How Can They Be Prevented?

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According to CDC, there has been a 54 percent increase in the number of pregnant women who’ve had strokes in 1995 to 1996 and in 2005 to 2006. While this may surprise some researchers, it certainly would not surprise clinicians who take care of pregnant women who have risk factors such as obesity, chronic hypertension or a lack of prenatal care. Ten percent of strokes occur in the first trimester, 40 percent during the second trimester and more than fifty percent occur during the post partum period and after the patient has been discharged home. Hypertension was the cause of one-third of stroke victims during pregnancy and fifty percent in the post partum period. Hypertension accounted for one-third of stroke cases during pregnancy and fifty percent in the post partum period. Many stroke cases might be prevented if blood pressure problems were treated appropriately during pregnancy.

Pregnant women who have high blood pressure during the first trimester are treated with medication and are classified as having chronic hypertension. The problem occurs when Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

NYT Reports On Research That Links Height To Cancer Risk

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Female models may be tall and beautiful, but they are also at markedly increased risk of developing cancer. The New York Times reported on a fascinating research article regarding height of a women and risk of cancer.

Specifically, for every four-inch increase in height over 5 feet 1 inch, the risk that a woman would develop cancer increased by about 16 percent, especially for:

• Colon Cancer (RR per 10 cm increase in height 1.25, 95% CI 1.19—1.30)
• Rectal Cancer (1.14, 1.07—1.22)
• Malignant Melanoma Read more »

*This blog post was originally published at Fauquier ENT Blog*

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IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

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