The more we know, the more unnecessary President Bush’s stent seems
October 16, 2013 By Steven E. Greer, MD
A recent short article in an obscure Washington, DC wonky journal triggered national media when it asserted that President George W. Bush’s (43rd President) coronary artery disease was far more dangerous than originally reported in August. NBC Nightly news picked up the story along with numerous other national outlets. The headline was “President Bush had a 95% blockage of the artery”.
When President Bush first received a coronary stent in August, after a routine “Executive Physical” exam at the Texas Cooper Clinic found coronary artery disease, the national TV and print news (and this author) widely reported that the stent was unnecessary and did little to reduce his chance of future heart attack. A Washington Post Op-Ed went on to use the Bush case as an example of expensive ineffective therapy in the American healthcare system. A contrarian view came from Fox News’ Dr. Marc Siegel in his USA Today Op-Ed.
On October 15th, in response to the NBC, Dr. Siegel appeared on afternoon Fox News to scream to the world that “We got this story first” and send the message, “Told you so. The Bush stent was critical to saving his life and the doctors in Texas were Super Heroes”. During his segment, Dr. Siegel insinuated that he is very close with President Bush and that President Bush personally informed him of the details of his coronary artery lesion, location, etc.
Dr. Siegel’s behavior seemed so erratic and manic that the credibility of his comments were in question. We emailed him to clarify a few points, and he promptly replied by telephone. What ensued was a bizarre series of calls.
In the first call, which lasted 16-minutes, Dr. Siegel proceeded to establish his importance and national prestige, saying, “Here’s the story with this. I’ll give you the entire story. First of all, I’m very friendly with President Bush…. The Bush camp, whom I am very closely in touch with, was very happy with my reporting on it. But what happened was that two oncologists wrote an Op-Ed in the Washington Post where they claimed that the stent was unnecessary and that he should have had a colonoscopy instead…you should look this up. This is how you report on stuff, or how I report on stuff…and the Op-Ed pissed off President Bush, and the reason is, he doesn’t care, he’s taken a lot of criticism obviously over the years (laugh) but he was upset because he felt his doctors were being slammed…. I mean, his senior spokesperson called me up after…after the Op-Ed in the Washington Post and he said “President Bush would like you to correct the record on this.” He told me the facts of the case in mid-August…At that point I wrote an Op-Ed for USA Today. OK? The Op-Ed was reviewed by president Bush himself and by these doctors you are talking about that are not going on the record…for accuracy…and basically what the Op-Ed said was that this was a severe lesion…you should look up my Op-Ed.”.
Dr. Siegel then proceeded to detail and justify the steps taken by Mr. Bush’s doctors at the Texas Cooper Clinic, “So basically, he had this stent done for a critical lesion. I know the location, but I am not going to say it to you. OK? So he had a critical lesion, I know exactly where it was. Today it is coming out that it was a 95% blockage, I know where it was. I know the symptoms that he had beforehand. They weren’t chest pain but he was having some symptoms. that’s what led to his stress test. His stress test was abnormal. That’s what led them to do a CT angiogram, which, ironically, a lot of people would have gone right from a stress test to a cath, but then of course guys would be saying, “Whoaa”…..You know, I mean everyone is second guessing what they don’t have. They did a CT-angio to confirm what the stress test showed. The stress test was markedly abnormal and showed early changes. They could have gone right to the cath. They did a CT-angio to confirm that it was a critical lesion, and then they went and they stented. It was absolutely textbook medicine, and I think that the doctors did a great job, both from the point of view of reacting to vague symptoms, to to to doing a a stress test, to stress test hitting gold, to taking the stress to going, doing a CT-angio, which again THAT might have been unnecessary, but then the Doubting Thomas’s “Why did you go right to the cath?” and then the cath confirmed the lesion. The lesion, the type of lesion this is, is well studied in the medical literature, and the choices are not medication, as everyone was saying and wrongly reporting, the choices are, in cases of this particular lesion, the choices are either stent or surgery. OK, it is very clear in the medical literature.”
When asked to explain the medical literature that justified the need for a stent to have been placed in President Bush, or any data that demonstrates a stent will reduce the chance of death for Mr. Bush, Dr. Siegel stonewalled, and finally said, ” Steve. I am not answering your question. You have to show me some respect…. Let’s talk about stents. OK. Let’s talk about stents for a minute. Alright. I am very familiar with the COURAGE trial. trust me…. I would have to address that by A) giving you my view of the COURAGE trial, and B) the issue of a person’s anatomy. That’s how I could answer that….. The COURAGE trial started with 40,000 patients and reduced to 20,000. They cherry picked patients….”
Dr. Siegel could not recite any clinical data to justify the therapeutic steps administered to Mr. Bush. His only response was to use ad hominem attack of the COURAGE trial.
On Fox News, Dr. Siegel claimed that President Bush did in fact have symptoms prior to his stent procedure, which contradicted widespread reports. However, in our interview, Dr. Siegel admitted, “He had no angina. He had vague symptoms.”.
When asked whether he knew what the increased risk of major stroke and GI bleeding was from the blood thinners that Mr. Bush must take as a result of his stent, Dr. Siegel did not know. When asked if he knew of the radiation dosages administered to Mr. Bush from the nuclear stress test, coronary CT-scan, and cath lab fluoroscopy, Dr. Siegel did not know. He replied, “It sounds like you would never use a stent.”.
Dr. Siegel then said, “Steve, you want to know something. The way you are talking to me is disgusting. I probably would have told you where the lesion was before this conversation, now I won’t confirm anything…. I mean, you are so out to get people. You are a disgusting human being…(click, hung up the phone)”
Dr. Siegel then called back after a few minutes, and said, “Steve, listen, it’s Dr. Siegel again. I didn’t mean to get upset with you. Let’s leave it be….(about the coronary CT-scan Mr. Bush received), I agree with you, that was not necessary….The National Journal is a rag. It’s a piece of garbage. OK. What they actually did today is they stole my information, did not attribute it to me, wrote a piece of crap article, two months after the fact, which NBC News then picked up on”
Regarding the appropriateness of Mr. Bush’s stent and whether it will reduce his chances in the future of sudden cardiac death, the literature does not support it. Assuming his lesion was the mythical “widow maker” proximal left anterior descending (LAD), given Mr. Bush’s lack of angina symptoms and his healthy heart capable of powering his body through 100K bike rides, medical therapy would indeed have been a viable option.
A recent cardiology paper by Dr. William Boden (Principal Investigator of the seminal COURAGE trial), to appear in American Heart Journal, concluded that stenting of the proximal LAD conferred no reduction in risk of cardiac death. Dr. Boden stated to The Healthcare Channel, “We cannot identify any anatomic subset (including proximal LAD) that benefits from stenting for death or MI reduction. But, alas, despite such evidence, the interventional community ignores this.”
The stent does not come without risks. A stent itself raises the risk of heart attack, and that is why long-term powerful blood thinners are required. Those blood thinners also greatly increase the risk of hemorrhagic stroke and deadly GI bleeds into the colon or stomach.
In a recent interview, Mr. Bush was asked how he was doing after his stenting procedure and he replied, “Other than the fact that I nearly bled to death when I nicked myself shaving because I’m taking blood thinner, I’m doing pretty good,” he said. “I thought you were going to have to put a tourniquet on me.” Mr. Bush’s once active exercise routine is affected by the easy bruising and risk of serious bleeding if her were to fall while biking or jogging. His quality of life is seriously diminished.
In contrast to the way the national TV news reported the revelation that Mr. Bush had a 95% coronary artery blockage, the reality is that Mr. Bush’s therapies seem even more unnecessary as the details emerge. His diagnostic workup preformed at the Cooper Clinic, which includes routine coronary CT-scan, is also utterly indefensible.
Is cath lab fluoroscopy radiation exposure dangerous?
Medical imaging is more dangerous than the Japan or Chernobyl accidents
Cardiac surgery, Cardiology, Cardiology/interventional, NYU Med Ctr, Op-Ed, Policy | apples49 | 
November 29, 2013 1:01 pm
2 Comments
Other Links to this Post
Notice: comments_rss_link is deprecated since version 2.5! Use post_comments_feed_link() instead. in /data/30/1/121/80/1121895/user/1185656/htdocs/wordpress/wp-includes/functions.php on line 3406
RSS feed for comments on this post.
By William Boden, MD, October 16, 2013 @ 5:27 pm
We have a paper we published from COURAGE coming out within the past 2 months. We cannot identify any anatomic subset (including proximal LAD) that benefits from stenting for death or MI reduction. But, alas, despite such evidence, the interventional community ignores this.
William E. Boden, MD, FACC, FAHA
Professor of Medicine
Albany Medical College
Chief of Medicine
Samuel S. Stratton VA Medical Center
Vice-Chairman, Department of Medicine
Albany Medical Center
By Bijan Salehizadeh, MD, October 16, 2013 @ 5:28 pm
This is some seriously good coverage and analysis by you