In fact, there is so little self-regulation of this procedure that some doctors have wildly abused it. In Baltimore, John R. McLean, M.D., was convicted of six counts of health care fraud after a jury heard he had inserted stents in more than 100 patients without medical justification.
St. Joseph's Medical Center in Towson, Md., had to notify more than 500 patients that its former chief of cardiology, Mark Midei, M.D., might have performed questionable stent procedures on them. Midei, who has since lost his medical license, once implanted 30 stents in a single day, investigators found.
Other cases of improper procedures have been reported in Pennsylvania, Louisiana and Texas, suggesting that this may be just the tip of the iceberg, experts say.
Redberg agrees doctors may not have sufficient incentive to follow guidelines, and has called for Medicare to quit paying for useless interventions. She also wants to see more informed discussion with patients about the risks and benefits of drug therapy versus stents. "That would help a lot, because clearly the recent data shows that patients are under the impression that stents are better for preventing heart attacks," she says.
Redberg agrees with Chan that a fee-for-service system that pays doctors for the number of procedures they perform needs to change. "We're spending almost $3 trillion a year for health care, and you wonder, how did we get here?" she says.
"When you pay a lot of money for doing a lot of expensive procedures, you get a lot of expensive procedures," she says. "We're not differentiating between the ones that help people feel better and the ones that aren't."
Michael Haederle is a freelance writer whose work has appeared in People, the New York Times and the Los Angeles Times.