Atrial Fibrillation and Conflicts of Interest

Man, lots of interesting read from the Wall Street Journal about the relationship of the Cleveland Clinic and their investigators failure to disclose conflicts of interest with their patients.... Big centers like this can leverage their name for professional and even personal gain it seems. There are lots of smart docs out there looking for ways to develop equity in the field of their expertise, but they HAVE to disclose this relationship. The technology with Atricure is cool, tho' (uses a scissor-like clamp to burn tissue between the two blades using a bipolar application of radiofrequency energy during either open chest or "minimally" invasive "keyhole" cardiothoracic surgery to place insulating lines in the atrium to fix atrial fibrillation). I understand the surgeon's enthusiasm for the technology - but it still doesn't get these docs off the hook for non-disclosure. These are big boys in the big leagues. They took lots of tests and checked LOTS of boxes on standardized tests correctly to get where they are.... the "oops, I checked the wrong box" excuse just doesn't fly.

I actually worked with Mike Hooven (now"Chief Technical Officer" (but the real brains)) of Atricure which was a spin off from his first venture in bipolar scissors for minimally-invasive vein harvesting for coronary bypass grafting, Enable Medical) when I was in Cincinnati Ohio about 5 years ago. Atricure is now public and Mike has made a few zillion bucks, I'm sure. My hat's off to him. Mike's one smart "engi-nerd".... but I left Cincinnati for personal reasons (the medical climate there is tough, to say the least: too many hospitals, not enough patients/businesses) and was surprised to see all this! But the story really isn't about Mike, it's about the relationship of major centers taking stake in a company and "researching" and "teaching" without disclosing to the patient's or community to whom they teach (like fellow docs). Hmmm, seems the course at The University of Oklahoma Health Sciences Center Cardiac Arrhythmia Research Institute on "Minimally Invasive Surgical Ablation for Atrial Fibrillation" recently scheduled for 1 Feb 2006 was recently "rescheduled" after the Wall Street Journal piece appeared... Atricure, I'm sure, was to play prominently in the meeting.

Here's the problems in a nutshell:

The Cleveland Clinic has been an advocate of heart surgery with a device from AtriCure Inc. and has done the operation on 1,247 patients while having undisclosed ties to the manufacturer.
Among them:

A venture fund the Cleveland Clinic helped set up and put money into invested in AtriCure.

The Clinic's CEO (Cosgrove) helped manage that fund and invested in it himself.

The Clinic's CEO (Cosgrove) sat on AtriCure's board.

Cosgrove developed a device AtriCure plans to market, which would bring him royalties.

Another Clinic doctor, who used the device and reviewed it favorably in publications, was a paid consultant to AtriCure.

It might be best to let the dust settle a bit before having that conference....

--Wes

PS: I recently updated my bit on atrial fibrillation with a few more figures. Hopefully it will help out folks trying to sort all the incredible information out there. If it's too technical, let me know. I can clarify if need be. The point is to take yet another approach to the discussion and evaluation of afib that keeps the patient first.... Hmmm, an interesting approach these days....

PPS: Oh, for purposes of disclosure, I am on the Speaker's Bureau for Medtronic, Inc. :)

Asthma? COPD? Other respiratory conditions?

As a parent of a child with reactive airway disease, and as a physician, it was abundantly clear that breathing is one of the most important things we do and take for granted. Millions of folks are out there struggling to breath, and need some support.... Recognizing this need, I asked a clever cardiology fellow (about to complete his cardiology training) if he could think up any ideas for a shirt just before we scrubbed into a case to install a defibrillator. He thought and thought and we tossed around a few ideas, then he smiled, and came up with this idea for a t-shirt:

It obviously harkens back to the days of Bill Clinton's election bid stance on whether he used illicit drugs "... but I didn't inhale!" and we tried to keep it acceptable to all ages by including a picture of an inhaler (yes, it's an Atrovent inhaler belonging to my son....). So enjoy! Share it with friends and feel free to contribute your ideas to make another person's day a bit brighter! Oh, yeah, you can find it at: http://www.cafepress.com/medtees/1076980. A portion of proceeds are contributed to the American Lung Association.

--Wes

Back from the holidays

Well, it's been a wonderful Christmas season! Too bad we now have to get back to work to prepare for the new year. Got a really cool gift just waiting for summer....

The best part of these sandals is the bottle opener on the bottom! It should be great for the beach in the summer! Oh, they can be found here (I have no commercial interest...just thought you'd like to know). As we are entering into the coldest part of the season in the Chicago area, the thought of wearing these on the beach in the summer will help carry me through....

We'll get on to more interesting heart-related matters soon enough. Sometimes it's good to kick back and relax a bit!

All the best-

--Wes

Power of the people

It's been a while since my last post here. It's a crazy time. My son is working for UPS off-loading trucks, and those guys are REALLY working LONG hours to make sure we get those packages we ordered, medical supplies delivered, and office gifts distributed. He had one guy INSIST that his computer was on that truck (it wasn't) and climbed on board and scoured through the back like a mad-man, complaining he had taken the entire day off from work waiting for this shipment! What a narcisistic guy! God forbid he call and track the delivery! Anyway, fortunately one jerk's behavior was quickly circumventented by plenty of other folks offering coffee and cookies to the laborers from UPS at many stops. It really shows that MOST folks are genuinely good people and can think about others toiling late a night to make the holidays a bright one. This holiday, be sure to remember your mailman, garbage man, postal worker, UPS deliverer (it might be my son :) ), FedEx worker, etc. Hey, we're all human and kindness goes alot further than narcissistic tyraids.

In case you're still looking for a gift for the office or your boss, there has been alot of interest in our shirt for "obsessive compulsives." It certainly makes a statement and makes folks think.... anyway, it's sure to bring a smile and, yes, a portion of proceeds are donated to the Obsessive Compulsive Foundation.


Also, just wanted to update folks on the puch to raise $500 for hurricaine victims through the sale of t-shirts on MedTees.com: we're up to $329 from the beginning of the campaign! Thanks to all who have bought shirts.... Every little bit helps, and the contributions to the advocacy groups are also important. And we still have quite a few days before the New Year. We'll post our first 6 month's contributions in Jan '06 when we get a final tally.

Stay healthy-

-- Wes

Power Medical Scooters

I had a lovely woman come to see me in follow-up for her heart arrhythmia and was impressed by her wonderful upbeat attitude as she sat there in her wheelchair with oxygen tubing beneath her nose and being pushed by her male "companion." She paused her speech between breaths, but was determined to keep going and was thankful that we had corrected her rapid heart rhythms through the use of a pacemaker and catheter ablation procedure.

When asked about her mobility at home, she said she was pretty much restricted to a chair and slept there because it felt better to be sitting up. I asked her how she gets around in her apartment, and she said it was VERY difficult. I asked if she had ever thought about a medical scooter. She had never considered this. I suggested several websites she could read more and knew that there was a rule she had to have a physical therapist or pulmonologist or rheumatologist provide a "Letter of Medical Necessity," but a little research on my part disclosed this requirement was removed this year! (Sometimes I'm a little late to the party.) Now ANY prescribing physician can provide a prescription for a medical scooter provided the patient has been seen "face-to-face" by their provider within 30 days and there is a FUNCTIONAL need for such a device.

Just thought you might want to know in case you're late to the party, too!

--Wes

Lemieux with Afib

Recent article about Mario Lemieux being let go from hospital for atrial fib. It can happen to anyone. Now his heart muscle function is probably OK so aspirin anticoagulation might be OK, but man, those hockey fights would be IMPRESSIVE if he were on coumadin! :)

Our thoughts and prayers go out to him.

--Wes

One fake, one real, guess which?

The power of people to overcome their adversity continues to amaze me. Had a wonderful woman suggest the above tag for a new shirt for breast cancer survivors that we have up on our site now. Imagine, someone who's been through the diagnosis, biopsy, mastectomy, chemo, radiation, and eventual reconstruction with this shirt! Awesome. And to still be able to laugh a bit after all she's been through! This really shows the power of the human condition in a situation that defies imagination. And yet, there is a subtle and powerful message here that commands respect of anyone who'se gone through this ordeal. And this might be the most empowering for the individual after all. Way to go!

--Wes

"All Conditions Suited to a T"

Thanks to all who have made this journey into the internet world so enjoyable. The story of our simple website, MedTees.com, is catching on and gaining momentum. A story and pics from Pioneer Press from 1 Dec 2005 touches a bit on the inspiration and motivation for the site. We've heard from TONS of folks about the power of humor and support to help them deal with their tough illnesses and continue to expand the medical conditions we cover and charities to whom we donate. We hope to generate the $5K needed to make us a REAL non-profit so that folks can be reassured that their donation will be tax-deductible. (Funny how lawyers always get their fees FIRST....oh, er, sorry, the doctor in me leaks out sometimes. :) )

If there's any graphic designers out there who'd like to design and donate a really cool shirt design for a medical cause near and dear to their heart, and in turn use our site as a marketing stepping stone to greatness, we'd be happy to post your design on a t-shirt and acknowledge you as the designer (and provide a link to your site).... it's just a thought, but who knows... it might generate some interest in your work.... just e-mail the design to me from the MedTees website under the "Contact Us" tab.

Oh, for those of you interested in purchases there, be aware there will be a TWO-DAY SALE on 7 and 8 Dec 2005 of $5 off on any purchase over $20, $10 off more then $40, and $25 off any purchase over $100. You'll have to enter a special code to get the credit on your purchase. So keep your eye on the sales graphic on the front page....

Happy holidays!

--Wes