But this depends on the severity of the blockage, the location and the patient’s individual history. Several societies, including the American College of Cardiology (ACC) and the Society of Cardiovascular Angiography and Interventions (SCAI), have guidelines in place for interventional cardiologists to follow.

“In a hypothetical case, it’s very clear-cut. There are people who absolutely need stents, and people who absolutely don’t,” says Gacioch. “The place where there’s been controversy is in between.”

Dr. Christopher White, president-elect of SCAI, also agrees that the guidelines aren’t specific to all the cases he sees. “There’s black and white, and then there’s that gray zone,” says White. “As physicians, we need to be careful about what we do in the gray zone.”

Physicians like Midei, Morcos and Bou Samra are alleged to have breached protocol in this gray zone. The allegations have cast a shadow on the profession, according to Gacioch.

“Even if the allegations turn out to be completely false, it has still hurt our reputation,” he says. “And it’s going to take a while to come back.”

But Gacioch also sees the controversy as something that goes beyond the doctor’s office. He says there are several levels of controversy happening at once — one in the scientific community, another in the political community, and a third in the public. For the controversy to see any resolution, Gacioch says, everyone needs to be on the same page.

Dr. William Boden, clinical chief of the division of cardiovascular medicine at the University of Buffalo, is familiar with the controversy in scientific circles. In fact, he is partly responsible for starting it. His study, called Courage, cast doubt on the effectiveness of stents in patients suffering from chronic chest pain and focused national attention on the popular procedure.

After following 2,287 patients for five years, Boden and his colleagues found that stents are not necessarily more effective than drug therapy in patients with chronic stable angina. The study, which appeared in an April 2007 issue of the New England Journal of Medicine, created a furor.

Nearly all major news organizations picked up the story, which made the front page of the New York Times and The Wall Street Journal. Dr. Steve Nissen, chairman of the ACC, called Courage a “practice-changing,” “blockbuster” study. The ripple effects were far-reaching: the day the news broke, shares for Boston Scientific Corp., a leading stent maker, plummeted in anticipation of the fallout.

“It was a major shot across the bow,” says Boden, recalling the immediate reaction to the study. “It polarized the community for several months.”

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