Threat betrays big medicine's profit obsession

I called David Pacitti, vice president of global marketing for Abbott Laboratories' cardiac-plumbing division, to ask why he seems to want goons to beat me up in the newspaper parking lot.

"Don't you have connections in Baltimore?????" Pacitti e-mailed a subordinate regarding a January column I wrote on heart-artery stents. "Someone needs to take this writer outside and kick his ass! Do I need to send in the Philly mob?"

Pacitti and other Abbott execs apparently don't care for suggestions that their expensive vascular devices often do patients little good and that a star Baltimore doctor took their encouragement to be "truly outstanding" a bit too much to heart.

If America is to avoid choking on health care costs, it must halt the out-of-control marketing of medical treatments and pay for them only when science shows they work. Abbott's fawning over Dr. Mark Midei and its reaction when The Baltimore Sun reported that Midei was alleged to have needlessly installed hundreds of Abbott stents show how hard that will be.

If you had a stent implanted at Towson's St. Joseph Medical Center on Aug. 29, 2008, congratulations. You're a part of cardiology history. Now call your family doctor to make sure you needed the hardware.

That day Midei installed 30 Abbott stents — metal mesh tubes that are supposed to prop open clogged heart arteries. Abbott bosses had never heard of anybody's doing so many in a day. They were all but chest-bumping over the revenue it would generate.

"I was going to send Mark an email to congrat him on his '30-stent' day," John M. Capek, an Abbott executive vice president, e-mailed a sales rep. A few days later he did, thanking Midei for his support and for "perhaps settiing [sic] the single-day implant record."

The e-mails, including the one seeking a contract on my scalp, were subpoenaed by the Senate Finance Committee and published Monday in a report on its investigation into St. Joseph's stent business.

Midei worked for St. Joseph, but by summer 2008 he might have been mistaken for an Abbott subsidiary.

Capek knew about Midei's 30-stent day no later than the following morning, e-mails show. Abbott's "Project Victory" for hawking stents singled out Midei for "VIP trips" and visits from Abbott bigwigs.

"In my 15 years of being in this business, I have never seen personal relationships as strong as the ones you have developed with Drs. Mark Midei" and two other docs, wrote a regional sales manager to a sales rep.

Abbott feted Midei at Ruth's Chris Steak House. It paid $1,235 for an " Alabama Pig Pickin'" barbecue at his Monkton home two days after the 30-stent marathon. A month earlier it paid $690 for beer and crabs served during a meeting at his house to discuss Abbott's "business strategy."

By late 2008 Midei was installing Abbott's new "Xience V" stent almost exclusively and in large volume — a rate of 2,000 per year. There were clinical reasons to prefer Xience over other products; trials had shown it had less association with constricted blood flow after implantation than other stents.

But maybe the "extra fixin's" at the barbecue and nonstop flattery made a difference, too. Abbott executives certainly think they did.

In early 2010 it became clear that Abbott owed part of its prosperity to hundreds of stents that Midei allegedly implanted in minimally blocked arteries, against medical protocol. Rather than distance itself from a physician under accusations of grave misconduct, Abbott doubled down, hiring Midei as a consultant and sending him to push stents around the world.

Shame that the media "became involved in a very aggressive manner" covering the Midei allegations, an Abbott sales rep complained in an e-mail. "The press is just too hot" to have Midei give presentations in the United States, an executive wrote. Eventually it got too hot even to even employ Midei in Japan. The company pledged to continue to work with him "behind the scenes."

In January I interviewed Dr. William E. Boden, who led a landmark study showing that stents prevented death and heart attacks no better than pills in patients with chronic chest pain. Whether Midei implanted stents in unblocked arteries was a big question, I wrote, but maybe not as big as whether stents were unnecessary even in many cases where protocols authorized them.

That prompted Pacitti's fantasy about breaking my legs.

So Abbott executives treated The Sun's coverage of the Midei scandal as a nuisance that disrupted their marketing, not an account of alleged abuse and betrayal of the patients Abbott says it cares about.

The Senate Finance Committee uncovered Abbott's cozy relationship with Midei, but what about other stent doctors? There is still no word on whether Medicare is following Maryland's lead by conducting a statistical review on potential stent overuse. A spokeswoman at the Centers for Medicare & Medicaid Services did not respond to my inquiries on Monday.

A new federal law requires disclosure of payments to doctors by pharmaceutical and medical-device companies. But it ought to outlaw most of them, as Vermont has. The battle to stop physicians from prescribing expensive, ineffective procedures has barely been joined.

Pacitti didn't return my phone calls, but an Abbott flack got in touch on Monday.

"We sincerely apologize if this caused you any concern or distress," the company spokesman said. Pacitti's comment, he said, "wasn't meant to be taken seriously."

Yeah, that's what King Henry II said after they whacked Thomas Becket.

My kneecaps are fine, but the U.S. medical system isn't. I'm concerned and distressed about that.