Whatever happened to "first, do no harm?"

My father had a colleague, Henry, who had his leg amputated. I don't think Henry was my father's boss, but he was higher up in the hierarchy of his company. (I did not, of course, call him Henry. To me, he was Mr. Mxxxxxx.)

I remember going over to Henry's house so my father could drop something off and seeing Henry in his wheelchair, with his stub, shortly after he lost his leg. 

It was not the nature of my parents to discuss personal matters - their own, or those of anyone in the family, among their friends, in the neighborhood, at work, or anywhere else in their acquaintanceship - in front of their children, but, as a child, I was an inveterate eavesdropper - my father nicknamed me Radar Ears - so I'm pretty sure that I somehow learned that Henry's amputation had something to do with his drinking. 

Now I'm guessing that Henry had peripheral artery disease (PAD) which can be associated with alcoholism. 

I didn't exactly know Henry. I was about ten when he lost his leg, and he died not that much longer afterwards. But I can't think of anyone else I've ever known who lost a limb. And I do know that, over the 6+ decades since Henry died, they've certainly made strides in treating those with PAD. 

But there are some folks for whom treatment hasn't done anything other than make matters worse.

Some of them were chronicled in a recent article in the NY Times (which is why Henry M came to mind) that focused on the use of a procedure called atherectomy - and what happens when an atherectomy goes awry. One of the physicians discussed in the article was Dr. Jihad Mustapha, whose patients have suffered an inordinate number of amputations.

Dr. Mustapha is no back-alley operator working in the shadows of the medical establishment, an investigation by The New York Times has found. With the financial backing of medical device manufacturers, he has become a leader of a booming cottage industry that peddles risky procedures to millions of Americans — enriching doctors and device companies and sometimes costing patients their limbs.

The industry targets the roughly 12 million Americans with peripheral artery disease, in which plaque, a sticky slurry of fat, calcium and other materials, accumulates in the arteries of the legs. For a tiny portion of patients, the plaque can choke off blood flow, leading to amputations or death.

But more than a decade of medical research has shown that the vast majority of people with peripheral artery disease have mild or no symptoms and don’t require treatment, aside from getting more exercise and taking medication. Experts said even those who do have severe symptoms, like Ms. [Kelly] Hanna [who lost her leg after multiple procedures] shouldn’t undergo repeated procedures in a short period of time.(Source: NY Times)

An atherectomy isn't the only procedure used to treat PAD, but it may be the riskiest. A disproportionate of patients who have one end up losing a leg. 

Atherectomies are also pretty lucrative. A doctor can make $10K per. And they can be performed assembly-line fashion.

The number of atherectomies performed is growing. In part because Medicare approved outpatient atherectomies, "transforming the  procedure into a surefire moneymaker." If a procedure is performed in the hospital, the doctor only gets a small cut of the action. In their own clinic, they get it all. And private insurers typically follow Medicare in terms of procedures they pay for. So the market isn't just old geezers (although old geezers are more likely to suffer from PAD, of course).

Not to mention that equipment manufacturers quickly figured out that it could be a "surefire moneymaker" for them, too. So big guns like Abbott Labs, Boston Scientific, and Philips jumped in to the atherectomy biz, promoting its use bigtime, even lending physicians money to open up clinics and rewarding "high-volume doctors" who run vascular clinics where there's a lot less regulation and oversight than there would be in hospitals. Like Dr. Mustapha. 

Meanwhile, the research suggests that there's better (and cheaper) treatment for PAD, including lifestyle changes. But atherectomies are lucrative. And they often require repeat procedures, so the lucre train chugs on. 

“There is a clear business motive for treating people with no symptoms,” said Dr. Caitlin Hicks, an associate professor of surgery at Johns Hopkins University School of Medicine who has studied the overuse of atherectomies.

Whatever happened to "first, do no harm?"